attends team meetings to augment information on informants. However, at an early stage of research I decided that I would not request access to patients’ medical records although did note verbal information on patients from staff. My reasons were partially practical and partially ideological. Medical notes were kept on the ward and staff consultations of them took place in plain sight of patients, so that it was not possible to avoid being seen reading them. Any such activity would have been conspicuous and instantly noted by patients, and I feared that this therefore might interfere in forming relationships of trust with patients. Furthermore, I felt that these could probably contribute little in the way of understanding interactions in the hospital; my interest was located in everyday events and the perceptions of informants, rather than in turgid medical information, which could largely provide me only with details of admissions, discharges and medication. Finally, I also felt strongly that this was a transgression of privacy, to which my status as researcher could not really entitle me. This position was justified when patients prefaced their interviews by asking me if I had read their medical notes. I felt that my reassurance that I had not read them created a more confiding environment in which to seek personal disclosures from patients, who might otherwise see me as a sort of member of staff, or some such similar type of authority, although this of course did nevertheless happen.
Despite my good intentions however, I had not bargained for the frequent invitations by staff to read the notes. The nurses and medical assistants often seemed to feel the need to fit me into some type of legitimate medical role and offered me the records on numerous occasions, sometimes opening them at certain pages and putting them in front of me, which made it difficult to refuse a quick perusal. This bears comparison with Burgess’s (1995) research experiences in a school setting, where he describes a similar need by staff to try and neutralise him through assimilation into the professional corps he was in part studying. Similarly therefore the invitation of medical notes not only legitimised my presence but also my research, which otherwise probably seemed a nebulous and unscientific way of going about things. The notes offered concrete and valid information in the eyes of staff, as opposed to the naïve and no doubt foolish questions I asked. My insistence on sitting with and talking to patients was commented on, to reiterate, with levity, incomprehension, or thinly veiled hostility.
Language and meaning
Competence in the language of informants is usually perceived to be part of the ‘mystique’ of ethnographic work, to paraphrase Aull Davies (1999: 76) who goes on to expand on the limitations imposed by reliance on translation. Accordingly, Agar (1996) comments on the uncomfortable feeling associated with having insufficient control during fieldwork when obliged to use interpreters, but comments that this is probably not an uncommon sensation for fellow researchers. Equally Ardener (1995: 106) notes how ‘alienating’ it can be to rely on translators and that time spent attempting to learn the language is well used. Martha Macintyre (1993) comments ruefully on the anthropological assumption of linguistic competence and her initial despair at her complete inability to speak Tubetube.
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
