In East Malaysia, as in Peninsular Malaysia, the national language is Bahasa Malayu, and all Malaysian civil servants, including medical staff, are expected, in theory, to reach a high level of proficiency if they wish to secure permanent posts. The Peninsula uses a refined version, but in East Malaysia a shortened, simplified version is the common argot. This is not to suggest, however, that Bahasa Malayu is understood and used by everyone: the cultural diversity of people has meant that for many it remains a largely foreign tongue. The Dayak language Iban, for instance, has many similarities to Bahasa Malayu, but Bidayuh has a completely different structure and many obscure dialects. It is not uncommon to find that the older generation, specifically Chinese, Indian and Dayak families, speak English with greater fluency (due to the region’s colonial history) than the official language. In the early sixties Dr K.E. Schmidt, described the problems caused by linguistic diversity in the following way:
The chaos of languages in Sarawak constitutes the main difficulty for anyone concerned with mental health in this country. Among its bare three-quarters of a million people, at least twenty-one different languages (not dialects) are spoken. This situation obviously militates strongly against hospitalization, which is avoided as much as possible, since even normal people are unable to converse freely with each other (Schmidt, 1964:155).
At Hospital Tranquillity therefore a combination of languages and dialects are used, but most members of staff are familiar with English having been trained in that medium. Few patients, however, are particularly competent in English and will instead use a mixture of Malay, Iban, Bidayuh and Chinese dialects, such as Foochow or Hokkien. Despite the plurality of languages, staff and patients manage to verbally interact reasonably well, and there is usually someone to hand who can translate.
As with Dr Schmidt, communication in my basic Malay was at first problematic, especially as my ability with other commonly used languages was non-existent. Painfully aware of my ineptness in this area I was happy to recruit a few of my most promising multilingual final-year social work students as translators some of the time, primarily for the more formalised, one-to-one interviews with non-English speakers. Their comprehension of the issues at stake and professional, ethical grounding proved invaluable to the study, where our drives home were filled with dialogue about the interview, assisting me to develop a closer idea of how our individual assumptions and beliefs had coloured our impressions.
The bulk of the study was therefore undertaken alone and involved an immersion into the linguistic environment, which improved my language competence considerably under the tutelage of participants. Translations with patients were still required at times of course, however these were often spontaneously provided by other participants who might also be translating the general meaning to others. This did not always work: once I appealed to a patient standing by and apparently listening to the monologue of one particular person, asking ‘what is she saying?’. To which the unconcerned but affable reply was, ‘I also do not understand, never mind’. Generally, however, I did understand much of what was being said, the gist was usually caught without too many problems, words falling into specific meaning at a later date, although sometimes irascible Maya, a long-stay patient, would crossly tell me I was bodoh (stupid) for not understanding her.
Due to my slow and hesitant use of language I was heavily reliant on the circumstances in which utterances and gestures took place and who responded to speakers or who ignored them (Fabian, 1996). It was some time later that I came across Unni Wikan’s (1993) comments on her own very similar position, whereby she utilises a postmodernist debate about whether language is able to fully represent and express the relationship between the self and the external world. Wikan dismisses an ethnographic preoccupation with words, such as is the basis of discourse analysis and argues for a more ‘empathic’ attitude, commenting that it may instead be necessary to
Transcend the words, we need to attend to the speaker’s intention, and the social position they emanate from, to judge correctly what they are doing (Wikan, 1993: 193).
Empathy combined with good listening and observation skills were put to good use in this study, where the context of communication in relation to the literal message conveyed vital meaning. I came to note, for example, how little substance and attention were granted to patients’ words by staff and fellow patients. By contrast the statements of staff were weighty and authoritative, as Robert Desjarlais (1996) notes of desk staff at a shelter for the mentally ill in Boston, USA in his ethnographic study. At Tranquillity, English was used by staff largely as the language of medical authority and nearly all nursing staff spoke a formalised English to the ward doctors, but among themselves returned to the locally flavoured English garnished with Malay (Spradley, 1979). Finally, while physical distance was the norm between the medical staff, physical proximity and touch was also used as another dominant and most eloquent medium of communication by many of the women patients. I experienced having my hand held, embraces, pats and strokes and at the other extreme threatened slaps or spitting conveyed a wealth of meaning, which often made verbal communication redundant.
Ethics and fieldwork
Ethical considerations permeated the fieldwork experience, one of the main ones being how far I should involve myself in those events taking place around me which I interpreted as being of a dubious nature. On some occasions, I felt that I should intervene, whilst on others I remained uncertain and kept silent, inducing anxieties about tacit collusion, which remained unresolved. Two short examples serve to illustrate this dilemma quite well. The first took place during an informal chat with a medical assistant who was talking about his job in an animated fashion. Close by a male patient was aiming vicious kicks and blows at another who was cowering without retaliation. It is very likely that this would have continued if I had not quite quickly drawn the medical assistant’s attention to what was taking place a few yards behind him. My interference at this point I felt to be perfectly proper behaviour, however on another occasion during the early days of fieldwork I witnessed a woman patient approach a nurse to ask for a sanitary towel. A brief wrestling match ensued while the nurse attempted to expose the woman’s naked genitals in public to verify that the patient’s menses had really begun. Judging from the patient’s reaction this was clearly a humiliating violation of personal privacy, but one in which I did not intervene but instead carefully noted.
The first example shows me in a paternalistic light as the two men were patients who also suffered from learning disabilities. I also assumed at the time that the medical assistant seemed to be momentarily neglecting his duties, perhaps because I was distracting him, and that therefore this accidental omission gave me license to interfere. In the latter case, the emancipatory aims of this study notwithstanding, I was uncertain of how much authority I could bring to bear on the situation, and whether my primary role was to observe or to intervene. Whilst naturally the self-interested thought flickered through my mind that interference between a nurse and her patient would also jeopardise my tenuous standing on the ward, and consequently my study.
Subsequently I witnessed other episodes involving staff and patients that worried me, but more often, I was presented with low-key dilemmas; for example, one woman that I got to know quite well asked me to intercede with the staff on her behalf. Once or twice I did bring these kinds of matters to the attention of the staff, but most of the time I tried to encourage patients to voice their own concerns to the appropriate authority. I wanted to avoid being seen as either an unorthodox member of staff or alternatively as an adopted advocate on patient issues. Thereby I found myself neatly caught in quandaries and dilemmas as a researcher faced with actual instances of oppression in the field. I reasoned that either situation would probably interfere with developing relations with groups of informants, as well as probably contravene my agreed role. Therefore, caught on the horns of a dilemma I also attempted to confine my role to simple observation and did not interfere with events taking place around me, yet the issue remained, perplexing,