Language and cultural awareness of a non-native ESP teacher

Upon the triumph of the Cuban revolution in 1959, a single university hospital and a medical school along with a dominant private sector and a rudimentary public health system existed in the island. Only a third of the Cuban doctors lived in the biggest cities and towns outside the capital, while none served in rural areas where death preventable diseases were rampant.

With the radicalization of the political and socio-economic process in the early 1960s, no less than 3 000 (around 50 %) left the country for the US, making the situation much more precarious. Twenty years later, the new Cuban Health Care System (CHCS) recognized health care as a human right as well as the state’s responsibility in providing such care. In addition, international collaboration was instituted. Countries such as Jamaica and Nicaragua in the Americas as well as Angola, Mozambique, and Congo in Africa were among the first to benefit from such principle. In 2013, Werlau reported that nearly 280 thousand Cubans had worked in 154 countries, a fact that, reflected in GDP terms, meant a 68 % rise ($ 9 660k) in service exports, most of which were in health care. In other words1, “[by 2012] Cuban medical staff had cared for more people [more than 70 million] and had saved more lives in the developing countries [1,5 million] than all the G-8 countries, the World Health Organization and Doctors Without Borders [original in French] put together”2. Furthermore, after almost a 50-year American embargo, or “blockade” as the Cubans call it, the island’s health indicators in terms of infant mortality, low birth weight rate, sustained access to improved sources of drinking water, and doctor-patient ratio were already significantly superior in 2010 to those of the historical enemy and almost the same in life expectancy [1]. In other words, the Cuban public health feat has no parallels in human history and is, in part, the result of changes in medical education, and particularly, in foreign language teaching.

This revolution in English language teaching in medical sciences took place in Cuba in the mid 1980’s and was aimed at offering health services to poor countries. As a result, the two-year reading courses were substituted by five-year communicative-language-teaching (CLT)-based programs so that the future medical professional could learn how to communicate accurately and fluently in the English language while working in other parts of the world. This change implied significant increases in the English department staff of all institutes and faculties as well as the reorganization of the teaching learning process, training of new faculty, and acquisition of bibliography.

The next few years bore testimony of the teachers’ gradual development towards today’s ESP- teacher language awareness (TLA). This assertion is founded on a brief historical assessment based on the criteria experience in ESP teaching and knowledge of subject matter that allowed the identification of two periods in the development in ESP-TLA: (1) Learning and Adaptation to the new situation (1984-1986), and (2) Accommodation and Emergence of ESP-TLA (circa 1987-onwards).

During the Learning and Adaptation period, it was necessary to transform teaching practices such as the faithful implementation of textbooks, error correction, and little or no attention to the context of situation, participants in the exchange, and register which characterize professional exchanges. Beliefs such as communication is paramount, and grammar is no longer explicitly taught were quite often discussed at length.

The solution to those problems was found in intensive methodological work implemented since the very beginning of the 1984-1985 academic course including post-graduate courses, collaboration between medical faculties and universities all over the country; the local medical staff at the universities and hospitals provided the necessary working knowledge to deal with the program contents and medical jargon that paved the way to understand the forms of communication within the profession. These group growth activities were also supplemented by autodidacticism and research.

As a result, three years after the implementation of the English as foreign language new curriculum, it could be said that the second period: Accommodation and Emergence of ESP-TLA was noticeable. The presence of English language teachers with their students under the supervision of an English language proficient medical doctor was common in ward rounds, case discussions and presentations in hospitals. Furthermore, students investigated under the direction of a medical doctor, a dentist, or since 1991, a registered nurse, and later presented their research in English under the auspices of an English teacher. Teachers, at the same time, began publishing their work, first in the form of glossaries for different medical specialties, and later, on the peculiarities of specialized communication forms such as interviews, the language of physical examinations, lab test readings, and the writing of case reports and nursing care plans as medical genres. Since the early 1990s, English teachers from higher medical institutions began working as interpreters and translators in cardiology, neurology, and natural and traditional medicine congresses as well as in humanitarian projects such as those developed by Orbis International in the country.

At least four features make the Cuban ESP experience higher medical education distinctive. First, the uniqueness of its objective – to give free health care to poor countries in the world – clearly defined the rest of the components of the teaching learning process such as the contents: common health problems in third world countries; the methods: CLT, still in its infancy, for oral communicative practice in the classroom and hospitals; teaching aids; and evaluation. A second distinctive feature was the EFL-ESP integral formation of the undergraduate which presupposed a first cycle of General English during the first three years in medical education and a second of ESP in the last two. Each of these was followed by a compulsory proficiency exam. A third feature was the exchange of knowledge and skills between the staff of all health institutions as bodies of medical knowledge and practice and the university English staff. Finally, the possibility to evaluate the outcomes of the experience in the long term and correct the process through feedback. As thousands of young doctors, dentists and nurses went after graduation to work in Africa, the Arab world, or the Caribbean, their vacation period or work completion were fertile sources of information for the evaluation and improvement of the EFL-ESP teaching learning process at the university.

A comparison between the Cuban experience with all its achievements and failures with that of others in the international context is difficult because of the very essence of the country’s educational system and idiosyncrasy. Nevertheless, it could be said that not all the Cuban undergraduates in medical universities welcomed the introduction of such a heavy emphasis in English, because it added to their already loaded curriculum, and thus unacknowledged the relevance of the ESP courses, an issue closely related to motivation. In the international context, ESP education is generally aimed at using disciplinary knowledge in the production of new knowledge during the future professional practice and takes the form of written or monologic communication. The Cuban experience emphasized oral communication with other professionals or the patients as well as reading for information in the classroom about which Forteza [5] pointed out the lack of preparation of health professionals to publish and participate in international academic exchanges. No scientific account has been found about long term feedback on the effectiveness of ESP courses and subsequent correction in other parts of the world.

In the early 1990s, when the first medical doctors and nurses returned to Cuba on vacation or after finishing their work abroad, some talked about their lives in other countries and, anecdotically, mentioned instances of what is known today as cultural shock. The use of English in their work had posed no problems but, cultural differences had. For instance, after finishing nursing school in the early 1980s, while in a middle east country, A. Pavon Lopez, RN, MSc., recalls that Bedouins visiting the medical post usually wanted to give part of their medications to family members or friends accompanying them. Once a man presenting with a streptococcal endocarditis, because he had business to attend, pleaded to be injected in one day the 10-day antibiotic treatment prescribed. This nurse, quite young at the time, says it took the medical team hours to convince the man that this was utterly impossible. In the end, the Bedouin left the post to attend his business but was brought back in worse conditions a few days later (personal information).

Based on the teaching learning process results and other accomplishments after 1986-1987, it seems that English teachers in Cuban medical institutions had developed TLA in an ESP situation; however, by not approaching the ESP teaching learning process from a cultural perspective as well, the ESP teachers had not provided the students with all the necessary tools to do their jobs. That is, individual and institutional efforts, in a relatively short period of time, had transformed “the quality, extent and sophistication of [the] teacher’s cognitions about subject matter [all of which were] perhaps the most significant of the professional factors influencing the operations of TLA in [their] pedagogical practice” [6, p. 70], but missed the language cultural component.

However, TLA is only concerned with ELF, ESL, and TEFL. TLA in its original conception is reflected in recent theorizing and research in ESP teachers’ competences. In discussing the potential instructor, Feak [7, p. 44] argued that often non-native speakers of a language might in fact be more proficient than native speakers because of their knowledge of the language systems as well as familiarization with the discourse community genres and their communicative purposes. The ESP instructors might be EFL teachers provided they received necessary preparation and subject specialist cooperation Khalifa Mohammed [8]. These claims are in line with everything done during and after the implementation of the Cuban ESP experience in medical schools after 1984 that quite early saw the need for specialization, rigorous selection processes, and general and specialized training for those potential [and in-service] instructors [9]. On the other hand, Górska-Poreçka’s conceptualization, though a coherent commendable step forward in the theory and practice of ESP, could be further advanced by adding “cultural awareness” – as part of that special kind of knowledge needed to bridge the gap between ESP and the multi-culturally diverse social contexts in which the learners might employ it [10].

Based on the shortcomings of the Cuban experience and the necessary competencies on subject matter in ESP teaching [10], this paper argues in favor of the inclusion of cultural awareness as part of that special kind of knowledge ESP teachers need to enable learners to go beyond appropriacy in the context of situation to appropriacy in the context of culture.