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Your Spanish-speaking Patient: Low versus High Context Communication

Vitalworks-Hospital-CCO Public Domain

By Mari D. González

Published at DTC Perspectives on September 16, 2014

As a professional medical interpreter and a cross-cultural communication consultant, I find cultural contexts the most challenging and fascinating aspect of translating between Spanish-dominant patients and English-dominant doctors during medical interpreting assignments.

Cross-cultural communication refers to the comparing and contrasting of different communication styles based on culture. One of the basic tenets in cross-cultural communication is the influence of our personal and social identities on the way we communicate.

If we are dominant in one language—in the case of monolingual speakers—or more dominant in one language than another—in the case of Spanish-dominant or English-dominant speakers—a particular cultural programming or set of values, world view, or behavior always dominates when we converse. Harry C. Triandis observes in his article, “The Self and Social Behavior in Differing Cultural Contexts” that “People who speak different languages or live in nonadjacent locations…have different subjective cultures” (1989, p. 506). Our dominant or primary language provides an essential clue into our social upbringing and communication styles.

Spanish-dominant Latinos/Hispanics are predominantly “collectivist” and “high context” due to their group-based identity and their ability to get implied meanings in oral communication. Triandis further states, “Individualists give priority to personal goals over the goals of collectives; collectivists either make no distinctions between personal and collective goals, or if they do make such distinctions, they subordinate their personal goals to the collective goals” (p. 509).

Generally, Spanish-dominant patients lack the necessary knowledge of U.S. culture to completely understand the narrowness, linear-ness, and precision of “individualist” or “low context” communication. On the other hand, a medical provider or physician whose primary language is English may often get frustrated by the expansiveness, circular-ness and all-over-the-place “high-context” communication style of Spanish-dominant patients.

The medical interpreter, in her role as cultural broker, performs a delicate balancing act: She has to explain to doctors that the patient is giving the context for his or her answer while explaining to the patient that the doctor is looking for a precise, specific, and short answer. Impatience is the doctor’s natural reaction to a perceived overload of information. This need for exactness is crucial in the financial, accounting, and technology fields, but it is not always recommended at the doctor’s office because impatience does not help in building trust. It results in patients not asking the right questions or reporting inaccurate information due to a fear that the doctor may get upset.

People from collectivist cultures, such as Spanish-dominants, value harmony over confrontation. Harmony is an essential value if you come from a large and extended family. Maintaining harmony and balance is a requirement to keep large groups functioning. Furthermore, people from high-context societies sharply scan emotions and grasp what was not explicitly said. It does not matter if a doctor smiles at the patient while being impatient. The emotion and what he or she implied was perceived first.

To mediate this exchange of low context and high context communications, medical interpreters find themselves repeating the doctor’s linear and precise questions to patients who typically give the whole context by using stories and not answering with a yes or no or with a specific number. Most patients eventually understand that their doctors are looking for clear-cut information, but they do not always understand why the rest of the information is not as important.

Let’s not confuse a basic-to-intermediate-level of fluency in a foreign language with understanding the culture of those who speak it as their primary language. Applicants for jobs as health care providers may include fluency in Spanish, or any other second language for that matter, among their qualifications, but that may indicate nothing about their “cultural fluency.” Cultural fluency is gained through socialization or a constant association with those who speak a different language, which promotes a sense of shared comfortableness. If language fluency was acquired indirectly through media such as CDs, DVDs, books, or even through courses that are devoid of people from that culture, the cultural fluency that allows one to perceive differences in communications styles will be lacking.

Activist and Jornalist

Jorge RamosJorge Ramos’ track record as one the best journalists in the U.S. cannot be dismissed by his activism. Yet, simple-minded people who see the world as either/or and feel threatened by his influence wished they could so.

Latino en Estados Unidos

El párrafo al final escrito por Alex Gonzlar describe claramente el sentimiento de ser Latino en Estados Unidos o lo que es identificarse con los demás inmigrantes de Latino América.

“El momento final de la ceremonia de entrega de los Premios Oscar, y uno de los momentos más importantes de toda la noche…; cuando el director Alejandro González Iñarritu, de descendencia o ascendencia mexicana, y quien ya había ganado minutos antes, el Premio como Mejor Director; luego, al recibir su Premio Oscar, a la Mejor Película, pidió la atención de todos, al final, para un extraordinario mensaje a favor del movimiento pro-Reforma migratoria en esta nación, al decir lo siguiente : “Para finalizar, solo quiero tomar un segundo, quiero dedicar este premio también a mis compatriotas mexicanos…, aquellos que viven en México.., es mi oración que podamos construir el gobierno que todos merecemos…; y para aquellos que viven en esta nación, quienes son parte de la más reciente generación de inmigrantes en este país…, es mi oración también, que puedan ser tratados con la misma dignidad y respeto de todos aquellos que vinieron antes, y construyeron esta increíble NACION DE INMIGRANTES…!!”

Wowww…!! Tremendo mensaje político…; valiente, fino, claro, fuerte, elegante, consistente, honesto, y directo a la yugular….!!! Excelente hermano Alejandro…, gracias, porque aun cuando no somos mexicanos, indirectamente nos incluiste a todos quienes somos inmigrantes, y nos sentimos en ese instante, completamente identificados con tus palabras….!!! Gracias, amigo…!! #OscarAwards  Alex Gonzlar

Spanish-dominant Bilingual Youth

Bilingual youth who construct their vocabulary between what they learned at home in Spanish and what they learned at school or work in English are more comfortable with a casual language among their peers that mixes phrases and words of these two languages.

According to my study of language preferences in digital media among 18-25 year-old Latinos/Hispanics, the less acculturated ones side with Spanglish-themed programming such as the no longer existing Univision-owned radio station “La Kalle,” because mainstream media does not resonate with who they are collectively.

“Spanglish” Speakers

To attract “Spanglish” speakers, you need to appeal, invite, and get close to a younger generation of Latinos who do not necessarily are fully fluent in Spanish but have acquired the emotional vocabulary of their parents’ language.

Speaking Spanglish represents having a dual and hybrid cultural identity. The language itself is a mix of what is relevant in Spanish but does not exist in English or cannot be completely expressed in English.

Aculturado, Retroaculturado y Asimilado

El aculturado vive en dos mundos—el del país donde creció—su cultura de origen y en la de residencia—donde vive; por ejemplo, Shakira.

El retroaculturado está más empapado de la cultura de residencia pero tiene interés en aprender la cultura de sus padres o abuelos; por ejemplo, Eva Longoria.

El asimilado es quien de tantas generaciones ha perdido conexión con la cultura de origen de sus padres o abuelos y socio-culturalmente funciona mejor en un solo mundo—el de residencia; por ejemplo, Jessica de Alba.

Sin embargo, la nueva generación de Latinos en EEUU tiene el privilegio de poder operar simultáneamente en la cultura de residencia y de origen ya que puede estar en constante contacto con familiares y amigos del país o paises de sus padres.

Low-Context and High-Context at the Oscars

By Mari D. González

The Oscars’ controversial comment by Sean Penn when presenting Alejandro González Iñárritu is a great example on how communication between members of Low-context and High-context groups causes misinterpretation.

According to anthropologist and intercultural communication pioneer, Edward T. Hall, North European and North American macro-cultures would be defined as “Low-context” because their communication preference is characterized by explicit verbal messages. Hall further explains that in Low-context, “Effective verbal communication is expected to be direct and unambiguous.” On the other hand, societies from the rest of the world including Latin America, Asia, and Arab countries utilize “High-context” communication in which, “most of the information is part of the context or internalized in the person; very little is made explicit (Hall, as cited by de Mooij, 2014). In these countries, people are programmed to read context and meaning between words.

Low-context communication is related to an individualistic identity in which people are “I” conscious and express private opinions publicly. Conversely, in High-context or collectivist societies expressing personal opinions and disregarding group of reference’s perceptions is not recommended. There is a risk of making them feel humiliated or what Asians call “losing face.”

In collectivist cultures, personal identity is related to and not separate from that of the group of reference as in “we.” An offense to a person of that group is an offense to all members who identify with that in-group. Hence, a perceived offense to Iñárritu could be perceived as an offense to those who identify as Mexicans because their individual identity is not separate from that of the group of reference as it is for members of individualistic cultures.

Digital Divide and Latinos: A Comcast Opportunity

 

[College] InternetForAllNow

 

By Mari D. González

 

Many argue that Latinos are ahead of the curve when it comes to online interactions—gaming and social media consumption—but they might ignore the fact that 30 percent of Latino families, including school children, college students and working parents, do not have access to basic Internet services at home simply because they cannot afford it. They are deprived of fully participating in and contributing to a society that now depends on Internet as it once depended on home phone services.

Internet services are no longer an option as cable TV. Internet is not just about consuming entertainment. We are now required to complete employment and college applications online and research homework via the World Wide Web. Some wealthy school districts even require students to watch educational online courses to enrich the classroom teaching.

Do we want a society divided by the ability to access information and make use of an essential technology such as the Internet? Do we want low-income Latinos to be relegated to a segment that “over indexes” on consumption? Or, do we want them to be active participants, contributors, and creators online? Affordable Internet services should be the right for every family in the U.S.

Comcast Opportunity

Comcast has fallen short in signing up people in need for its $10-per month service “Internet Essentials”—a program started to ensure the NBC Universal merger in 2011. Now that Comcast has proposed acquisition of Time Warner Cable, the Federal Communications Commission must be pressured to require Comcast to 1) Extend Internet Essentials to all low-income households, 2) Increase Internet Essentials subscribers until the program reaches 80% adoption—which is now at 14%, and 3) Create a strategic plan to close the Digital Divide by allocating funds for non-profits to assist in achieving subscriber goals.

Join the #Internet4All movement! Sign the petition: Demand Affordable Internet for All

“Latino” Preferred in California

By Mari D. González

The term Latino/a is preferred in California because it is associated with a sense of self-power, “for more educated Californians, ‘Latino’ is the new Chicano in that it evokes their indigenous roots, a shared history of struggle and the colonization of the people in Latin American countries.” Alcoff, L. M. (2005). Latino vs. Hispanic: The politics of ethnic names. Philosophy & Social Criticism, 31(4), 395-407.

Latinos in the U.S.

By Mari D. González

This is a comment I shared on the Hispanic Professionals LinkedIn Group discussion titled, “Bilingualism Key to Breach the Gap.”

“The hope for the advancement of Latinos in the U.S. lies among young educated and aware Latinos/Hispanics who are the product of bilingualism for they did not grow up during the time when speaking Spanish was prohibited.

Unfortunately, before the 1970′s  Latinos or Mexican Americans were either forced to identify  with the general, macro, dominant culture–white–or to be secluded in cluster communities up to the explosion of the Chicano Movement which proclaimed the recognition of the indigenous roots of Mexican culture and empowered Mexican Americans to advance politically.  As radical as it was, the painful conscientious movement was indeed needed.

As a result, young Latinos and Latinas are enjoying one of the greatest legacies from it–bilingualism. We are also more knowledgeable of the two cultures that makes us up. We are integrated. We are expanding our awareness of our culture of origin–Latin America–by socializing online, by traveling and by being more exposed to different cultures and places.

Young Latinos and Latinas are currently graduating from college in record numbers. This can be attributed to our collectivist values, or group efforts to mentor and tutor, to expand culturally appropriate program in colleges and high schools such as Puente and above all to having a willingness of being role models to upcoming students.

That is what differentiates Latinos from whites and blacks. Latinos have a strong commitment to improve their communities. Even when succeeding Latinos might leave their neighborhoods to study or work, most return to uplift others.

Who needs JLo, Jessica de Alba, Ted Cruz, or any of those washed out Latinos. While they might be popular, they have no true influence. Influence is acquired by taking responsibility for and by making an impact on others’ lives and by uplifting human values.

Being Latino is not a label. Being Latino is a strong community commitment to help Latinos in need. Yet, we need to move away from history to create a clear vision of the future as one cultural group. We must ask ourselves, What is it that we want as a group?  Where are we moving toward? What our direction should be?”