You don't know what they translate (2006)

“You Don’t Know What TheyTranslate”: Language Contact,

Institutional Procedure, and LiteracyPractice in Neighborhood Health

Clinics in Urban Flanders

This article examines how local, institutional communicative economies adjust tochanges in multilingual client populations of immigrants and refugees in a health clinicin the Flemish city of Ghent. The focus of the article is on how language ideologies in acontext of multilingual diversity bear on the development of institutional proceduresand interactional routines through the planning and use of print materials. These ide-ologies include assumptions about language competencies, multilingual repertoires, andtheir efficiency, and are shown to shade over into forms of social categorization andindexicalities of noncomprehension. Solutions to perceived problems of noncomprehen-sion take the form of literacy artifacts that have unintended consequences in their use.[migration, Belgium, language ideologies, literacy practices, health care]

As anthropologists, we must therefore work both in and outside the official record, bothwith and beyond the guardians of memory in the societies we study. In order to reconstructthe annals of a cultural imagination, moreover, we have to operate with a working theorynot merely of the social world, but also of the role of inscriptions of various kinds in themaking of ideology and argument.

—Comaroff and Comaroff 1992:34

As researchers fated to “work both in and outside the official record,” webring together in this article lines of inquiry that are often kept separate. Weexplore how language ideologies in a context of multilingual diversity bear

on the development of institutional procedures/protocols and interactional rou-tines in a specific field of professional practice, namely, general medicine. Moreparticularly, we examine how language ideologies, which include assumptionsabout language competencies, multilingual repertoires, and their efficiency, informthe situational shaping and activation of actualized repertoires. This shaping and

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Journal of Linguistic Anthropology, Vol. 16, Issue 2, pp. 249–268, ISSN 1055-1360, electronic ISSN 1548-1395.© 2006 by the American Anthropological Association. All rights reserved. Please direct all requests forpermission to photocopy or reproduce article content through the University of California Press’s Rightsand Permissions website, at http://www.ucpressjournals.com/reprintInfo.asp.

■ James CollinsSTATE UNIVERSITY OF NEW YORK, ALBANY

■ Stef SlembrouckGHENT UNIVERSITY

activation result in and from the development of certain literacy practices that areintended as a response to perceived obstacles in oral communication. Our“working theory of the social world” thus also concerns itself with “the role ofinscriptions,” that is, the relationship of literacy practices to ideology and reason-ing. The specific site we report on is a neighborhood health clinic calledWijkgezondheidscentrum Brugse Poort in the most densely populated part of a ring of19th-century houses around the Flemish city of Ghent.1 Although our larger proj-ect engages in a more general linguistic ethnography of multilingual routines, lit-eracy practices, and processes of translation and interpreting in immigrantneighborhoods, our focus in this article is on the planning and implementation ofone specific set of resources: a printed multilingual consultation manual designedto facilitate medical consultation in a context where doctors are faced with gaps inavailable language competencies and frequently report “miscommunication prob-lems.” We analyze one way in which local, institutional communicative economiesadjust to long-term changes and short-term fluctuations in client populations.

Literature in professional discourse studies and in sociolinguistics more generallyshows how medical information schemas and patients’ concerns may diverge(Atkinson 1995; Sarangi and Slembrouck 1996; Tannen and Wallat 1999). What hasreceived less attention, however, is the issue of how perceptions of the communicativerepertoires that patients bring to institutional encounters inform particular measuresand strategies of implementation (e.g., the in-house development of the printed man-ual whose properties and use we are analyzing here) and how these measures, in turn,have shaping effects on interactional routines. The step from development to use ofcommunicative media is not a straightforward one. It invites a range of ethnomethod-ologically informed questions about literacy practices pertaining to the actual circula-tion and distribution of the printed texts, the remedial values attached to their design,and the functional values attached to their use, as well as the transformative impact oftheir use on interaction in real-time participation frameworks. In the case of the con-sultation manual, we ask: After their development, how often were the materials used,and for what purposes? Which value assessments informed the design? How wasinteraction affected by the manual’s insertion into the institutional encounter?

In addition to examining the dynamic interplay of staff perceptions, strategies,and reported routines, we also consider how all are sensitive to processes of scalingthat bear on the institutional and neighborhood space of the health clinic. We use theconcept of scale2 to argue that specific places in which multilingual interactionsdevelop are meaningful in relation to other places. In the case analyzed in this article,sociogeographic scaling is involved in the development of relatively stable assump-tions about the multilingual repertoires of specific national groups, such as “theAlbanians” or “the Turks.” Scale considerations are also implicated in the health cen-ter’s collaborative efforts to grapple with the “immigrant language problem,”because this involves networks of agencies and funding beyond the specific sitebeing examined. Finally, scaling is also implied in the development of the literacyartifact that is our primary focus of attention and that artifact’s subsequent recon-textualizations (Bauman and Briggs 1990; Collins 1996; Mertz 1996). Although the lit-eracy artifact was implemented at a specific site, a health center in the Flemish cityof Ghent, and although it had considerable effects on face-to-face encounters duringmedical consultation, the “finished product” had a distribution beyond the confinesof this site (other organizations subsequently adopted the manual).

We argue that the literacy practices centering on the manual offer a window intothe ways in which professionals routinely grapple with contemporary languagediversity. The presence of immigrants in an urban environment affects immigrants’multilingual repertoires: they find themselves confronted with the task of acquiringthe communicative resources of the autochthonous, “native-born,” population. It alsoaffects the autochthonous population and local and national institutions: they findthemselves confronted with linguistic-communicative processes and resources previ-ously “alien” to their environment. In our ethnographic case, we examine a clinic that

250 Journal of Linguistic Anthropology

has a history of offering “free medicine for the people,” whose self-declared missionprioritizes “outreach” and “multilingual inclusion.” This mission, itself a response tothe challenges of language diversity brought by immigrant populations, has resultedin the development of a specific manual that attempts to distill medical knowledgeand procedure and present them in multiple languages. As we show in some detail,the manual anticipates practices of recontextualization by drawing on practitioners’and language experts’ assumptions about (1) the problems to which the manual isperceived to be responding, as well as assumptions about (2) what matters informa-tionally and interactionally in medical consultation. Assumptions of both kindsinformed the design and development of the manual.

The implementation of the manual turned out to be problematic, revealing furtherassumptions about communication across languages. This has implications for howwe typically think about text, professional reasoning, and encounters with linguisti-cally and culturally distinct interlocutors. We argue that the dynamics of develop-ment and use venture onto the terrain of language ideologies. We see languageideologies as value-laden assumptions about language structure or use and alwaysopen to negotiation and revision. We accept the standard view that language ideolo-gies mediate between large-scale social structure and situated communicative prac-tice (Fairclough 1989; Gee 1996; Schieffelin et al. 1998; Blommaert 1999). In the casestudied here, the mediating process involves forms of communication, professionalreasoning, and kinds of people. Understanding mediation requires that we ask whenand why particular solutions to problems of noncomprehension emerge.

Ethnographic Context

We regard analytically sharpened description as a way of focusing ethnography so asto bring out the particularities of a case while also addressing the general social con-cerns and theoretical issues. In our view, this involves consideration of other sites andsocial scales.3 It also entails a necessary reflexivity, as ethnographers explore the worldwhile also asking how knowledge about the world is constructed. As we will see below,access to sites and their inhabitants is shaped by the very structures and processes thatthe research seeks to investigate (Slembrouck 2004). Ethnography, which requires closedescription and analysis of observations made, conversations had, and representationsencountered, forces us to continually examine categories of analysis as well as general-theoretical claims. As we will demonstrate below, the analytic distinction betweenstatements about language and statements about kinds of person is not always clear-cut, and the line between language ideologies and literacy practices remains unclear.With these issues in mind, let us proceed to a description of our ethnographic site.

Our analysis focuses on a medical clinic serving a multiethnic, multilingual neigh-borhood in the city of Ghent in Flanders. Ghent is a city of some 250 thousand resi-dents, with an economy based on ports and industry, higher education and theuniversity, high-tech services, and tourism. Away from the medieval center of thecity, in a ring of 19th-century neighborhoods linked to a former textile industry andtypically inhabited by working-class families, we find five neighborhoods oftenidentified as “immigrant neighborhoods”: Brugse Poort, Rabot, Muide, Ledeberg,and Dampoort. Brugse Poort is the largest and most densely populated; it presentsan elaborate temporal layering of resident groups. An aging, autochthonous Flemishpopulation of working-class backgrounds and younger, highly educated couples andfamilies attracted by affordable housing live among Turks, an established immigrantpopulation of several generations’ settlement. The population of Turkish descent is theresult of government-organized immigration in the early 1960s; it also includes a con-tinuing stream of newcomers from Turkey. This is the largest national-ethnic minoritygroup in Ghent, as well as in Brugse Poort. There are also Maghrebians, in census fig-ures the second-largest group. They are predominantly from Morocco and arrived laterin this neighborhood. Immigrants from sub-Saharan Africa, especially Ghana,Rwanda, and the Congo, reflect Belgium’s 19th- and 20th-century colonial history; insmall numbers they have been a presence in Brugse Poort for a number of decades.

Language Contact, Institutional Procedure, and Literacy Practice 251

Lastly, people from troubled parts of the Balkans and the former Soviet bloc(Albania, Slovakia, Bulgaria, and Russia) arrived during the 1990s.

Known as a relatively poor neighborhood for several decades, Brugse Poort hasbeen home since 1972 to a Wijkgezondheidscentrum (WGC), a community healthcenter, which takes as its central mission to provide affordable, accessible health careto the ethnically and linguistically diverse populations that now make up theneighborhood.4 Because it aims to serve a diverse local clientele, including the leastprivileged (for example, a just-arrived refugee family), the clinic is aware of languageissues, in particular the challenges posed by and the resources available to respondto multilingualism. Clinic staff are well aware that they provide medical care to peo-ple speaking a wide range of languages and that they must be prepared to interpret,translate, and otherwise accommodate communication across languages. In dealingwith the wide linguistic diversity of its client population, the WGC uses a variety ofstrategies. These include using the multilingual language abilities of its clerical,social work, and medical staff (the lingua francas covered in this way areFlemish/Dutch, English, French, German, and Spanish); expecting that patients willbring interpreters from the neighborhood (this is reported by the staff as the prevail-ing response to the well-established need for Turkish and Arabic/Berber); calling onprofessional translation and interpreting services (especially for languages perceivedas “further afield,” such as Albanian, Slovakian, and Russian); and preparing infor-mation brochures and manuals in different languages. How they organize and eval-uate translation or otherwise accommodate to immigrant language diversity itselfoften depends on professional judgments (see below) as well as on scale judgments,for example, viewing clientele in terms of national (“the Albanians,” “the Turks”) orEuropean regional categories (“immigrants from the former Soviet Union”). It alsodepends on contingent considerations, for example, the need for translation oflanguages from the former Soviet Union was acute during the mid-1990s but subse-quently diminished. In terms of a broader sociolinguistic context, the WGC can itselfbe seen as a nodal point in a wider institutional network of official and semiofficialFlemish responses to multilingualism (involving agencies such as Babel, a nationalphone service for interpreting based in Brussels, and TGV, the city’s own translationand interpreting office in the Department of Ethnic-Cultural Minorities).

Among the language resources in the clinic, the reception staff of three womenspeak among themselves Dutch, French, and English, as well as German andSpanish.5 This repertoire enables them to do much of the registration and schedulingwork of the clinic, and, in some cases, to assist doctors in consultations when trans-lation is necessary. The reception staff have also prepared leaflets in a range of lan-guages explaining registration and billing procedures to prospective clinic members.In the clinic there is also a staff of two social workers who speak “the Big Three ofBelgium”: Dutch, French, and English. They are responsible for community outreachhealth programs, and because of this work as well as their membership in Flemishsocial worker organizations and networks, they are necessarily aware of the issues oflanguage diversity posed by contemporary Belgian households. Lastly, there is amedical staff of 12 people: seven doctors, two nurses, and three physical therapists;all speak Dutch, French, and English with varying degrees of fluency. Clinic staff atWGC are always aware that the in-house linguistic repertoires and resources can beinsufficient for the communicative tasks at hand and that the linguistic diversity ofthe neighborhood, and thus the clientele, changes over time. It was the post-1995influx of immigrants from Eastern Europe that resulted in the development of themultilingual consultation manual that we analyze below. The manual was designedby one of the resident doctors, together with one of the social workers and a doctorfrom an affiliated practice in another neighborhood.

In addition to the languages spoken “in house,” there are various other resourcesthat can be drawn on for grappling with communication across languages. Amongthe resources in Brugse Poort, and Ghent and Flanders more widely, there are time-honored immigrant strategies as well as professional enterprises. First among those


strategies is that of simply bringing someone along with some facility in a contactlanguage. For patients who do not speak one of the languages available in the clinicwell enough, they will often bring an interpreter. This person may be a child or otherfamily member, or someone of the same ethnicity/language who lives in the neigh-borhood, who may or may not be paid by the patient for the help. There are also inGhent, and Flanders more generally, professional translation services. These includeBabel, a service that offers profession-specific translation over the phone, and thereare provincial and urban translation services. These services comprise a network offreelance or self-employed translators and interpreters “on call,” who can provide insitu interpreting or text translations.

Each strategy and service is perceived within WGC as having strengths and pit-falls. Some immigrant groups, such as Turks, are long-settled in Belgium, and theirchildren are (seen by the WGC staff as) quite likely to speak “good Dutch.” Othersmay have access to one or more of the general lingua francas of Belgium, say,Moroccans who know French or Ghanaians who know English. There are others,however, only recently arrived, such as Eastern and Central Europeans in the 1990s,who are in a situation where their children have not yet learned Dutch, and the peo-ple in their networks do not speak one of the lingua francas. In addition, there aremedical considerations that are perceived as affecting the suitability of a particulartype of interpreter. An accompanying translator, whether a child or family member,may be unable to translate certain questions or terms; or it may be a matter for whichthe translator is an inappropriate mediator, given the nature of the medical issue andthe age or gender of the accompanying translator (for example, a child translatinggynecological or gastroenterological problems). Further, a translator typically reliedon may be unavailable. In such circumstances, if the medical and other clinic staff areunable to communicate adequately with the patient, a phone translation may beattempted, which involves putting the interpreter “on loudspeaker.” Although inter-preting over the phone offers the advantages of professionally trained mediatorswho routinely offer services that take less than five minutes to set up, this can be awk-ward given the exigencies of medical consultations, in which much is done nonverbally,through sight, gesture, and touch. If the staff have sufficient time and a clear enoughsense of a likely sequence of clinic events, it is possible to schedule a hired interpreter tobe present, from the city or provincial translation services or from a neighborhood cen-ter. Even then, however, there is the perennial problem with translation, expressed bya social worker at the clinic as “you don’t know what they translate.” As we discussbelow, judgments about the reliability of translators are sometimes tied to ethnicstereotypes.

The situation that confronts us in Brugse Poort and the clinic is that people arehighly aware of issues of language contact, and there is a range of linguistic resourcesavailable for “dealing with multilingual contact,” but this problem of contact is scalebound as well as informed by specific professional-medical considerations, some ofwhich we have hinted at above (such as having children act as interpreters or hav-ing professional interpreters who do not share the visual action space of generalpractitioner and patient).6 The framing of communication issues in terms of spatialscale and institution-specific concerns is found across institutions as well. We haveevidence that service providers in different institutional sites have different perspec-tives on a “language problem” depending on how they view different groups. In sev-eral Ghent schools with high immigrant student populations, teachers were of theopinion that Turks learn Dutch slowly and Moroccans are quick learners (see alsoCreve and Willaert 2003), an observation that is sometimes related to the density ofneighborhood familial networks among the Turks (see Jaspers 2005). From the per-spective of the WGC, however, Turkish children typically speak “good Dutch,”whereas other children, Albanian or Russian, are perceived as lacking the necessarylinguistic knowledge of Dutch for interpreting. In an interview with a child and familywelfare official from the Kind & Gezin agency,7 we were given an account that encom-passed both views: that Turks are an older immigrant group, more likely to have


Belgian-raised adult bilinguals who could serve as mediators, but also a group intowhich there is a steady stream of recent in-migration, of newcomers straight fromTurkey. That is, from within the “nation”-scale category “Turkish” there were new-comers whose schoolchildren would know little Dutch, and settled immigrants whowould have bilingual (or even Dutch-dominant) household members. Similarly,from another scale category, a “region,” the Balkans or the former USSR, presented awave of new immigrants who understood neither the Dutch language nor theBelgian social system. When using other nation-scale categories, however, otherjudgments were given: one of the receptionists expressed doubts about the reliabil-ity of (Balkan) Albanian translators, whereas the center’s social worker opined that(former USSR) Russians are likely to be educated and to learn Dutch quickly.8

We first encountered one way in which scale-bound categories of language differ-ence interact with other institutional framings and procedures when a Brugse Poortreception staff member remarked that patients always want to say more about theirailments and conditions than the doctor needs or wants for the diagnosis. That is, themismatch between layperson and specialist was crosscut by language difference.This remark came up during an initial interview with the reception staff, who com-mented that things can go awry despite the best intentions to provide translations.Responding in the late 1990s to a perceived increase in the demand for Russian,Albanian, and Slovak, the clinic had prepared a multilingual text resource, but withthe unforeseen result that the desire to say more on the part of the patient not onlywent beyond the doctor’s need for information but, indeed, beyond their capacity tounderstand. The irony of intention versus outcome rests on assumptions about wherethe onus of communication falls: on patients who are too verbose, but also, as we willsee, on text artifacts that, put into practice, turn out to be too unwieldy for situatedcommunication. We discuss in the next section what motivated the construction ofthe manual, what its communicative presuppositions were, how it appears to havebeen used, and what unforeseen problems occurred.

IJsbrekers: The Literacy Artifact

In establishing a context for discussing the manual, let us reiterate some of the char-acteristics of the WGC health clinic regarding language use. It is a site characterizedby a range of multilingual clinic–patient dyads, and the center avails itself of a rangeof remedial resources. The salience of specific dyads reveals a history and trajectoryof institutional responses to shifting landscapes of immigrants and internationalrefugees, because salience is linked to the perceived influx of specific populations inthe neighborhood. This is especially the case for a health clinic that maintains a closeworking relationship with the neighborhood refugee center. Multilingual diversity isseen as a constant source of concern and a response that permeates the activities ofall staff involved in the center, though it is not a fixed item on the agenda of weeklymeetings. These concerns/responses are subject to complex temporal trajectories.Over time the attention shifts between different multilingual translation resources,because “solutions” deemed better at one specific point in time often seem less work-able later for reasons that may be organizational (e.g., changes that affect ease ofaccess) or population specific.

The name of the translation manual project, IJsbrekers, alludes to “breaking the ice,”a metaphor for successful communication; it is also the Dutch word for an icebreaker,with connotations of clearing serious obstacles. As the subtitle on the front pageexplains, it was developed as “een methodiek ter ondersteuning van de huisarts bijhet werken met vluchtelingen” [‘a methodology in support of the general practitionerwhen working with refugees’]. The initiative was taken locally at WGC, and the devel-opment of the manual counts as an instance of language planning “from below,” withbottom-up resourcing of institutional networks: additional funding was sought fromthe provincial authorities, where the Department of Ethnic-cultural Minoritiesprovided financial resources, organized the translation work in house, and now also



Figure 1Sample page from IJsbrekers, titled “Maagpijn” (“Stomach Pain”).

distributes the manual. The manual itself is designed around a hierarchically organ-ized flowchart model of medical consultation (this was the input of the two GPs). Itstarts with a page of general orientation questions. These allow the medic to chooseamong color-coded thematic chapters (e.g., fever, pain, coughing, vomiting, dizziness,etc.). Each chapter consists of a maximum of two pages, which contain key utterances(questions, phrases, instructions, etc.) and cross-references to other chapters.

The instructions in the preface describe the manual as steering a middle coursebetween nonverbal communication and the use of an interpreter. All text is presentedsimultaneously in Dutch and three other languages: Russian, Albanian, and Slovakian.An identical set of pages is developed for each language. The chapter on “stomachpain” (in Dutch and Albanian) is reproduced in Figure 1 by way of example.

Using this text, the GP can point to an utterance in Dutch (printed in bold).Patients are expected to read the same utterance in their language, as printedimmediately underneath. They can respond nonverbally to questions when they canor rely on finger-pointing by using the “general” page (see below). To facilitate find-ing one’s way around the manual, the amount of text has been kept to a minimum(for instance, requests that can be accomplished nonverbally, say, could you take adeep breath, have been excluded). The instructions add that the manual should notreplace the use of an interpreter but, rather, should be used in situations where aninterpreter is either not available or not desired. The manual’s flowchart design, withits internal cross-references among the chapters, is intended to ensure that thepatient’s complaints form the point of departure of the doctor–patient interview. Theselection of chapters is oriented to the most commonly occurring complaints (painand fever) and the most critical diagnoses (cardiac and pulmonary problems). Eachchapter ends with a section on “diagnosis.” There are two additional “general” chap-ters: a chapter titled “General” with key time, calendar, and number terminology aswell as administrative questions (e.g., “What is your address?”) and a chapter thatprovides translation materials for “what to do next” (medication, follow-up appoint-ments, referrals, and the need to involve an interpreter).

As mentioned earlier, the manual was developed in the late 1990s and reflects a“scaled” perception of language challenges: Albanian is linked to the presence ofrefugees from the war in Kosovo, Russian is discussed in a context of mostly eco-nomic refugees from the former USSR, and the need for Slovak is linked to the pres-ence of Roma gypsies in the neighborhood. From the interview with the socialworker, we also learned that the manual was developed in response to the percep-tion of problems in the use of other multilingual resources, some of which we havealready touched on above. Situations where relatives or others in the neighborhoodact as interpreters can pose problems, because of the sensitivities involved in talkingabout a medical condition, because their reliability can be questioned, and becausechild interpreters may not have developed the kind of interactional and cognitiveawareness needed to talk about bodies and the medical conditions that may afflictthem. There was also talk of cases where paid interpreters organized by local opera-tors take advantage of new arrivals in the neighborhood. Additionally, unlike theprofessional interpreters provided by the city, symptoms and medical conditions donot come “by appointment.” Instead, a patient arrives, with or without a translator.A later focus group–like session with four of WGC’s general practitioners confirmedthe picture of a definite perception that communication “broke down” in the mid-1990s. Previously, not many Turks had been visiting the WGC. Speakers of otherlanguages who visited the center were mostly English-speaking Ghanaians andFrench-speaking Maghrebians (but generally not many anderstaligen were beingserved in the early 1990s). Then, in the mid-1990s, with the arrival of Croats andAlbanians, experiences of “difficult” communication peaked. This is the context outof which IJsbrekers developed.

At one time, IJsbrekers was thought of as the solution to the problem of languagebarriers (as one social worker put it, they saw the manual as het ei van Columbus).9 In2004, the manual was still present in each of the WGC’s consultation rooms, butsome of the enthusiasm had clearly waned. The manual had not been extended toother languages or other medical categories; nor had its design, despite stated inten-tions in this direction, been refined further in response to use. This was the case fora number of reasons, some of which were organizational.10 Other reasons had to dowith perceived problems of use. The feedback we received from various actors in thecenter regarding problems experienced in its use highlight specific dimensions andaspects of the multilingual experience in medical encounters. In the next two sec-tions, we will discuss what we learned from successive field encounters about thedesign/use of the manual and its uptake and insertion into daily medical practice.Our analysis will focus on a particular one-sidedness in the provision of the transla-tions and on the highly specific coordinated activities and participation frameworks


(specific to time, place, and field) on which the manual’s use depends. After that, wewill address some of the scalar dimensions that underpin the manual’s developmentand use and attend to how it functions in a communicative economy that is perme-ated by perceptions of noncomprehension and “problematic people.” We will developour analysis, in part, by engaging in a comparison with another site and institution.

The Artifact in Use

We first learned about the manual during our first interview at the center. It wascommented on by one of the receptionists in an illustrative anecdote that character-izes the manual as a self-defeating instrument. The anecdote is part of a negativeresponse to the question of whether multilingualism is an issue discussed actively atteam meetings; as such, it drew attention to how language differences are indeed aconcern of center-initiated remedial work, yet often with unintended consequences:11

The problem is when they chose, when they [the doctors] pick out a question, er, “Hoe zeg jeer? Do you have stomach pains?” then the people start to explain in Slovenian [laughterfrom all at the table] their whole situation; but the doctor only asked one question [for thepatient] to say yes or a no, but they give their whole explanation, so actually it doesn’t help.

Rather than getting patients to provide a minimal but unambiguous answer to a veryspecific question, the use of the manual ironically leads in some cases to the produc-tion of more talk in the “foreign language.”

Toward the end of the interview we were given a copy of the manual to take awayand study in detail. The manual became one of the main topics in our subsequentinterview with the social worker who had helped produce it. We began to ask herabout the difficulties experienced in its use. In her responses, the social worker listedthe use of a lingua franca, the use of relatives-translators, and more direct, nonver-bal means of communication as superior resources. In addition, she also referred totime management as a major concern and a reason for the manual’s decreasing pop-ularity. She suggested that the WGC is an extremely busy medical practice and thatusing the manual involves too much browsing and “searching for the right page.”

Many of these points were reiterated or elaborated in an informal interview with asenior GP at the clinic. The GP suggested that child or neighborhood interpreters arefelt to be unreliable and that patients and doctors experience miscommunication as aresult of their involvement in the consultation; in contrast, professional interpretersoffer definite advantages in this respect but are called in only in cases judged medically“serious.” He noted, finally, that medical staff feel that they can get a lot of communi-cation done through nonverbal channels. His specific comments concerning uses ofIJsbrekers were that he had used the manual infrequently, partly because he was onlypart-time at the center. When he did make use of the instrument, he used it asintended, reporting that it facilitates the formulation of an initiating utterance but thatinterpreting the response is more difficult. Additionally, IJsbrekers did not seem to bewell suited to open the consultation with a “patient track” (a point we develop below).

The second GP interviewed, a younger doctor who had been at the center for acouple of years and who had worked with refugees a lot, reported that the manualhas not turned out to be as useful as he expected. Rather than integrate it into hisconsultation practice, he uses the manual only when the situation calls for it, that is,not necessarily at the beginning of the consultation but often only for a specificpart—and sometimes merely as a bilingual dictionary in support of a specific ques-tion or a piece of advice he wishes to communicate.

On closer inspection, the development of a set of written translations turns out tobe a form of problem solving that largely takes the pressure away from profession-als to expand their own repertoires: the manual offers translations on behalf of themedic. One way to look at the manual is to see the copresent lines as representingparticipant roles in a dyad. The doctor reads the text in Dutch to be able to “finger-point” to a question, an instruction, or a piece of treatment advice in Albanian.


And, although the question of “patient illiteracy” was also raised by some WGCstaff, only the senior GP raised potential difficulties related to, for instance, whetherdoctors correctly interpret patients’ responses to finger-pointed items. In contrast,the health prevention worker steered us away from the assumption that doctorswould be expected to try to actually read any of these translations aloud. Doctors arenot expected to develop competencies in Albanian, an observation that echoes theanecdote cited at the beginning of this section: the self-defeating effects of the manualare attributed entirely to the patient’s response to its presence and use. The trainee doc-tors’ observations during a seminar session on the manual add to this analysis: they werequick to point out that the manual is restricted to “[initiating] firsts in Dutch, which areaccompanied by translations in the patient language.” There is no corresponding setwith “[response] seconds in the other language with translations into Dutch.”

The detail about finger-pointing is important. It serves as a reminder that the suc-cessful use of the manual depends on highly coordinated interactive activity.Although the simultaneous presence of text in two languages is taken to represent aninstrument shared between patient and doctor with insufficiently overlapping reper-toires, the successful use of the manual depends on delicate decision making andcareful staging, which, moreover require a considerable amount of subsequent inter-active work. This indicates that the relative success of the instrument is not exclu-sively, or even primarily, related to the qualities and design of the verbal material(e.g., the quality of the textually expressed translations and the success of the flow-chart design in matching and directing real interactional expectations about consul-tation activity). Communicative adequacy is certainly just as much a matter of whatthe manual does to the interaction, whether the introduction of a printed repertoireof dovetailed stretches of text facilitates communication or leads to “further compli-cations.” The process begins with a decision to turn to the manual. Does one turn toit at the beginning of a consultation, on the basis of language information obtainedfrom the patient’s record, or does one wait until signs of less-than-smooth commu-nication occur during a consultation?

Once opened, the sections in the manual need to be scanned by the doctor for theappropriate page. The manual is a big ring binder with pages inserted in plasticcovers (see Figure 2). Before getting to the appropriate page, the GP may have to skip


Figure 2The IJsbrekers manual.

large sections in such a way that the pages do not come off the rings. There are alsothe effects of loss of eye contact during such searches.

In addition, there are the interactional dynamics brought about at the level of themedical questions/instructions presented to the patient. The preferred second partor reply to a GP finger-pointing a question in Albanian is a minimal but clearly iden-tifiable response (e.g., nodding in response to, “D: Heb je dunne stoelgang? P: A tëshkon barku?”[Have you had a bowel movement?]). Responses can range from nod-ding, to verbal or other signs of not being able to understand, to short utterances thatprovide a qualification, to responses that are the beginning of an elaborate account.Each of these needs to be managed in some sort of way, and though the manual doesgive instructions about use (see above), it does not contain bilingual sections thatexplain this to the patient (in short, the manual does not tell doctors how to commu-nicate to their patients that they are expected to nod or shake their head in response).

In the case of the example recounted by the receptionist, about a patient respond-ing at length in Slovenian, the actual second may be a stretch of talk in the foreignlanguage that is difficult to understand because the patient mistakes the doctor’spointing to a sentence in his or her language for a sign that indexes the presence ofspecific oral competencies in the health clinic. Roberts, Sarangi, and Moss (2004)point to the combination of reporting symptoms, an account of the context in whichthey occur, and a particular affective or epistemic stance as a regular feature of theway in which patients present a medical condition (e.g., a patient will add that shefirst wanted to wait and see how the symptoms developed, but as they got worseovernight she came to see the doctor immediately the next day). The production ofthe manual seems to have come with a suspension of such expectations, as wasindeed also noted by the senior GP: A consultation should open with what he calleda “patient track,” that is, a response to, “Why do you come to see me?” IJsbrekersinhibits this phase. Additionally, the GP reported that while the manual helps phras-ing on the doctors’ end, responses from patients could be unpredictable. As Goffman(1981a) shows, much can come between a “first” and its “second.”12 Participantsmay, for instance, retreat into metatalk or metagesture because the protocols of theinstrument remain unclear to them.

To the extent that the development and design of the manual were based onassumptions that communication problems can be channeled and contained bydeveloping a restricted set of glossaries, oriented to a bare minimal sequence ofessential interactional moves but designed on the model of bilingual dictionaries, thereported practices of inserting the manual into medical consultation sequences giveus a different picture. The manual now appears as a factor in the medical interactionthat may be difficult to control, as an instrument whose efficiency depends on inter-actional dynamics that demand a great deal of effort on the part of the interactantsin terms of how the use of the instrument is staged, framed, and kept within man-ageable bounds. The manual may originally have been designed as a written substi-tute for a sequentially organized oral activity, but it ends up bringing about a changein “footing” (Goffman 1981b) that poses additional challenges at the level of partici-pation frameworks. Not unimportantly, much may depend on whether patients and,to a lesser extent, doctors are prepared to yield their “authorial” status to the man-ual, with their speakerhood restricted to the role of a “mouthpiece” who acts out apreprinted script.

A last question we ask of this multilingual resource is to what extent IJsbrekers isspecifically medical. In addition to the schematic knowledge about steps taken in amedical consultation procedure that informs the basic design of the manual, the pref-erence for direct nonverbal communication echoes how doctors see themselves asdealing with bodies (medical encounters involve a great deal of visual and auditorysemiotics—listening to coughs, observing moving arms, noting where patients indi-cate pain, etc.). However, if we compare IJsbrekers with multilingual print resourcesfrom another institution, Kind & Gezin, a number of differences become apparent. Ifin the case of the WGC, the multilingual manual is the professional’s instrument for


frontline health care (he or she is the primary user), in Kind & Gezin the mission ofthe nurses is to assist new parents in coping with parenting, and its multilingualstickers and brochures play a different role in a different time sequence. If theIJsbrekers questions on stomach problems (see Figure 1) are intended for the exigen-cies of real-time consultation procedures, Kind & Gezin’s bilingual instructions (on,say, how to make a fruit mash) are resources to be consulted by parents on their ownafter their contact with nurses (and possibly with one text explaining or facilitatinginterpretation of the other). The point we wish to stress is that, despite obvious for-mal similarities (copresence of translated and “original” text), field-specific differ-ences in professional orientation go together with considerable differences as towhen and how the translated text enters into the interactional space and whobecomes its primary user. Correspondingly, and not unsurprisingly, we see that theKind & Gezin coordinator reported that clients have given feedback on “poor trans-lations,” whereas feedback of this kind was not mentioned in the interviews we hadwith the WGC staff about IJsbrekers. That is to say, the texts are used and evaluated—or not—in different participation and temporal frameworks. There is no a priori wayto “fix” the use of a literacy instrument (Collins and Blot 2003) because formally sim-ilar materials are contextualized in different institutional practices. As we discussnext, issues of scale and language perception are relevant to the production and useof different written materials.

Scaling and Comparison of Literacy and Translation PracticesAcross Institutions—WGC and Kind & Gezin

A comparison between the two sites, doctoring and nursing, has also been useful inour exploration of some dimensions of scaling. For us, “scaling” means that theworld can be interpreted as organized in nested spatial and temporal hierarchies. Aswe argue elsewhere (Blommaert, Collins, and Slembrouck 2005), scaling is also a con-cept that helps us to throw light on the connections between policies, organizationalroutines, and face-to-face communicative demands in multilingual encounters andpractices. We will discuss two aspects: scaling as a dimension of the size of the insti-tution and the way it is organizationally networked, and scaling at the level whereparticular languages are allocated to particular resources. The two, we will argue, areinterconnected.

Let us begin with a set of parallels concerning the allocation of particular lan-guages/populations to particular resources in view of time in the country and sizeof the populations served. First, English, Flemish, and French are seen as resourcesto be embodied in the professional staff, appropriate to Flanders and Belgium giventheir international orientation. Second, Turkish and Arabic surface from our researchas the languages of “internally provided” interpreting; their usage is perceived asoccurring within easy reach of established immigrant populations. In the case of theWGC, the interpreters are family or neighborhood-based bilinguals. In the case ofKind & Gezin, they are intercultural interpreters who are employed by the organi-zation (the first were recruited in 1992). A third group of languages comprisesAlbanian, Slovak, and Russian. For these languages interpreting is provided either inthe form of translated, printed resources or in the form of “external” resources pro-vided by other service organizations (such as the translation departments of the city,the provincial authorities, and the phone translation service Babel). This languagehierarchy, which seems to be very similar in both institutions, reflects a scale of prox-imity and salience: from “part of professional linguistic capacities,” to “employed orhome-provided interpreters,” to “contractual interpreters”; from “oral” to “written”;and from “very strongly established,” to “recently established,” to “corresponding toshort-term needs of immigrants and minorities.”

At the same time, there are considerable differences between Kind & Gezin’s andWGC’s provisions for translation, which are related to Kind & Gezin being a larger-scale, nationally and regionally networked organization equipped with a level of


technical, financial, and human resources that far exceeds that of the local healthclinic. For instance, within WGC an “interpreter within easy reach” means “bringyour child/a neighbor/a friend”; in the case of Kind & Gezin it can also mean “wesend one of our own employed interpreters along.” This difference also results indivergent processes of (re)scaling in the provision of multilingual resources. Forinstance, the translated brochures produced by Kind & Gezin tend to be developedin response to locally experienced needs that have been reported regionally; they areproduced through regional centers but distributed nationally. The distribution hap-pens in top-down fashion to all centers across Flanders through the organization’sown computer intranet. Not surprisingly, Kind & Gezin’s range of translated printmaterials is vast, extending into Turkish and Arabic. It also includes audiovisualmaterials in languages other than Dutch imported from sister organizations in theNetherlands.

Scale, in this comparison of institutional sites, also extends to a distinctionbetween professionally printed materials and materials printed “on demand”using a PC. Quite interestingly, this is a dimension of practice where organizationalroutine and official language policy intersect. This intersection is revealed in a levelof decision making that is absent from WGC’s small-scale response to the chal-lenges posed by local multilingualism. The translated brochures of Kind & Gezinare accessed through the laptop computers that accompany the nurses during theirwork. Each morning the nurses upload yesterday’s client files on the intranet-provided database. Next, they download today’s client files. All administrativeaspects of the job are thus handled through the PC. This dimension of institutionalpractice reflects another role of Kind & Gezin: It is a major provider of statisticalinformation about families (e.g., statistics on growth relative to age, statistics aboutinoculations, etc.). Using computers to make all translations printable on demandmeans that one does not have to walk the neighborhood with a bulky bag ofprinted brochures in seven or eight languages. In addition, as the coordinator forEast Flanders intimated to us, one should not forget that Kind & Gezin is an offi-cial institution administered by the Flemish government. The organization is quiteaware that its official working language is Dutch and Dutch only. Printing theglossy brochures in other languages would be an expense and a noticeable one. Theuse of computer-produced printouts “on demand” is a practical solution to multi-lingual realities in the context of an official monolingual language ideology—itcounts as a face-saving “off-the-record” practice that also indicates that the organi-zation’s budgets are spent responsibly. In Kind & Gezin’s translation practices,technological efficiency, practical convenience, budgetary control, and statutoryrequirements converge in durable ad hoc procedures.

Ideologies of Person and Language: “They Would Nod Their Head,but They Would Not Understand”

A comparison between the sites of doctoring and nursing also underlines how state-ments about problems of interlingual communication often blend with commentsabout problematic populations. Situations of nonelite multilingual contact are oftensaturated with indexes of noncomprehension. People may be highly tolerant of thisin certain circumstances (refugee camps and transitional immigrant neighborhoodscome to mind) as they work with limited shared-language repertoires, gesture, andavailable contextual signs in order to accomplish service encounters and other briefinteractions. Things appear differently, however, when we ask how institutionsgrapple with difficulties in communication. A notable feature of our researchencounters with members of Flemish social and medical services for immigrants hasbeen the expression of unease with translation and communication. Thus at theWGC, reception staff peppered their discussion of the strategies for dealing withmultilingual clienteles with statements about the unreliability of certain kinds oftranslators. In the context of explaining why doctors prefer having a written manual


to dealing with translators in consultations, a social worker made the statement thatforms part of our title: “You don’t know what they translate.” We also haveethnographic evidence from other sources that school-based social workers, who arepart of their institutions’ outreach efforts to families, prefer to work through sharedlanguages, however minimal, and not use translators. In our interview with the Kind& Gezin translation coordinator, she began our exchange with a general-purposestatement raising the specter of misunderstanding, of flawed communication: “Theywould nod their head [‘yes,’] but they would not understand.” In this case, uneaseabout feigned understanding provides a rationale for translations about which onecould be sure of “what they said”—that is, written translations. Put most generally,recurrent references to uncertainty about comprehension (not) having taken placehave been a primary factor in framing explanations for why certain initiatives wereundertaken and written resources were developed.

As a general concern, unease about lack of comprehension is found in many fieldsof human activity, and there are many ways of trying to secure communication.Professions are known for their specialized languages: Engineers and architects pro-vide designs with numerically rendered specifications; lawyers use a specialized lex-icon, extended paraphrase, and extensive syntactic parallelism. Doctors, for theirpart, must work through dyadic exchanges with patients, and hence doctor–patientcommunication has a status as a problem and research arena that, say, lawyer–clientcommunication does not. Social workers, in turn, belong to a profession that relieson establishing rapport with their (generally socially subordinate) client populationin order to transmit and receive information from these clients, so it is perhaps quiteunderstandable that they should report unease with mediators and the quality ofcommunication in multilingual encounters.

It is worth noting, however, that in both WGC and Kind & Gezin we found state-ments made in which problems of interlingual communication blended with com-ments about problematic populations. In our conversations with reception staff atthe WGC, for instance, the most unreliable translators were said to be the Albanians.No precise instances of mistranslation were cited. Instead the staff reported theirview that Albanian translators do not seem to know well the clients on whose behalfthey translate and, further, that they—the Albanians—are likely to be “gangsters.”13

When we asked our Kind & Gezin interviewee about bilingual nurses—as one ofseveral agency strategies for dealing with multilingual encounters during homenurse visits—she said that families prefer bilingual nurses above other mediators orwritten materials but that there were only two such nurses—one “Turkish” and one“Moroccan”—in the larger eastern Flemish region. She attributed their scarcity toproblems of recruiting qualified persons.14 In addition, she stressed that these nurseswere professionally socialized (or disciplined): “In order to prove they are goodnurses,” the bilingual nurses were first assigned to work with Flemish-speakingfamilies in health centers serving Flemish-majority communities. We were not toldwhy working first in a Flemish community would “prove they are good nurses,” butone can hazard a guess that it signified that they placed professional allegiance overethnic identification. Our interviewee also commented favorably that the two bilin-gual nurses were “very well integrated.” That is, they were good, unremarkableBelgians, not “standing apart.” She then wondered aloud whether Belgian/autochtho-nous families would accept a Kind & Gezin nurse “in a chador” (drawing a picturearound her own face with her hand). She followed this with two comments: that theuse of the chador is on the increase,15 and that, in a local Kind & Gezin consultationcenter in the Kiekenstraat (Brugse Poort, Ghent), some Flemish families refused to goto the center because the “waiting room was full of allochthones.”

The general point that we wish to draw from these examples is that concern withcommunication, with language that may or may not be understood or faithfullytranslated, shades over into judgments about kinds of persons. Fear or distrust ofthose who will not answer reliably, whose communication may somehow be hiddenor not transparent, is common enough in situations of sharply unequal power and


resources. Under patriarchal regimes there is often a masculine concern with femi-nine “wiles” and “gossip” (Crain 1991). In the case discussed in this article, however,we are dealing with concerns about language difference and flawed communicationthat are tied to concerns about particular kinds of persons, kinds of buitenlanders(foreigners), outsiders now on the inside (Haviland [2003] and Urciuoli [1996] pro-vide cases from both U.S. coasts in which anglophone fear of Spanish moves quicklyfrom language use to person and back again). We cannot, of course, simply dismissthe professional concerns of doctors with understanding what patients say, or con-versely of patients with understanding what doctors ask or say to them, but what wenote is that translation “problems” get contextualized in specific ways, and certaincategories of immigrants are the cited examples of “what can go wrong.”

Conclusions

The immediately preceding section underlines how language ideologies are centralto the argumentation that we develop in this article. As noted in our introduction, wesee language ideologies as value-laden assumptions about language structure or usethat mediate between large-scale social structures and situated communicative practice.In the case studied here, the mediating process involves forms of communication,professional reasoning, and kinds of people. Understanding mediation requires thatwe ask why and when particular solutions to problems of noncomprehensionemerge. Our major findings regarding language ideologies in this case study can bestated as follows:

(1) professional authority in the context of “care” is best achieved through direct, unmedi-ated, face-to-face communication; and

(2) when communication problems emerge within this matrix, they are best handledthrough recourse to literacy.

Regarding (1), we find that in both medical and social work encounters, preferenceis for face-to-face communication, with initiative and assessment vested in the pro-fessional expert and with assumptions of perfect or near-perfect understanding inplace. This allows for professional autonomy and judgment, for in-theory control ofthe communicative encounter. Translators and other intermediaries are viewed asbest avoided when possible. In situations where language diversity exceeds the lin-guistic repertoires of professional staff, communication problems inevitably emerge.How they are perceived and dealt with involves a cline of spatiotemporal proximityand a range of communicative resources, and these in turn implicate both a sense oftrustworthiness and a scope for checking. As we have seen, translation needs are com-mon in WGC medical consultations and Kind & Gezin home nurse visits. However,the reliability of translation is often confounded with judgments about kinds of per-son, and we see in this case how language ideologies are also social ideologies, andvice versa: problematic people are associated with problematic translation.

Regarding (2), we find that communication problems in multilingual professionalencounters, paradigmatically perceived as translation problems, result in a prefer-ence for using written materials as resources. In the cases above, written materialsfulfill many purposes. They allow the institutional actors (WGC and Kind & Gezin)to fix information in bilingual formats and appear to control interaction exchanges(see the discussion of finger-pointing above). In addition, written materials appear tobe easy to decontextualize and recontextualize, that is, to insert in multiple contexts.They appear adaptable to use in diverse contexts—the IJsbrekers manual was alsoacquired by the Brugse Poort refugee center and by Doctors without Borders. Lastly,written materials provide immediate, tangible evidence that an institution isresponding to language needs (as is discussed below).

Our concern with literacy practices led us to investigate how materials areproduced, distributed, and used (Barton and Hamilton 1998; Collins and Blot 2003;


Street 1984). What we find, not surprisingly, is that exigencies of use frequentlyundermine intentions. Simply put, in the case of IJsbrekers, the manual iscumbersome to use. It can impede as well as enable intersubjective understanding.For example, the senior GP at the clinic reported that although the manual may helphim to communicate—in Slovak, say, to a patient who suffers from migraines—itgives him no way to check what the patient might understand by “migraine” andhow symptoms might be tied to social conditions such as stress. The ideology ofunmediated communication competes with and undermines the ideal of a literacysolution to the problem of language difference.

This article can be situated at the interstices of new literacy studies, professionaldiscourse studies, translation studies, and interactional sociolinguistic inquiry. In thecase above we see that an inquiry into professional reasoning inevitably requiredattention to questions of language difference, which in turn led us to the study oftranslation practices, involving multiscale networks of translation resources, bothface-to-face interpreting and written translation. As argued earlier, we feel stronglythat this kind of complexity of themes and issues is best addressed through linguis-tic ethnography. It comes with a need for case-driven dialogues with other forms ofsocial analysis. The situation or site is never an isolate, and we have tried to analyzeinterconnections by attending to space and scale.

We also view the practice of (linguistic) ethnography as always needing a reflex-ive awareness about the production of knowledge. In our case, power-laden ideolo-gies of language insinuated themselves not only into translation materials andjudgments about the communicative trustworthiness of linguistic others but alsointo the very materials through which “accountability for language” was providedto us as researchers. We note here a contrast between the gradual marginalization ofthe consultation manual within actual consultation practices and its salience in ourseries of research encounters. It seems that literacy practices quickly come to mind toinstitutional representatives when they are approached by researchers in interviewsabout their responses to diversity in multilingual contact. The researchers did notknow about the manual’s existence when they first approached the WGC for aninterview with the receptionists; it was brought to the interview encounter as some-thing that the institution could display as tangible evidence of actual efforts taken todeal with multilingual diversity. One can infer a similar framing of the encounter asthe reason for the display of an affluence of printed materials in the Kind & Gezinoffice during our interview with the organization’s translation coordinator. Here, theinterviewee not only offered us seats around the PC monitor, with translatedbrochures at just a mouse click away (any of them could be printed for us to take),she also punctuated the on-record part of the interview with items of display: mov-ing about, sitting down and getting up again, and showing, one after the other, arange of brochures and information booklets obtained from a cupboard.16

It is also worth noting that gaining access to the doctors for an interview was themore difficult part of our researcher efforts in the health clinic; similarly, the Kind &Gezin translation coordinator did not herself raise the topic of bilingual nurses.Institutions channel research queries in the direction of those spaces of interaction thatare routinely designed to include encounters with outsider-visitors (e.g., an interviewwith Kind & Gezin’s translation coordinator is easier to get than permission toobserve nurses during home visits). At the same time, the push is toward documentedevidence, which can be passed on in the absence of its users as textual artifacts thatreplace and stand for practice. The further implication is that textual production is notjust ideologically productive through the meanings expressed in it but also throughthe very fact that a text is being produced in response to a particular contextual read-ing of problematic communication and that a text of a particular kind is beingdesigned and distributed through an institutional arena and thus becomes dis-playable as a tangible and portable token of responsible and responsive practice.

There is a double challenge in this for ethnographic inquiry: how to approach tex-tual artifacts and how to grapple with the complex, many-sided realities that are all


too easily obscured by the “official record” of established institutions. As suggested inthe epigraph to this article, the task is indeed rather like that of the anthropologicalhistorian or historical ethnographer who has to “work both in and outside the officialrecord, both with and beyond the guardians of memory in the societies we study”(Comaroff and Comaroff 1992:34). Our goal has been to embrace the tangible artifactthrough the analysis of literacy practices while resisting the lure of “just the artifact”by remaining alert to the play of language ideologies and social categorizations.

Notes

1. The fieldwork for the research reported here was conducted with the support of a visit-ing researcher grant. It was conducted in May–June 2003 and continued in the spring of 2004within the framework of a joint research fellowship at the Royal Flemish Academy of Belgiumfor Science and the Arts (Koninklijke Vlaamse Academie van België voor Wetenschappen enKunsten, Brussels). Some follow-up interviewing took place in late 2004. We are grateful to theacademy and Ghent University Research Council for providing us with the opportunity andwork space to undertake this collaborative research. We are even more thankful to the variousstaff at the Wijkgezondheidscentrum Brugse Poort and the Ghent office of Kind & Gezin, whogave generously of time, materials, and information. Thanks also go to TGV staff, Raïssa DeKeyzer, and Babel for key conversations on professional experiences of community/medicalinterpreting in the Ghent area. Thanks are also due to the University at Albany (especially thedepartments of Anthropology and Reading) and Ghent University (English Department) formaking it possible for the authors to take a research leave in order to undertake the work inthe winter and spring of 2004. We also point out that this article is fully collaborative: Theorder of authors’ names solely reflects alphabetical precedence.

2. We have discussed the concept of “scale” elsewhere (Blommaert, Collins and Slembrouck2005: 204). Our discussion shares affinities with Irvine and Gal’s (2000) concept of “fractalrecursivity,” in that we see scale-sensitive ideological reasoning as involving center–peripheryjudgments that operate across multiple levels.

3. Our larger research project is concerned with multilingual routines across a number of“globalized” urban neighborhood sites in Belgium (medical centers, schools, churches, shops,etc.). Our project approximates Marcus’s discussion of multilocale ethnographies of a “systemor a major social drama encompassed by it” (1986:172).

4. Our field account is based on joint interviews with the three receptionists, an interviewwith the social worker involved in the development of the multilingual consultation manual,two informal interviews with individual GPs, and a focus group–like session at the end of oneof the health center’s weekly coordination meetings. The Kind & Gezin part involved anextensive encounter with the regional language/translation coordinator in the central provin-cial offices for East Flanders. In addition, some observations derive from Slembrouck’s shortinterviews (late 2004) with professional interpreters and Babel’s coordinator (early 2005).Finally, some additional insights about the consultation manual were arrived at in a seminarsession with senior medical students as part of a course module on language contact andmultilingual provisions in general practice (early 2005).

5. Reference to the “Big Three: Dutch, French, and English” reflects an outsider’s perspec-tive. As a short-term visitor to Belgium, it was clear to Collins that the communicative econ-omy of services in Flemish cities and smaller towns, as well as much of the press offerings andother media, gives priority to French, Flemish, and English (see also the Bulletin 2004).However, Belgium has three officially recognized languages: Flemish, French, and German.The German community is administratively embedded in the French-speaking community(communauté/Gemeenschap) of Wallonia.

6. Note that although phone interpreters exclusively rely on and respond to what they hearover the phone, professional interpreters on site in the consultation room are equally requiredduring the physical examination part of the consultation to sit with their back to doctor andpatient.

7. Kind & Gezin (‘Child and Family’) is the Flemish government’s postnatal child and familyservice.

8. We know little, at this point, about how immigrants perceive the question of languagecontact. We do have initial ethnographic evidence suggesting that immigrants in our sampleexpress strong desires that their children learn the national or regional language(s) and bragabout their proficiency when they have done so. As is also typical of immigrant situations,when children learn the national language and have the wide social contacts that both their


linguistic repertoires and their social activities enable, they upset the traditional authority ofhome, where parents often lack the national or lingua franca languages. Unsurprisingly, thesame adults can express pride in their children excelling in the host language, Dutch, and dis-pleasure at their relative lack of facility in their “own” language.

9. Het ei van Columbus means, literally, “the egg of Columbus” or, idiomatically, “the great-est thing since sliced bread.”

10. In 2001, the practice adopted a system of “registered patients.” The motivation for thiswas one of financial solidarity. The change also affected the constitution of the center’s patientpopulation. It has now become less susceptible to the short-term comings and goings of pop-ulations in the neighborhood. “Fixed registration” means that patients no longer pay for indi-vidual consultations; instead, the practice receives a fixed amount per year per registeredpatient. There is an upper limit (at the moment this is about 4,000 patients). In response to aperceived split in patient constituencies, the intake of new allochthonous/autochthonouspatients is now monitored proportionally. WGC believes that it is important to serve both pop-ulations, and it feels it can only do so well if its resources are not constantly stretched. In prac-tice, this means there is a waiting list, with a monthly intake of about 20 new patients.

11. The interview had been cleared during the weekly coordination meeting. From the cen-ter’s point of view, the IJsbreker project was their contribution to the list of topics for the inter-view, as they were also looking for feedback from professional linguists with an active interestin multilingualism.

12. This issue is the subject of Goffman’s essay “Replies and Responses” (1981a), where hecalls into question the assumption that interaction is organized into predictable sequences.

13. The assumption here is that Albanians in Belgium might be more associated with blackmarket or other illicit activities than, say, autochthonous Flemish. This state of affairs is plau-sible given their place in the Belgian social structure as recently arrived refugees with little orno access to legitimate employment. As Lee (1995) observes in his novel about KoreanAmericans, immigrants often most exploit what they can: themselves and other immigrants.Immigrants facing “ethnicization” in host countries often work “clannish” networks of soli-darity, political and economic entrepreneurship, and crime. Witness the Irish, Jews, andItalians in 19th- and 20th-century United States.

14. Few immigrant girls from these backgrounds get to the higher tiers of education that arenecessary for becoming a fully accredited A1 nurse.

15. The increase in the use of the chador was much discussed in the media in spring 2004because of a French law forbidding students to wear it in public schools and, shortly after that,similar plans unfolding in Belgium.

16. Three further points can be made in connection with the foregrounding of printed mate-rials. One is that textual materials, especially when produced in multiple copies, are tangibleartifacts that can easily be taken from the rooms of health and social welfare practices to thecorridors of the academy. In fact, it is conceivable that a researcher might walk away from theWGC, text in hand, with the optimistic feeling of having obtained the most important bit oflinguistic data for subsequent use, with the research that follows solely focused on an analy-sis of the quality of the translated texts and, correspondingly, with questions of communica-tive practice being reduced to translational adequacy (cf. McElhinny 2003:851 on textualistconcerns in discourse analysis; see Haviland 2003 on ideologies of translation). A second pointis that textual materials—often in the form of brochures and booklets—are typically itemstaken away from first encounters when clients find out more about an institution. Researchprocesses are indeed caught up in institutional service routines, communicative regimes ofleafleting within which clients and researchers alike symbolically carry the institution to a“home” context of textual consumption, where information can be accessed further at will.This observation is just one illustration of a larger structural given, which is our third point:Printed materials serve as evidence and proof that actions in certain areas and directions havebeen taken; they reflect and enact a societal context in which literacy practices are accordedprestige as constituting a supreme form (and often the only form) of documented and account-able action.

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James CollinsDepartment of AnthropologyUniversity at Albany/State University of New YorkAlbany, NY [email protected]

Stef SlembrouckDepartment of EnglishGhent UniversityRozier 44B-9000 Ghent, [email protected]


You don't know what they translate (2006)

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