I’ve seen this in Cameroon – French is, technically, my first language, but for the first few weeks in country, my “French” was translated into “French.” As I now call it, that’s French-French to Cameroonian-French. I was incomprehensible. I understood what was being said to me, or I thought I did. In time, I changed – I had to. It’s the inflection, the diction, the choice of words, the syntax, the prosody, the sentence length, word order, ways to get attention, non-verbal sounds to punctuate phrases…
It’s not the same language.
I see it now as general, amorphous “French” for the basic structure – and there’s the French-French, the Cameroonian-French, the Senegalese-French, the Malagasy-French . . . they’re all different.
(And why shouldn’t they be? It’s obvious enough for Belgium and Québec).
But Africa was colonized.
The marks are there. Senegal was more closely held for longer – the French is closer to French-French in accent. Cameroon got passed over from Germany. French is different – the culture, too, is different.
And then there’s Anglophone – as PCVs, we defined at least three (basic) languages in the Anglophone (previously British-held) provinces of Northwest and Southwest. “Grammar” is the “Queen’s English,” or so they say. (Grammar – reductive; it’s language without culture or any social attachments. Pejorative? True? The way English was taught in former colonies (and is still), it’s the generic, over-arching Language. This Is. How could something so authoritative have meaning to real people, terre-à-terre?)
Anglophone. Not quite grammar, or – it is “grammar”, but we call it something else. English? No. That’s British-English. “Anglophone” is, like Cameroonian-French, related to accent, inflection, diction, syntax, vocabulary… it’s neither British nor American English nor any other Western form. We Americans were not always well-understood speaking American English.
So what did we do?
We spoke Anglophone.
(And many volunteers who lived in the NW and SW learned and spoke pidgin, as well as other local languages – as a visitor to the Anglophone regions from my own francophone province, I didn’t go further than Anglophone and a few phrases in pidgin).
It’s reflexive, now.
This is what we do.
|The Vegetarian Carnivore - Rhumsiki, Cameroun|
I do the same in other languages, though – it’s either a function of being bilingual (since I’ve had language, lucky lucky) or just of being…strange. Speaking English with French people who have some accent in English, some significant accent, my speech softens slightly. Slightly. I’m not going to speak with an accent I don’t have, but...it changes. Situational. If I know a person’s first or native language, it’s hard for me to speak to her in anything else.
Thus, in Cameroon – Cameroonian-French and Anglophone.
When I went to Kenya, I started to speak what I think of as Anglophone – it was English-speaking Africa, after all…
I got a few Looks.
(What does the mzungu think she’s doing…)
(Just like, when, in response to “I want to marry you” or “I love you” in Bulu, the mintangen shot back “Teke djom!” or “Ma vini wo!” (Never/I hate you).
In Kenya, they don’t speak Anglophone. The English in Kenya, yes, does have a distinctive Kenyan accent, diction, syntax, etc etc etc. But it is closer to British English, in some ways, than Anglophone sounds. Longer occupation and more in situ because there are good safari parks.
It was hard to remember to speak English at first, actually. For me – Africa meant “speak French,” for the most part.
In Equatorial Guinea (briefly), I had to remember to speak Spanish – Spanish mixed with Bulu, that is, as differentiated from the French mixed with Bulu that I was used to – same ethnic group, arbitrary border.
It makes the most sense for me to speak all my languages at once.
In Cameroon – as in many places, but this is what I know – there are 240 local languages. Country the size of California. Several of the languages are related in various groups, granted. But there’s the reason there is no African official language (as Wolof in Senegal or Malagasy in Madagascar) – there isn’t one. Not enough of one. (If Biya could decide that, on top of everything else, it would be a Beti-family language. Of which Bulu is one, actually).
One village to another could be a different language. French and English are necessary to communicate in a country with 8 Francophone provinces, 2 Anglophone provinces, a German past, and 240 other languages…
Bilingual has a strict definition in people’s minds: French and English.
I, then, am bilingual. Every Peace Corps Volunteer in country is bilingual.
And my friends who spoke 3 (least amount), 4, 5, 6 languages?
Didn’t count themselves as bilingual unless English was truly amongst those.
Every single person I know in Cameroon speaks more languages more fluently than I do. Most of them don’t count them as languages. They call them “patois” – dialect. Pejorative. Some are written, now, some have been, some are being codified by missionaries and/or linguists. In Bulu, there is Kalate Zambe – Bible, or “god book.”
Books are Serious.
Because I was often seen reading, people thought I was constantly working. Constantly. Always studying. It didn’t matter that some of the “serious” books I was always reading included books I consider equivalent to TV – passive entertainment – in a village where I couldn’t watch TV or movies.
But it’s not just that there’s not a conception of reading for pleasure (there’s not), for so many cultural reasons….*
Books are expensive. Books are expensive and sold on sidewalks. There are bookstores in Yaoundé, the capital – two, I think. Small. Most things are copies, copies of copies for university, and it’s hard to get them (corruption/competition and otherwise) and it’s expensive.
It’s not books. Even benches are shared – and paid for. Books are very expensive. Magazines, too. Anything that’s reading material, anything printed, thus gains value.
*I’m reminded of nights in my homestay in Bandjoun (perhaps written, 2005, the earliest posts here…). There was power. Technically. Low voltage. The bulb over the dining table was so dim that I rarely really knew what we were eating. For studying at night (in truth) or reading (in general) or writing letters, I needed an extra candle/kerosene lamp. This was probably (was) considered wasteful. My host sisters somehow sat, hunched, and did homework, after doing all the cooking/cleaning/taking care of the three screaming children under four. My host parents graded papers that way. But the TV and DVD player worked. In my room, with the light on, I read by flashlight.
In Mvangan, until I got a table made (long saga and looooong time in production…), there were evenings lying on the floor with the book or letter, trying to get in the right angle with the light to see enough. (A headlamp, later, helped).
That’s both the importance of reading/writing to me – and the barriers that are set up just by the physical parameters. And no one but wasteful me (or other PCVs) would light more than one candle or use more than one lamp just to be able to see well.
But I was going to talk about language.
It’s not the same language. And yet, the books are French-French. In college, I got to take a Francophone (Diaspora) literature class – actually, it was an intro to French literature, and the professor (Returned Peace Corps Volunteer from Chad), focuses on Francophone versus French. I’ve probably read more than most people in Africa have, of that canon. I can buy the books here. More easily. Writers are getting prizes in France, in the US…
I reviewed a book of Cameroonian poetry. The poet teaches and lives in the States.
Literature – the language of a people – should make sense.
And then there’s medicine.
Words are always approximate. Always. Every art is approximate. The closest thing to anything, I think, would directly involve the body – and thus there’s singing (or any music not involving instruments) and dance.
We interact with this art form, shaping it and trying to understand it – I’m talking about surgery, I’m not talking about changing things through medicine, I might be talking about psychiatry, in some respects, but it’s not exactly that.
We ask people to describe and quantify things in common words.
Where is it? Where?
And what about referred pain – how do you actually know the locus of anything, as everything is “all in your head” – interpretation of pain.
For many things, the body isn’t actually very good at that.
I worry about this with the optometrist. What if I get it wrong? What if I can’t exactly record the nuances of the images, which is really better, or just a little bit better, or not at all better?
(At my last visit, he assured me that I couldn’t mess it up – he used each image enough times, each diopter, and in contrast to other things that I should recognize more easily. This was slightly helpful – but still, I’m not completely convinced).
What about the power of suggestion? The review of systems. If I hadn’t asked about something, would the patient have thought about it or noticed it?
(For some patients, this actually does become an issue – asking the ROS becomes a litany of issues they’d never considered or might be slightly off kilter).
We define these things and assume people understand.
Pointing is helpful – that’s the body speaking more directly – and yet, with anything visceral (in basic terms, organ-related) – the body isn’t good at localizing. Take the classic case of appendicitis:
(this is textbook)
Initially, pain is dull, maybe, and periumbilical (around the belly button). Vague, diffuse.
(Is the appendix there? No. Not usually).
And then it moves to a more specific location – McBurney’s point, 2/3 on the direct line between the umbilicus and the ASIS (anterior superior iliac spine). That’s classic. And the only reason it localizes, then, is that the appendix is so inflamed that it’s actually directly touching and irritating the peritoneum (wall of the body cavity). It’s not just the intestine anymore. And all of a sudden the body has a better idea of where it is.
The body, too, isn’t the best historian.
A friend (who just started med school) told me last night that his pain had begun at 6:30 pm the previous evening. “That’s precise…” “Well, give or take half an hour. Med students are good historians, aren’t they?”
Yes, and sometimes hypochondriacs (I do think that improves with time, though).
What happens when you start to acquire the language of the body? The basics, as always, come back to pleasure and pain. And in order to communicate that to doctors (specified: doctors. Or any health professionals. Or people in a medicalized context).
Do doctors care about pleasure in the body?
Begs the question.
You could call importance of the patient feeling better as pleasure. Joy in resuming activities – or adding them, when things are truly “better.” When the patient-provider relationship has resulted in something positive and productive. There is joy in the improvement (or ceasing! gone!) of disease. (One patient called me “an angel” for helping with his cholesterol and getting him an expedient appointment with a surgeon for his hernia. Me – hardly. That’s the point of all of this, isn’t it? That’s what we learn, for? Behavior change communication, harm reduction, and then the medicines and then the surgery (order depending on the issue and its acuity).
How does the body – and how does the person – represent pain? The patient with metastatic cancer who says she’s in pain is more – terrifying, to me – than the five-year-old who is crying over a scraped knee. But?
A friend explained it this way. She was in the beginning stages of labor, with her first child. The nurse asked what her pain level was*. “Nine.” The nurse paused. Surprised. “You know…the actual birth is going to be a lot more than this.” “I know. But right now, this is just about the worst I can imagine. And now I’ve experienced this…so later, it’ll still be a nine.”
*This is a person who would probably be among the most stoic. This may have contributed to the nurse’s surprise. Also, this friend is in medicine.
Everything’s relative. The utility in measuring, quantifying, qualifying in common language is that we feel we can treat something, that we can communicate effectively with the patient.
That’s why physicians like the physical exam and lab tests, too.
But how much of the physical exam is truly objective?
And for lab tests – much closer – as is imaging, certainly – but unless there are specific points of comparison, you don’t know what the patient’s baseline might be.
(Patient. Person. Patient. Person).
|Small small catch monkey|
(offered to me as a present, Mvangan, Cameroun)
Epocrates isn’t quite a thesaurus, but . . . working on it.
(this is already far too long).