Focus
Student Scene
January 13, 2003
English as an Instrument for Care
Last year for the first time, I entered a classroom as a teacher. It was a small classroom in the Boston Chinatown Neighborhood Center, and I had come with Vanessa, a classmate and fellow tutor in English as a Second or Other Language (ESOL). We had just finished our training to become ESOL tutors as part of a Medical School volunteer program, and we were eager to begin putting our training to use.
| Most importantly, their increased confidence translated into increased communication with their doctors. |
Sam, one of the center teachers, made the introductions and explained to the women that Vanessa and I were students from Harvard Medical School who would be teaching a new class with a focus on health topics. Since this didn't seem to excite their interest, Sam also mentioned that this would be an excellent opportunity to practice conversational English. At this, several of the women nodded and smiled.
Getting to Know You
The introductions were short and sweet and, in a matter of minutes, Vanessa and I were left completely alone. We tried another round of more in-depth introductions, calling upon all the combined ice-breaker knowledge we had accumulated in college. Soon, I could feel the uncomfortable silence settling slowly around the table again--that awkwardness that comes after the small talk and getting-to-know-yous are done, when you just don't know what to say.As I sat there, the pauses seemed interminable and the differences between us seemed glaringly obvious: I'm a 23-year-old, American-born Chinese (ABC, as they call us) who went to medical school straight from college, and these women are immigrants from Indonesia, China, and Vietnam. Even among the women there were many differences. One, the most elderly of the group, had moved to the U.S. from Macau 14 years before but still felt her heart pound whenever she had to speak in English. Another, a stylish young mother, had worked at an English-speaking office in Hong Kong before coming to the U.S. in the past year. Yet another woman from China worked a full-time job at a fast food restaurant while taking care of her son and taking several ESOL classes. Everyone had a different background and a different level of English. But, as I soon found out, these differences were no match for their common desire to communicate and express themselves fully in English.
The Language Barriers
Since it was the first time I had ever been a classroom teacher, I had no practical knowledge about how to prepare a curriculum or run a class. All I knew was that at the end of the term, I wanted my students to feel comfortable talking about their health.As a native English speaker who knows some Chinese, I had always taken verbal communication for granted. My perspective changed, though, when I saw how difficult it was for my students to ask questions about their health and describe what they were feeling. From the beginning, it was clear that everyone had a thirst for vocabulary. "Give us more new words" was a common request. As a medical student who often complains about having too much to study, I was truly inspired to see my students' love and dedication to learning. To me, it seemed that the single greatest obstacle to communication was not a lack of desire or basic skills but, rather, a lack of confidence in the skills they did possess.
These students were perfectionists seeking the holy grail of ESOL teaching: maximum accuracy with maximum fluency. But the drive for total accuracy chipped away at their fluency--at times to the point where they felt too self-conscious even to speak. This, it seemed, was too high a price to pay for proper grammar and syntax. So, having made the decision to emphasize fluency over accuracy, Vanessa and I patterned the class after problem-based learning, focusing the students on teaching one another through discussion.
English as a Vehicle
Every week for two hours, the students would read a short story involving a central character's encounter with some aspect of medicine or health. The stories were designed to be no longer than a few paragraphs, and the scenarios unfolded gradually. After reading each page, a discussion of the scene followed. The goal was to provide a general framework of key concepts and vocabulary while allowing the students to control the direction of the discussion.At first, the discussions were minimal. The students took turns reading the short stories and, following a long pause, someone would offer a timid one-sentence opinion. Vanessa and I often had to resort to games or playacting to get the women to talk. We spent most of the time either defining vocabulary words as a group or answering difficult grammar questions. For example, congestion was a new vocabulary word in a story about the common cold. One student asked if this was the same word as that used when talking about traffic. While the students tended to pull in the direction of grammar and syntax, Vanessa and I tried to focus on free talk. "Don't be afraid to speak even if your grammar is not completely correct" became a mantra in the class.
Eventually, the students began to speak up. By the time we had covered the flu, reading medicine labels, high cholesterol, and proper nutrition, the women began describing their own experiences with health issues. The talk in the class became less and less centered on making sure the proper verb conjugation was used and more focused on sharing stories and opinions.
Joyriding
As the one-sentence opinions morphed into longer discussions, the mood of the class also lifted from sedate and timid responses to light-hearted conversation. Speaking virtually all English, the women were telling funny stories and using terms like osteoporosis and lactose intolerance as if they had been using them all their lives. I found that my role was less to start discussions or ask questions than to act as a talking bilingual dictionary. While speaking, the students would pause and turn to me with the Chinese word that they wanted to use. I'd scour my brain for the English equivalent, and then they would continue whatever it was they were saying. It was beautiful to see the students conversing so fluently about their health. Many times, they were not completely grammatical, but what they were trying to say was always clear.Most importantly, their increased confidence translated into increased communication with their doctors. A few months after the discussion on osteoporosis, one of my students came to class and told us that she had asked the doctor to check her bone density because she was worried about osteoporosis. The test results indicated that she did have decreased bone density, and she proudly told the class that she was able to talk to her doctor about ways to get calcium even when lactose intolerant. This was the same student who used to get so nervous speaking English that she would break out in a cold sweat.
Toward Mastery
Classes these days are a far cry from that first day of silence. Now, the students speak English to one another even before Vanessa and I arrive. They usually have some questions ready for us as soon as we get there. We've all become friends, and everyone feels open and comfortable about sharing their own health experiences with one another. We've covered a wide range of topics from cancer, hepatitis, and stroke to more sensitive subjects like abortion and depression. It has been an amazing privilege for me to work with these women and learn about their viewpoints on medicine and health, patient-doctor relationships, and the immigrant experience.Our last class was in December. The demands of medical school and increased hours in the hospital have made it much more difficult for Vanessa and me to continue teaching every week. There is so much more to be done, however. In one brief year, I saw first-hand how incapacitating it is to be unable to communicate even the most basic information about one's own body and health. I also saw how empowering it is to feel comfortable sharing one's thoughts. Ultimately, this freedom and comfort in communication is really the heart of why we teach at all.
--Janice Jin, a second-year medical student at HMS
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.