Letters: Doctors' English

Foreign doctors in the UK need to have a good standard of English
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The Independent Online

Sir: I am writing in response to Janet Street-Porter's excellent piece on immigration ("We need people to do the dirty work", 9 March) and support her idea of an amnesty for existing illegal immigrants. However, we should recruit more teachers and doctors from our own country. Notwithstanding our tradition of training foreign doctors, there are simply too many doctors with a poor command of English.

Old people, who often have a multiplicity of problems, find it very hard to understand foreign accents and are often too embarrassed or well-mannered or afraid of seeming racist to say so. Many doctors from abroad do not understand customs, slang and idiom, and a shared sense of humour, but it is impossible to offer "whole person medicine" without a thorough understanding of the indigenous culture.

My mother recently had an appointment to see a Chinese gynaecologist at her local NHS hospital. After accusing her of bringing on her condition by taking a string of unpronounceable and unknown Chinese herbs (culturally highly unlikely in the case of an 85-year-old Englishwoman), he then asked her, "Have you had breast cancer before?", when what he actually meant was, "Have you ever had breast cancer?" It was hardly surprising she found this consultation, even with her hearing-aid in, not only distressing but a complete waste of time.

I can't help thinking there is a connection between the ailing NHS (which is both brilliant and dire, with too much down to who you see on the day), our failing schools, and our apparent inability to attract the numbers of doctors and teachers we need from within this island. The Government should encourage energetic and literate students from the best schools away from banking and into our hospitals and education system. There must be some way of making this "cool".



Severely disabled people can enjoy life

Sir: Having read Louise Scott's letter (13 March), I am very relieved that she is not one of the care workers who help me look after my severely disabled son. As an atheist, I think religion should be kept out of every aspect of life possible, but Ms Scott's letter emphasises the issues involved in declaring that certain people have a right to life and others don't.

Some people would think that my son is living a miserable life, but they would be wrong. He may not walk, talk, sit up or understand much, let alone dress himself or use the toilet. However, he enjoys his life, and he brings great joy to us and to the small army of carers who work with him. He hasn't been reduced to "dribbling and soiling himself", as he has always been this way, but he doesn't live a life of indignity - my family and his carers make sure of that. I feel confident that all of the carers who have worked with my son over the years would be equally upset by the suggestion that my son's life isn't worth living and that a carer would have such a judgmental opinion.

Of the five aims and outcomes of the "Every Child Matters" agenda, the only one that my son won't achieve is economic wellbeing. Given the severity of his disability, this isn't bad going and to a large degree is due to the tremendous support from carers from a variety of agencies.

A new world has been opened up to my family. It may be different from what we expected, but like everyone else's it has its highs and lows. I really hope that we may be able to move away from the notion that being different is wrong and concentrate on the right level of support for people with disabilities, not condemn them.



Sir: On Saturday (11 March), you published three letters objecting to Johann Hari's reasoned view that those suffering agonising or incurable illnesses should be allowed to die. One even put forward the view that Tony Bland, the Hillsborough victim, had been "killed", as opposed to "allowed to die".

With technological advances, it will only be a matter of time before our lives will be able to be prolonged indefinitely with the aid of medical intervention. Babies born prematurely, those born with such terrible disabilities as to make their lives a constant agony, those in persistent vegetative states (like Tony Bland) and the terminally ill, as well as those who simply don't ever want to die (and who does?) will be able to live for ever in a twilight zone of tubes and monitors, which will keep their hearts (real or artificial) beating while any consciousness is either absent or terminally impaired.

Where do the proponents of the right to life at any cost think the financial resources will come from to pay for this? We're one of the wealthiest countries in the world, but we still have difficulty providing decent education, health care and pensions for the consciously living. Life is undoubtedly precious, and we should have as much "right" to it while we are aware of it as a decent society allows its citizens, through protecting us from those who would take it away from us. I do not, however, believe that this right extends beyond our ability to be conscious of it.

It is not a matter of not being caring and compassionate, it is a matter of practicalities and social priorities in a world with finite resources. I congratulate Johann Hari and his brave stand.



Too soon to judge the war in Iraq

Sir: The reasons for the Iraq war are much wider than WMD (leading article, 9 March). The exit strategy is plain to see, for those who choose to publish it: Paul Bremer quick to hand over to an interim Iraqi leader, elections to form a widely based government (with even Sunni ex-Baathists invited), and de-Baathification of the armed forces and the Saddam regime (or should we have left the Nazis in power in 1945?) The gradual replacement of coalition military control with Iraqi civil and military authority, and the eventual withdrawal of coalition forces, when requested by the Iraqi government. A similar exit strategy took far longer in Germany and Japan after 1945 and three years in Iraq is too early to rush to judgement of failure.

Your forecasts of doom in the wider Middle East ignore the quietly accepted better relations between Israel and Jordan, Egypt and even Lebanon, the ensuing political responsibility on Hamas in Gaza, and the shedding of Syrian occupation in Lebanon.

You imply that the UN Security Council would be a better arbiter than Coalition military intervention. Would such a body agree to concerted action (witness the Balkans)? Would corrupt oil-for-food programmes or trade sanctions have been better than toppling a fascist dictatorship, even very belatedly?

I look forward to your editorial stance on the developing Iranian situation and we will see how the UN deals with this without common purpose in the Security Council.



Sir: One of the most immediate questions about Iraq to which we need an answer is: was it a war crime, and, specifically, a crime against peace as defined at Nuremberg in 1945?

To look at this clearly, we have to rid our minds of the idea that war crimes are the sort of thing that only other countries commit. We need all our reserves of honesty, clarity and courage.

We should read through the Nuremberg definition of "crimes against peace", asking ourselves whether it is at least possible that we did some of these things during the run-up to the invasion, or in the invasion itself. The text says: "Crimes against peace - namely, planning, preparation, initiation or waging of a war of aggression or a war in violation of international treaties, agreements or assurances, or participation in a common plan or conspiracy for the accomplishment of any of the foregoing."

If the answer is "yes, it is at least possible" (and I believe it is), then surely it is our duty to lay the matter before the International Tribunal on War Crimes now.



Persian carpets and the round world

Sir: Your list of Islamic inventions (11 March) is interesting and welcome, but two of them are much older than you suggest.

No 16: Plutarch (second century) in his life of Themistocles (fifth century BC) quotes him as referring to the intricate designs of Persian carpets. This was 1,000 years before Mohamed.

No 18: Almost no Greek (after about 600BC), or Roman or Christian scholars doubted that the Earth was round, and the fact therefore that the Sun is always vertically over some point of the Earth is not hard to see. Ovid (Metamorphoses), Chaucer (A Treatise on the Astrolabe) and above all Dante (Divine Comedy and Convivio) are non-scientific writers who describe the globe in some detail, while naming the Greek and Latin scientific writers who did would produce a long list, but Aristotle, Archimedes, Ptolemy, Pliny and Strabo gives a start.



Worry is nothing to worry about

Sir: Missing from Charles Nevin's litany of song lyrics about worry (The Third Leader, 8 March) is Randy Newman's "If you thought about it, you'd be worried too". This frank acceptance of worry is more likely to allow rest to the sleepless than all the lines seeking to deny that it is reasonable.

Since the song ("It's a Jungle Out There") is the theme music for the TV series Monk, it is also a welcome reminder to the insomniac of the comforting fiction that there is someone out there even more neurotic than themselves who nevertheless wins respect and affection.



Taped interview

Sir: I cannot understand why the Attorney General, Lord Goldsmith, is so "incensed over the breach of trust" after Sir Ian Blair, the Metropolitan Police Commissioner, recorded their telephone conversation. Surely, if the Attorney General has nothing to hide, then he has nothing to fear.



Best breast weigh-in

Sir: Breasts are not hemispherical (letter, 13 March). A simple method for determining the weight (mass) of a breast is as follows. The woman stands on bathroom scales, leaning forward, and records her weight. An assistant raises a bowl of water and fully immerses the breast. The decrease in weight registered on the scales is equal to the weight of the breast. This method works with any fleshy appendage which has the same density as water.



One small happy family

Sir: The most meaningful green gesture our political leaders could make is to limit their families to two children. Four young Blairs and three young Camerons will grow up with aspirations for the lifestyle of their parents. The Campbell family helps reduce the average, but I would like to see today's leaders proudly announcing their vasectomies.



French honorific

Sir: Your headline "De Villepin suffers poll backlash over jobs reform" (7 March) violates the convention that French names containing the particule nobiliaire keep the "de" only after titles (including Monsieur, as in M de Villepin), first names (Honoré de Balzac), or if they are monosyllabic (the memoirs of de Gaulle), before a vowel (the musketeer was d'Artagnan) or combined with "le" or "les" (the poet was du Bellay). Otherwise, drop it: Maupassant wrote short stories (Guy de), la Fontaine fables (Jean de). Only the English refer to De Quincey.



Fleeing bird flu

Sir: Are the people who are worried about contracting the H5N1 bird flu virus the same people who survived the Sars virus that spread like wildfire throughout the world a couple of years ago?