A lot of simple and ultimately uninteresting jobs last night, but two slightly funny things.

The first was our first call of the day - a man who had fainted in a betting shop. When we arrived we were told by the other patrons of the shop that the patient had already left. They shoved us to the door and pointed in the general direction of the busy street.

"There he is!", they shouted at us, waggling their hands in a general direction of 'outside of the shop'.

"Who?", I asked. "There are loads of people out there."

"Him - the one with the head".

I was a bit surprised by this description.

"They all have heads you silly sods!"

(We didn't find him in the end, he can't have been that ill to outrun an ambulance.)

The second started off as one of our usual types of calls, a four year old boy who had been vomiting. His mother was concerned and so we agreed to take him to hospital. As there was no other adult in the house the mother had to take the boy's sister with her.

Our patient was fine, fairly happy and no further signs of vomiting.

The sister however waited until we were within sight of the hospital before puking all over the floor of our ambulance. It seems that we are making people sick (literally) in the back of our ambulance.

I correctly identified the child's dinner as chicken and sweetcorn. Then I had to mop it up.

It's a glamorous job I have.

Ah, the joy of Windows computers. My desktop system has gone 'kerblam' and I find myself having to do a complete reinstall of the whole **expletive deleted** system. Which isn't as easy as you would think. Whatever happened to systems being sold with driver disks? It's not like I like to do anything 'fun' with my time off. Why, I haven't looked at my email or twitter alerts for at least two days.

But it's not all bad, I had a shift where everyone was really rather nice.

An elderly woman whose GP had called and decided that she needed hospital treatment. The family were lovely and completely understood why we were a couple of hours late for taking their mum into hospital. They were even nice enough to offer to carry our bags of medical equipment for us while we carried the patient downstairs.

Then there was the mother of a small child which had suffered a febrile fit. The mother was somewhat panicked but our showing up soon calmed her down, especially after we explained what had happened to her child. At the hospital she looked me in the eyes and thanked me, something that is unusual enough that it sticks in my memory.

Then there was the elderly man who was suffering severe back pain, especially when he tried to move. We arrived and the paramedic I was working with gave him some intravenous morphine to try and ease the pain a bit before we tried moving him. While she was doing this I was outside giving the patient's wife a hug as she was crying thinking that she was going to lose her husband. Thankfully the cause of the pain wasn't too serious and the man should make a full recovery.

Our other patients were similarly nice.

No lives saved that day, but everyone got the care they needed and thanked us at the end of it - so one of those days to mark up in the 'win' column.

(But before the race stuff - apparently NHS Direct are referring too many calls. What have us ambulance people been saying since it started?).

Before working for the ambulance service I was a nurse in North London. Where I worked there was a large Turkish and Greek community. But I've never met a Turkish or Greek nurse.

Where I work now there is a huge Bangladeshi population. I know of three ambulance staff on the road in my area who ethnically come from that vague area of the world. We also have one North African and one 'Black British' ambulance staff. If you were to look at the ethnic make-up of my patch of London (and here is the link for the other half of my patch) you would see that this is a massive under-representation of 'visible minority ethnic' people.

So why is this the case?

(I would suggest that they aren't daft enough to work for the NHS - but that may be seen as being snide).

I'm honestly not sure. I have a theory, and again - if people have other ideas please do educate me.

Some cultures have traditionally had to look after their own families, probably because the ambulance and health services in their country of origin are poor. I don't think that you get ambulances out in the Bangladesh countryside, so you would have to look after each other and the ambulance service isn't seen as an important job.

I have a colleague who lives in India for half of the year and she tells me that the patients relatives have to supply the food and sheets when that person enters a hospital.

Is this why certain populations in London don't consider the ambulance service for a career?

Given the amount of Eastern Europeans that are working in London at the moment it does surprise me that none of them want to join the ambulance service, although I suspect that being a plumber pays better, and why would you want to retrain when you already have a skill that transports easily.

But it goes the other way - I believe that nursing is seen as a worthwhile career in the Philippines and that is the reason there are so many nurses from there (coupled with our willingness to 'poach' nurses from other countries in a cyclical boom and bust fashion...)

The question that I haven't got an answer to is if there needs to be a change in this situation, and if so how to go about it. Beyond the normal tired 'roadshows' that tend to pop up when a committee discusses such ideas.

There is one thing that I do believe is that all the 'VME's' that work in my area in the ambulance service have been accepted by an overwhelmingly white English workforce. Of course I may be wrong, not having the same perspective that they have but I honestly think that we save our energies for our real enemies.

...Alcoholics, the government, ambulance management, St John ambulance, drug addicts, people who try to assault us, people who make frivolous claims against us, heavy people who want us to carry them downstairs, GPs, the press, nursing homes, hospitals, hospital management, hoax callers...*

This blogpost was delayed by playing Civilisation IV until the sun came up.

---

*Joke. Obviously. Well... mostly. I'm serious about the government.

There is a thing that really annoys me. It's when I turn up to a house and people who have lived here for some years who can't speak English.

In London there are enclaves of various cultures, In North London you have a large Jewish enclave, you also have gatherings of Greek and Turkish people. In my own particular area you have places that seem 90% Bengali, there is a smaller area that is Sri Lankan in make-up.

Now this is fine, people like people who look and act like themselves. This is natural.

But, when a large enough group of people get together there becomes less incentive to learn English. The government provides translation for hundreds of languages, the people get their groceries in shops run by people who speak their own language and they go to community centres and religious institutions where their language is spoken. They can go for months, if not years, without having to speak to anyone who doesn't understand them.

Until they call an ambulance, then we either use 'Language line', which is expensive, or we turn to our 'arm-waving, shouting slowly' skills of communication. Or I use the one word of Bangladeshi that I know.

'Bish?'.

(It means 'pain'. I am better at getting the general gist of what people are saying to me).

Some days I will go the whole shift without seeing any patients or relatives who can speak English.

But it's not the difficulty in communication that it makes me annoyed. What annoys me is that people who don't speak English are cutting themselves off from wider society. Most of our education about society these days comes, for better or worse, from television and newspapers. By not being able to understand English you are cutting the amount of information that you are getting by a huge amount.

This isn't to say that non-English speakers are uninterested in news - there are lots of foreign language TV channels out there, and while the news might be news about the UK (I have no idea), it is being presented through a different lens than 'native' newscasts. This then colours people's perceptions of what is happening out there.

This is why learning English is something that I consider an important part of living in this country. While it pains me to agree with a religious nut, Ruth Kelly thinks that this translation help should be cut as it only puts hurdles on integrating into the larger UK society. Look at the poor woman who was a victim of an 'honour killing' a spokesperson says that the community tried it's best to protect the murderers - without wanting to seem trite, would these people be so quick to defend this murder if they saw how unacceptable this was from 'Eastenders'* or similar dramas?

Enculturalisation via TV.

This insular nature of various cultures is a bad thing, and is only reinforced by not being able to speak English.

Look at my last post - the poor woman firstly thought that the treatment that she was getting from her husband was 'normal', secondly she thought that both the police and the ambulance staff would physically beat her up. This could all be corrected if she could understand some English TV.

Show me someone who watches 'Casualty' and thinks that Josh beats people up for 'honour'.

I think that withholding the learning of English it is sometimes a way of maintaining power over women. Often I will go to a call and it will be the men who can speak English, and the women who can't. Likewise I find women who have been 'shipped over' to marry men in the UK. These women seldom speak any English and I often fear that this is in order to keep them 'under control'.

Also how can you take part in the larger scheme of the UK if you don't understand the political issues? How do you know who you are voting for - we seem so intent to bring democracy to other countries yet we forget these large parts of our own country. Of course, language isn't the only barrier to this given decreasing voter turnouts.

In my job it also places that extra barrier between the patient and myself, I always trust that the questions and answers that are being translated back and forth are being done so accurately.

My dad is/was** illiterate and I saw how that barred him from large parts of society, so I can imagine how being unable to speak the language must feel. I know that I feel terribly isolated from the world when I'm on holiday in a place where English isn't spoken and while I try to learn enough to get by, understanding news reports (for instance) is far beyond me.

And of course, we shouldn't forget the Welsh who are being told that in business they should only speak the official language of the UK. Interesting that part of the reason is that it excludes those of us who are unfortunate enough to be monolingual.

As always, these thoughts are my own, based on my own experiences as a WASPish male; I love reading comments that educate me, so please do argue with me on this if you think that I am wide of the mark. I have only the vaguest idea what it is to be a person from a Bangladeshi background - so please educate me.

---

*I know people do bad things to each other in Eastenders, but they always get punished for it. For example, it's some sort of a rule that no-one in Eastenders can take drugs without having a 'bad trip', dying or going to prison.

**Is/was because I have no idea if he is still alive.

I'm going to do something a little different this week. I'm going to 'theme' the week around both the difficulties and the pleasures of working in a multicultural area. This is partly because there are various bits in the news about race at the moment and I have various thoughts churning around in my head, setting them out here will help me deal with them.

We were looking for the last job of the day, something simple that would leave us close to our home base. The job which came down our vehicle's terminal wasn't ideal, but it wasn't awful either.

"36 year old female, assaulted. Currently in police station".

It wasn't ideal because she would be going to a non-local hospital, but it wasn't too far from our station. We'd be getting paid overtime to drive back.

Our patient was sitting in the front of the police station talking to one of their civilian support workers. With her were two of her neighbours. All three came from the Indian subcontinent. Our patient didn't speak any English at all, the neighbours were translating as was the civilian support worker.

Out patient physically had a small injury - nothing too awful, it would be sorted out by a quick visit to hospital.

We set about getting a history of what had happened to her via the different translators.

Our patient (36 years old) was married to a sixty-year old man. She had been assaulted by him and by her daughter.

Except the neighbours told us that the daughter wasn't her daughter - she was the sixty year old man's other wife.

She is aged thirteen.

The neighbours had basically rescued our patient and brought her to the police station in order to get this state of affairs out in the open - the assault had been the final straw for them.

Our patient kept crying, partly because of what had happened, but also because she thought that the police, and us, would beat her up.

There are some weird (compared to how I was brought up) power dynamics in some of the communities around our area - young girls marrying men very much older than themselves is just one of them. This is the first one I have come across where the other wife has been under the legal age.

But then I wonder - in this community families live in large groups, perhaps I've taken more than one under-age wife to hospital. If they are described to me as a 'daughter' or 'sister', how am I to know? I've got so used to seeing lots of people packed into one bedroom that I don't think about it anymore. Is there a huge amount of child abuse going on that I have no way of knowing about?

I used to think that these large families were a good thing - the community would look after their own elderly population, I'e often been very impressed with the round the clock care that large families can give. But perhaps there is a dark side to this.

Two bits of good news. Well, one bit of good news and one bit of astoundingly brilliant news.

Firstly, remember the man who had a cardiac arrest and had immediate CPR by the St John ambulance fellow?

He's only gone and kept living, now he's sitting up and chatting with people and should be discharged soon.

A real success story.

And now for the astoundingly excellent news.

I have my travel mug back.

'W00t!' as I believe the young people say.

I think that I have the 'curse of the observer' at the moment. We dropped our first patient off at the hospital (a 36 year old female with a two day history of a cough and a headache. No, she hasn't taken any of her own painkillers), and have come away with a student nurse.

She is training to be a paediatric nurse and since picking her up we have traversed the length of our patch without a single call. We have even made it back to our station (unusual in itself) and have been put on a rest break. Which is why I'm typing this now as I won't have time to write anything tonight.

The 'Curse of the observer' takes two forms. The most common is that *nothing* happens all shift, or the calls that you do get are so utterly simple that it does the observer no good at all. The other, much rarer, form of the curse is where everything goes wrong - large patients who you can't move, people run over by trains and sick people seeming dropping out of the sky.

I'm guessing that we get the... peaceful type of the curse*

Today, just for fun, I'll be asking everyone who is in pain if they have taken any of their own painkillers - and if not I'll ask them why. Lets just imagine that it's the world's worst piece of research.

*People in the NHS never use the 'Q' word, it is seen as tempting fate, so a shift is 'peacful' or 'controlled', never 'Q***t'.