‘Of course I’ll care for my patients in their mother tongue – even if it’s my third language!’

Promoting minority language skills among migrants working in the health care sector

Ramziè Krol-Hage and Ruth Kircher
Mercator European Research Centre on Multilingualism and Language Learning

Try to imagine this: You are a migrant who has moved to the Netherlands and settled in the province of Fryslân, in the north of the country. You are thrilled to have found employment in a healthcare institution that cares for elderly people – a job that is similar to the one you had in your home-country, and where you feel confident you have the skills you need. You have also learned enough Dutch to communicate quite well with the people around you. But then, in your first working week, you start to notice that some of your patients speak a language you have never heard before, a language that some of your colleagues also speak during coffee breaks and in the corridors. When you ask one of the colleagues about this, they tell you that this language is Frisian: a minority language in the Netherlands that nevertheless holds official status, and that is spoken by more than half of the people in the province of Fryslân (Klinkenberg, Jonkman & Stefan, 2018). You suddenly start to feel a bit insecure because you can see how many of the Frisian-speaking patients respond best to their carers when they can speak their mother tongue, a level of comfort that you can’t offer them right now.

This kind of scenario is not exclusive to the Dutch province of Fryslân – this is a broader European issue. In addition to the 24 official languages spoken in the European Union, there are around 60 other languages that are spoken in specific regions (European Commission, n.d.). With increasing migration numbers throughout Europe (Eurostat, 2019), a lot of newcomers settle in bilingual regions where a local minority language plays a significant role in people’s daily lives. Many of the newcomers end up working in the healthcare sector, where it is known that patients’ quality of care is improved if the patients’ mother tongue is used (see e.g. Hemberg & Sved, 2019).

From September 2016 until September 2019, the Mercator Research Centre in Fryslân collaborated with five further organisations from bilingual regions in Europe to help such migrants – and especially those working in the healthcare sector. Together with Elhuyar Zubize and Banaiz Bagara Elkartea in the Basque Country (Spain), Danilo Dolci in Sicily (Italy), Swansea University in Wales (UK), and Axxell Utbildning AB in Swedish-speaking areas of Finland, Mercator worked on the Erasmus+ funded project Communication competences for migrants and disadvantaged background learners in bilingual work environments – COMBI for short (combiproject.eu). This project aimed to help migrants achieve the communication competences in the minority language of the region they have moved to, to improve their ability to interact with colleagues and patients in the workplace. 

So what exactly did the COMBI project entail? The project started with a cross-national needs analysis, to get an overview of the actual competence gap regarding communication skills in local languages in bilingual workplaces. The findings of this needs analysis revealed that none of the countries where the survey was carried out provided minority language training for migrants in health and social care settings (and no teachers were trained to teach this specific group of migrants). There is thus a gap between what migrants learn and know, linguistically, and the minority language skills that they need at work. 

To bridge this gap, a teacher training toolkit (TTT) was created: a handbook of guidelines for teachers to help them not only to analyse communication needs in the workplace, but also to plan courses with a multidisciplinary approach. The TTT can be used in different kinds of workplaces and language communities, and it can be adjusted depending on the specific needs and contexts. What makes this toolkit different from other language courses is the emphasis on the notion that even basic competences in the minority language should be valued and encouraged. (For example, the level of Frisian that is needed to check with an elderly patient if they need help with their personal care is different from the level of competence needed to write a novel in the Frisian language.) Complementary to the TTT, online modules were created that also offer best practices for teachers as well as policymakers. Moreover, the COMBI project developed a ‘roadmap’ for policy makers and stakeholders at policy making level in the field of multilingualism and linguistic diversity, employment and social affairs, as well as healthcare. All project outputs, in six languages, are freely available on the COMBI project website (combiproject.eu/outputs).

While the resources resulting from the COMBI project can be tremendously helpful in bilingual healthcare contexts, the findings of the needs analysis highlight a necessity for more research, and further policy and initiatives regarding minority language teaching to migrants in order to fully equip workers in the healthcare sector across Europe. The next, crucial step is to find out about the language attitudes of both healthcare managers and healthcare workers: What do the managers and the migrants themselves think about the necessity of language education for work-related purposes? And how can positive attitudes towards the local minority language be promoted? The answers to these questions are of great significance when it comes to language planning. As Lewis (1981: 262) puts it: 

Any policy for language […] has to take account of the attitudes of those that are likely to be affected. In the long run, no policy will succeed which does not do one of three things: conform to the expressed attitudes of those involved; persuade those who express negative attitudes about the rightness of the policy; or seek to remove the cause of the disagreement.

Overall, the aim of offering education to enhance migrants’ communication skills in the local minority language is to help them in their career by allowing them to build better connections with their patients – an aim which, ultimately, also benefits the patients, who can then be cared for in the language(s) they grew up with. 

Let’s go back to imagining the newcomer to Friesland who has just discovered the Frisian language at work: What would your primary motivation be to learn Frisian? And would you have any hesitations?


European Commission, n.d. Linguistic diversity. Available at: https://ec.europa.eu/education/policies/linguistic-diversity_en

Eurostat. 2019. Migration and migrant population statistics. Available at: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Migration_and_migrant_population_statistics#Migration_flows:_Immigration_to_the_EU_from_non-member_countries_was_2.4_million_in_2017

Hemberg, J. & Sved, E. 2019. The significance of communication and care in one’s mother tongue: Patients’ views. https://doi.org/10.1177/2057158519877794

Klinkenberg, E., Jonkman, R., & Stefan, N. (2018). TAAL YN FRYSLAN: de folgjende generaasje. Available at:  https://pure.knaw.nl/ws/portalfiles/portal/7213269/Taal_yn_Frysl_n_de_folgjende_generaasje_2018.pdf

Lewis, E. G. 1981. Bilingualism and Bilingual Education. Oxford: Pergamon.


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