Illiterate woman

The incident

I was admitted to a hospital after suffering from a high fever for several weeks and not receiving any substantial support from my GP.  The hospital was full, but still they found a bed for me.  It was Wednesday when I was hospitalised.  I was placed in a room with two other women, one an older Austrian woman who did not speak much, and one a Turkish woman, approximately 50 years, with a mobile phone which seemed to ring all the time, and was never turned off.  Also, it was a very cheap type of phone without the possibility of regulating the volume. The phone rang very loudly.

The Turkish woman would not sit still but was constantly moving around or had family members over for conversations.  In the evening 4-6 people were there at once.  I could not rest, my body was tired from the fever, and I had to stay clearheaded for several examinations.  I had no strength in my body and was upset because she had no respect for me and was acting irresponsibly with her loud voice and her loud phone.  She constantly smacked her lips loudly.

The first night I could not sleep. The Turkish woman switched on the lights several times, went to the toilet and left the door open, ate food and grunted and burped the whole night.  At 5.00 am she turned on the light in the room and loudly prayed her morning prayer without even caring that two people were still asleep.  I could not sleep at all and had a severe headache after that.  The situation did not change after several days.

The shock finally occurred when suddenly she stood in front of my bed, while I was trying to sleep, and pulled my arm.  She was very close to my face, which was awkward for me.  She then showed me the box with her medication, and asked me in Turkish, which one she should be taking right now.  I did not understand a word but guessed she was asking me that.  Through pointing at the different sections of the box it became obvious that she did not even understand which section said “morning”, which “evening”, indicating when to take which medication.  She was illiterate.  I pointed to the right section with the medication she should be taking at that hour of day and turned my back on her, signalling that I wanted no contact.

Thirty minutes later she threw herself to the floor and cried and shouted excessively until the doctors could calm her down.

I told the doctor that I needed another room, because I would not survive another night with this cruel person, whom I could not explain myself to due to our language barrier, and who had not even a spark of respect on how to share a room in a hospital.

If the doctors had not given me a different room, I would have checked myself out.

1. Identities of the actors in the situation
  1. Narrator

Sick woman in her 30s; born in Austria; speaks German, English, French, Russian; has a lot of international experience (lived in different countries); Protestant; highly educated (university degree) from a rather small family;

  1. Turkish patient

Sick woman in her 50s; born in Turkey; speaks Turkish; Muslim; no school education, illiterate; married with multiple children;

  1. Medical staff

Doctors and nurses coming into the room from time to time, yet not often enough to really experience what is going on in the room.

Both women are in the same situation as they are sick, hospitalised, having to share a multi-bed hospital room with other women.  While the narrator is highly educated, the Turkish patient is illiterate.  While the narrator came to the hospital to seek peace and quiet (and is alone most of the time), the Turkish patient is regularly surrounded by many of her family members.  What separates them further is that they do not share a common language in which to communicate.

The main difference between the narrator and the medical staff revolves around the fact that the latter are not in a state of physical discomfort but go about their professional tasks.  Furthermore, they are only present in the hospital room for short periods of time, thereby not experiencing how it is to lie there as the narrator did.

2. Context of the situation

The situation took place in a three-bed room in a public hospital in Vienna.  Inside the room there was a bathroom with a toilet, which could only be used by the three patients residing in the room.

The general atmosphere at the hospital unit was quiet, especially after six o’clock at night where there was nothing to be heard from the other rooms.  Most patients stayed in their rooms and there was not a lot of commotion.  Only the Turkish woman was constantly moving around in her room and in the hallway.

All patients wore white hospital gowns but the Turkish woman also wore a veil (not a type of burqa but a patterned headscarf).

The narrator was sick with a fever, not knowing what was going on and why the fever did not pass. She had a great desire for rest and calm.  She needed to stay clearheaded for most of the day and this contributed to a feeling of being worn-out.  Her pain and exhaustion was aggravated by the fact that she could not sleep since the Turkish patient kept her up all nights.

3. Emotional reaction

I was extremely angry.  How could she be so inconsiderate?  She seemed to have no empathy. I was also completely worn-out, tired, with a severe headache through lack of sleep.  I could not stand the situation any longer and I had to leave the room.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock

Respect and empathy is key for social organisation:

  • Empathy means that all people sharing an environment need to adapt to each other, take care of each other’s needs and try not to encroach on their boundaries.
  • The narrator perceives no consideration for her own needs which threatens her vision of how to socially interact and makes her feel unfairly treated due to lack of reciprocity.
  • Insecurity: What is the reason for the Turkish patient to violate these values of respect and empathy? Is it due to cultural differences, i.e. explained by stereotypical notions of Turkish families being louder than Austrian families? Or is it due to the lack of education? This insecurity prompts mixed feelings in the narrator, who is pitying the Turkish woman while being annoyed.
  • Orientation towards individualism: In regards to interacting with other people, the narrator wishes to focus on personal preferences, needs and boundaries. Negotiations about how one wishes to be treated and treat others shall be based on individual personalities, which to her implies an interest in the other person.
  • Orientation towards individual liberties ends where it has a negative bearing on others.
  • Being loud underscores power, remaining silent / quiet symbolises lack of power. Not respecting her need for quiet makes the narrator feel powerless.

Preference for negotiating social conduct:

  • Instead of following universal rules on the one hand or disregard for other people by an orientation towards one’s own wishes alone rather than others, the narrator prefers to negotiate context-specific forms of how to relate to other people present.
  • Orientation towards communication: It would have been different for the narrator had the Turkish woman informed her beforehand that she would turn on the lights during the night in order to pray. Without a vehicle for communication (shared language), the narrator feels at loss on how to negotiate with the Turkish woman and make her understand her own position, but also understand where she is coming from.
  • Negotiation across social boundaries: How to negotiate without a common language? How to negotiate with the Turkish woman who cannot even read?

Physical integrity:

  • High desire for quiet and calm, since she was tired, exhausted and worn-out.
  • A hospital is considered a space where people get better, a place for recovery. Patients are thought to need quiet, this being emphasised by the regulation of visiting hours and night rest starting very early.
  • Disgust over sounds and smell – especially notable in the context of being in a hospital where hygiene and avoiding hospital germs are important.
  • There are implicit rules guiding behaviour in hospitals and among patients sharing a hospital room: being quiet, considerate, minding one’s own business, since hospitals are also places where matters usually addressed and enacted in private are done semi-publicly. The narrator’s expectations of what will happen once she admits herself to the hospital were destroyed. Her possibility of recovery felt threatened.

Negotiating conduct within the specific context of a hospital:

  • Temporary hospital stay: it is unclear how long the narrator is going to stay or how long the other patients are going to stay. How can relationships and common communication be established under these circumstances?
  • The meshing of the public and the private typical for hospital stays generated insecurities on how to act. The narrator exhibits a preference for keeping private dimensions sheltered / hidden and not acting them out in a hospital room.

Prioritising of patient identity:

  • In a hospital all patients are primarily patients to the narrator, not family members, professionals etc. Certain behaviours follow from prioritising the patient role, i.e. general adherence to the implicit rules of a hospital stay.
  • Need for security and feeling of dependency; passive, hierarchical orientation: the hospital and its members are supposed to ensure order and well-being for all patients. The narrator felt she was left alone, no one was helping her in this uncomfortable situation.
5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

Inconsiderate; not empathetic; disrespectful; ignorant; simple.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator

Orientation towards private, familial self:

  • The patient behaves as she would in her own home.
  • Maybe her life outside of the hospital revolves primarily around her family, which leads to her having little experience of other types of selves / codes of conduct. Maybe she prioritises her family identity over other types, such as patient identity.
  • Being sick and in an unfamiliar setting she turns to common codes of conduct.
  • Insecurity and fear due to the hospital stay – caused by a lack of understanding of the procedures she is subjected to, her precarious status as a migrant and medical institutions being intimidating to many patients.

 

Collective orientation:

  • Not the individual, but the community (extended family) is the basic unit of social organisation. Needs, feelings and preferences are not so much grounded in internal characteristics like personality traits, but derived from group membership and the workings of the group. There is a focus on interdependence, the group members being very close and experiencing a strong connection to each other.
  • Having many family members visit and spend time, loudly chatting with each other or eating together is an element of enacting collectively and a way for the patient to correspond to group needs while in hospital.
  • The prioritisation of fulfilling collective needs and group requirements includes a reservation towards other patients / non-members of the group.

 

Demonstrative communication:

  • Preference for expressive forms of communicating with medical staff and other patients (body language, sounds etc.): Compensating the lack of verbal possibilities to communicate through sounds, moving around, loudly expressing pain; using a different form of communication than the spoken word.
  • Her actions – that she is constantly moving around, being awake – stand for curiosity, willingness to learn and engage.

 

Prioritisation of own needs:

  • Orientation towards recovery: elements needed are i.e. contact with family and praying in a certain way at a certain time.
  • Value of feeling comfortable, especially while being sick
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

Hospital as social space

  • Different patients with different needs and potentially colliding ideas of recovery share spaces and are often forced to go about their private business in very close proximity to each other. Thus, hospitals as institutions with heavily diverse users bear a high potential for conflict.
  • A typical set of conflicts might arise between patients adhering to a collective orientation and patients oriented towards individualism – especially when they have to share rooms, facilities etc. As depicted in this case, the two orientations go along with divergent frames of reference, complicating an interpretation of the other person’s actions, leading to attribution errors, insecurities how to act and frustration.
  • As a consequence rules on how to act in a hospital should take into account different ideas on recovery, but also safeguard basic needs (such as need for sleep).
  • Recommendations:
    • Communicating rules and codes of conduct in different languages and with icons: Where are the social rooms located for patients to spend time with their relatives? Where are prayer rooms etc?
    • Investing in emergency beds

 

Hospital staff as mediators?

  • Staff are usually pressed for time, so that it is often not possible for them to acknowledge what is going on in patients’ rooms.
  • Creating opportunities for patients to communicate high levels of disturbance; this carries the risk of hospital staff being swamped with complaints.
  • Training staff to be aware of conflict.

 

Comprehensive translation and interpreting services in hospitals

  • Expansion of in-house interpreters
  • Expansion of telephone and video translation services
  • Training health care professionals on how to deal with language barriers