I have to say communication in this country is seen as (and im being stereotypical here) "if you can't speak english then pah!" I was on HDU a few nights ago and there was a lovely chap with a trachy and he couldn't get a sound out, but me and him were having a right laugh together just by me reading his facial expressions and lip reading him. The other staff on the ward were, well completely oblivious to the fact that he could still communicate let alone trying to make conversation with him. (One comment really p'd me off (and the pt) was when I joked, as we were about to roll him, that I was going to leave his ileostomy bag full cuz id got a bet for £10 that it would burst at 0400, he mouthed, put £20 on it for me for 0500, so I laughed and said I'll make a note of it. Through this little bit of banter the SN had her back turned as she was getting gloved up, and she turned around and said in a very firm manner "what are you going to make a note of, I have done nothing wrong?".....) I think talking across communication barriers is more to do with the willingness of the communicator to try and get a message across, and the willingness of the receiver to try and interpret language in an alternative to words.