As Americans, we tend to be very insular in our thinking. Since we don’t generally need to know another language, most of us don’t understand anything but English. Since we typically have far fewer vacation days than other countries, our vacations tend to be short. Our travels are likely to be something like a week at an all-inclusive resort in Cozumel, where we never leave the beach or pool except to eat in the resort’s dining room. Or we focus on how much sight-seeing we can cram into that week—like pictures in front of the Taj Mahal—and the only people we speak to are the tour guides. Travel can, and should, make us at least consider other ways of thinking about life, which, in turn, can affect our approach to the documents we write. But this happens only if we talk to people, see how they live, and find out what they think and what they value.
My first major trip outside the US was the year I spent in graduate school in Montpellier, France. Unlike many programs where American students study abroad, I enrolled in the Université de Montpellier along with all the other French students, and I lived with a French family. I met virtually no other Americans during that year, so I was forced to speak nothing but French and live like a member of a French family. I was lucky that my family included a 4-year-old girl, Corinne, with whom I spent a lot of time before classes started. I could talk with her without worrying about my accent or my grammar, so by the time classes did start, I was totally comfortable speaking with my French colleagues and our professors.
As luck would have it, my year in Montpellier was the year they were undergoing major educational reforms. Rather than just sitting and listening to lectures for the whole year, they adopted typical American methods of teaching, including student presentations, quizzes, and having individual courses that were like what we have always had in US colleges. So, I was comfortable doing a class presentation, which none of the French students had ever done before. And I was comfortable discussing points of literature or politics with my teachers. Doing something like this was completely unheard of before that year, and my French colleagues were amazed (and occasionally appalled) that I would disagree in class with a professor. Previously, one teacher who didn’t like you could keep you from ever graduating and working in your chosen field. As much as I learned that year, I think the French students also learned a lot by seeing how we approach higher education.
After my marriage, my wife, Rosemary, and I spent a year in Madrid, Spain, where she studied for a master’s degree. We lived in an old section of the city, where there were no supermarkets, just small shops for every type of food. Since she was in class every day, I did a lot of the shopping. This gave me the opportunity to interact with neighbors and local shopkeepers. Obviously, that was a great way to improve my Spanish vocabulary, but it also gave us both the opportunity to see how our neighbors lived. I was a bit of an anomaly—a man doing the shopping. Everyone was convinced that I must have been her brother, since no Spanish husband would ever be seen shopping. For most of the Spanish women (and me), at least 2-3 hours daily were spent going from the butcher to the greengrocer to the seafood shop to the seller of chicken and eggs to the olive stand (you wouldn’t believe how many varieties of olive are actually out there) to the dairy, etc. The greengrocer was of particular interest. He was a gentleman in his 50s who spent the day chatting with customers and making just enough money every day to have a beer or glass of wine in the evening with his buddies. He wasn’t interested in becoming a millionaire—expanding to a chain of fruit stands—or any of the things that drive a lot of Americans. He was happy in the way he spent his day, and he was happy that his work enabled him to spend time with his friends. He didn’t need or want anything more than that, and who is to say he was wrong? That same year, I learned that a cardiologist I knew had a heart attack at the age of 39. Was his life better or happier than the fruit vendor?
That year abroad, we did our share of sightseeing. Yes, I admit to sight-seeing and taking pictures in front of the tourist attractions—it wasn’t the Taj Mahal, but we do have pictures in front of Notre Dame Cathedral in Paris. During that vacation in Paris, very close to Notre Dame, I was carrying several cameras with different lenses. A gentlemen approached us and asked, in halting English, if I knew anything about cameras. Rosemary realized immediately that he was Hispanic, so she asked him in Spanish what the problem was. After he explained, the three of us found a nearby camera shop where he explained to her in Spanish what the problem was, she explained it to me in English, and I explained it to the shopkeeper in French. We went back and forth that way until his problem was resolved. So, not only did we help someone out because we spoke other languages, but it turned out that he was a violinist with the Mexico City symphony orchestra. By way of thanks, he invited us to dinner that night at the oldest restaurant in Paris: Le Procope, where Voltaire had eaten more than 200 years earlier. We became friends, and we introduced him to a good friend in Madrid, with whom he corresponded for many years.
During another trip outside Madrid, we visited a small museum that had been the chapel in Segovia of the Knights Templar. All of us sometimes make unwarranted assumptions about people based on their job, their clothing, their house, their car, etc. Well, we made one of those assumptions about the man selling tickets to the museum. After all, what could we have in common with a ticket-seller and how could he be interesting to a pair of young students? As it turned out, we spent almost an hour before going into the museum discussing American theater and movies with this gentleman. That never would have happened if we did not speak Spanish and if we had not interacted with someone about whom we had very incorrect assumptions.
There is an Anne Tyler novel entitled, The Accidental Tourist, which won numerous literary awards and led to a gem of a movie with the same title that also won numerous awards. The main character in the novel/movie is an unhappy man who writes tourist guides for Americans, showing them how to have totally American experiences while traveling abroad—where to stay at an American-style hotel, what restaurants serve American-style food, etc. He is essentially describing how not to experience anything new while traveling, but he ultimately opens up to new experiences and gains his life back. We have always tried to live with that theme in mind: be open to new experiences, and they will come to you. True that may include not-so-great experiences as well as great ones, but the good generally outweigh the bad. And some of the bad experiences make for wonderful stories in retrospect.
We have learned the value of being able to speak even just a few phrases in another language. We are planning to go to Prague in a couple of years, and we don’t speak a word of Czech, but we know that it will benefit us to do so before we go. It is difficult to predict the benefits of speaking another language—even if just a few key phrases—but there are definitely benefits. For example, whenever we go to Mexico, we will almost always be offered something, like a free appetizer or free drink, when we speak Spanish at a restaurant, just because it’s so unexpected. Plus, our travels are always more enjoyable when we use the local language to say “please,” “thank you,” “where is the toilet,” and a few other essentials. At worst, we don’t come across as ugly Americans—a perception that is, unfortunately, out there and often justified by the way some of our compatriots behave. At best, we get good information, good food, and good smiles in return.
So, how does all of this apply to us as medical writers? Perhaps not directly, but I believe having an expanded view of the world, how other people live, and different perspectives can impact our writing. We all know that it’s important to know our audience, so, if we think a bit more about who we are writing a document for, it can help us be more inclusive in the words we put down. If we realize that not every patient with a condition being studied has our level of education or experience, it can help us write more simply and clearly to ensure that they will have a better understanding of the consent form, for example. An expanded awareness of different perspectives on life can also help us evaluate study results and draw conclusions that are more inclusive. We may, for example, have our own bias about what treatments should be for patients at a given stage in their disease or condition. Realizing that other people may have a different perspective can lead us to more inclusive language in our conclusions. If we are aware of cultural differences between us and citizens of another country, we may be able to ensure that their perspective is taken into consideration when helping to design a study protocol.
An excellent illustration of this final point is the Anne Fadiman book titled, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. This book (to quote from Wikipedia) “chronicles the struggles of a Hmong refugee family from…Laos…and their interactions with the health care system in Merced, California….” On the most basic level, the book tells the story of the family’s second youngest and favored daughter, Lia Lee, who was diagnosed with a severe form of epilepsy named Lennox-Gastaut syndrome, and the cultural conflict that complicates her treatment. Through miscommunications about medical dosages and parental refusal to give certain medicines due to mistrust, misunderstandings, and behavioral side effects, and the inability of the doctors to develop more empathy with the traditional Hmong lifestyle or try to learn more about the Hmong culture, Lia’s condition worsens. The dichotomy between the Hmong’s perceived spiritual factors and the Americans’ perceived scientific factors comprises the overall theme of the book.
As medical writers, while we may not be directly involved in healthcare, we can certainly keep cultural differences in mind as we create documents that will be used in the healthcare of diverse patients.
