Fieldset
Lost in translation

Mike is a family doctor (GP) from the UK. He's been working for Médecins Sans Frontières / Doctors Without Borders (MSF) in Irbid, Jordan, helping to provide medical care to Syrian refugees and vulnerable Jordanians. In this blog, he shares his thoughts on the complexities of communication amongst multinational, multilingual teams.

Recently, an MSF colleague in another project started to share with me some of the stories and poems he has written, inspired by his time in MSF.

Buried in part of a very absorbing story there was a reference to his uncertainty about the quality of his English.

For me, when we chat he’s fluent. I know I’m careless in his company and I forget his South Asian background, comfortable in what feels like our shared space. I speak as if I’m at home, chatting with friends in Sheffield.

Language barriers

Thinking about this, though, also reminded me that most of the time here I’m adjusting my language to avoid colloquialisms and to reduce my vocabulary, almost all the time. To keep It simpler and safer.

All of my colleagues are either working in a second language or have lived for several years in another language. I work in my mother tongue and, though for a while in the past I think I could dream in French, I’ve never felt that I was entirely comfortable in either this or Arabic.

One of the stories I was told before coming to Jordan was that my Arabic colleagues would never cope with losing face.

I’m not going to pretend that communication here is always easy for us. There have been moments when I’ve resorted to this age-old judgement about the culture of 'losing face', though I’m sometimes beginning to question this.

Re-learning

I’m re-learning Arabic whilst I am here. Two formal lessons a week, and, now that Ramadan is over, the informal chatting over coffee in Arabic has supplemented this teaching.

I’m quite aware that when talking I’ll try to lead the conversation to areas in which I have the vocabulary to express myself. My language knowledge is determining both how I talk in Arabic and what I want to talk about.

I’m also aware that my understanding of what's being said comes sometimes from the context of a conversation, as well as by recognising the words spoken. When I agree to things while we're speaking Arabic together, could it be that I’m avoiding language difficulties? Or just trying to avoid being reminded that we used these words last week… and I really should be expected to understand them better by now?

Saving face

So, recently when I found myself starting to talk to another international staff member about a Jordanian colleague who was saving face in a conversation with me … I paused and wondered what the differences were between my avoidance of checking the details in some Arabic conversations – to such an extent that I agree to things that I may not really understand – and my colleague’s saving face.

Could it be that I too like to save face?

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Nurses, one in a bright yellow hijab, check a patient's blood sugar
Nurses at work in Irib

Indeed, saving face may often be about things other than pride. Like wanting to avoid a personal upset, fear of being found out for not having great language skills, or not being quite as perfect at our jobs as we think others expect us to be. (This last point might be particularly relevant for anyone in Jordan, a country with a high rate of unemployment among skilled workers.)

This isn’t saying that we all indulge in our face-saving to the same extent, nor that some conversations here aren’t difficult.

In any organisation there are possible challenges because people work on different sites, doing different jobs and come from different backgrounds. Certainly, all those issues are present here.

However, thinking about the complexities and all of our behaviours is helping me to separate different types of “communication challenge” and avoiding assuming that all issues are down to "face-saving".

Checking conversations

Sometimes, and particularly on e-mail and WhatsApp, I’ve noticed Jordanian colleagues checking things several times after I’d thought that I’d been abundantly clear, or repeatedly asking questions when I thought it was all sorted. 

Pausing, I then guess that although my message may clear to those who live in the same language as me, I may have made all sorts of assumptions about what people will understand by my words.

For example, I told some colleagues that I was “waiting for final details” from other members of the team, and so only could share a plan for the next couple of days. I thought that was clear enough, but there followed a string of questions. Part of me was ready to get annoyed, but a few deep breaths and some reflection reminded me that my colleague could be asking questions simply to ensure they'd got the details right, especially across a language barrier. It also made me consider my assumptions that what I’d written was clear enough…

The unwritten rules

Sometimes, the rules that are hidden in how we communicate appear to be different and confusing.

Several months ago, I had a formal meeting with a colleague. It was my role to summarise the meeting, which I did, and then shared it with my colleague so that we could agree on the record.

I was surprised at a later request to remove a section. I checked and there was no disagreement about the factual accuracy of what I’d written, and we were in agreement that the particular statements had been said in the meeting. However, my colleague was still adamant that it should not be included in the record as it was not helpful.

Lots of conversations followed with me trying to understand why removing it might be good. I think that there were a lot of assumptions for us both about how this sort of meetings should be managed, and some of them were quite different.

Effective feedback

Part of my work is to support my Jordanian colleagues to be even better doctors, so it is important to offer them effective feedback.

I’ve been working hard to ensure that, as much as possible, I can do this based on evidence. I prefer to have a discussion based on performance and shared observation than to put forward a subjective opinion.

Sometimes, though, we will just look at their notes from previous patient consultations to learn from them. I’ve found that a clear statement observing how much information they recorded (for instance) can be experienced as a personal challenge by some colleagues. So, I’m trying to find other ways to get to the same area (i.e. is there enough information recorded for later doctors to know what has happened?).

One approach has been to effectively ask “What do you think I’m going to say about the information that has been recorded here?”.

By doing this, I’m trying to balance creating complex hypothetical questions, which might be a challenge linguistically, with ensuring that the feedback is actually coming from the colleague themselves – so they learn to critique their own work and justify it where appropriate.

It doesn’t work all the time, but I enjoy trying to avoid the trap of teacher and student.

Nuance

We have a multinational team of about 50 people, each with varying skills in our different languages. Combine this diversity with the stresses of our very different lives and a range of personality types, the fact that some of us are fasting at times, and the challenges of trying to achieve accessible healthcare on a tight budget and of course, communication becomes complex.

Communication, like so many things, is far more nuanced and complex than a simple assumption such as "losing face".

Much of my thoughts about communicating in a different country come back to the old reality that communication is about people.

And, the only bits of this that I can change are in me. Blame doesn’t help but exploring new ways to find success by changing my communication can.