Saturday, October 06, 2012

Why every doctor should watch English Vinglish

I just attended the premiere of the Hindi movie English Vinglish. This is a great movie and I thoroughly enjoyed myself. It's the story of an Indian woman from Pune ( played very well by Sridevi) whose children and husband speak fluent English, and who belittle her because she cannot do so . This affects her self-esteem, because they treat her like dirt; and she feels inadequate and incompetent because she cannot read and write English.

She is forced to fly all of a sudden to New York to help her sister , who has to single-handedly arrange her daughter’s wedding, and needs her help.  She finds herself in New York City , alone and helpless , because she cannot communicate in English. She joins a four-week class to help her learn English; and the story revolves around her experiences.

This is a touching film, and I feel every doctor should see this, because it will help them to understand what illiterate patients go through when they cannot understand what the doctor is saying. Just like Sridevi is lost in New York, patients will often find themselves stranded , lonely and miserable , when they are sick. They expect their doctor to act as friend, philosopher and guide, but if they're poor and illiterate, they will often find that doctors and other medical staff treat them quite cruelly. Medical students and residents often make fun of patients who cannot understand what they're saying ; and many get irritated when they have to repeat instructions to patients, who are not able to comprehend a language which is completely foreign to them.

There are a lot of parallels between Sridevi’s English illiteracy and a poor patient’s health illiteracy. Many patients who come from small villages in Maharashtra for treatment to municipal hospitals such as KEM and Nair. They cannot read or write English , because Marathi is their mother tongue. They have spent a lot of time , money and energy to come to these large hospitals which provide high quality specialized medical care , and they come with high hopes and expectations. However, what they find when they come to the hospital is very similar to Sridevi’s experience in New York City. Most of the signs in the hospital are in English – and they get lost very easily. Doctors and medical residents usually come from privileged urban backgrounds,  and think , read and write in English. Most of their education has been in English ; their medical textbooks are in English; and their professors lecture to them in English as well. While this means that their medical knowledge and technical expertise meets global standards, it also means that they have a hard time talking to illiterate patients. 

Doctors can learn a lot from both the many heroes and villains in the movie.  Amitabh Bacchan , who is sitting next to her on the flight from Mumbai to New York, is supportive and shows her how to use the call bell to summon the hostess. This is a great model for how expert patients can help others to navigate a healthcare system which is completely foreign to them.

In sharp contrast, the waitress behind the counter at the coffee shop is loud and obnoxious , because Sridevi cannot place her order in English and is holding up the other customers. She belittles  Sridevi, makes fun of her; and causes her to leave the cafĂ© in tears. You can watch the trailer on youtube !

What kind of doctor are you ? Do you take the extra time and trouble to learn how to communicate with your illiterate patients in terms which they can understand ?

 Illiterate patients are very vulnerable. They are often impoverished; scared; poorly informed and easily exploited. They are usually treated by doctors and nurses with little respect, who think of them as being stupid, just because they cannot speak English ! Some doctors take a perverse pride in looking down upon these patients – tragically, the very patients who need our compassion and kindness the most !

The story has a predictable happy ending,  and Sridevi’s self-esteem is restored , thanks to her motley bunch of classmates in her English language class , who show her that she's competent; and that learning English is a skill she is quite capable of mastering ! Just like doctors need to learn how to speak plainly, patients also need to learn basic medicalese – they cannot expect to be spoonfed all the time !

My favourite line in the movies is the scene in the US consulate office. When the US consular officer ask Sridevi - How will you manage to survive in the US if you cannot even speak English , his Indian colleague tells him – Exactly the same way you manage to live in India without being able to speak Hindi !

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