Whence Comest Thou?

About twenty five years ago in Middlemore Hospital emergency department, Auckland, New Zealand, I said to a doctor who I thought might be Chinese, “Where are you from?”  He coloured slightly, and said, “Auckland.”  That was the first time I realised that my question, even if well-intentioned, was fraught with difficulty.  At least I didn’t follow it up with, “Yes, but where are you really from?”

In New Zealand, people enquired of my provenance all the time.  “Do I detect an accent?”  (Actually they said, “Do ah duteect un uk-seent?”)  I would reply, “I don’t have an accent; you have an accent.”  Thus we would josh one another and that was okay.  Context is everything.  It seems that Lady Hussey compounded a problem last week by her persistence; an enquiry became an interrogation.  And I dare say there would be an issue of tone.  I remember seeing a fly-on-the-wall documentary on TV some years ago, when during a palace reception a lady from an African country asked her hostess, a lady of extremely high caste, whether she had visited her homeland.  “Visited it?  I gave you your independence!”  The whole purpose of the documentary was to pick up such nuggets as this, and to broadcast them without comment.  The aristocrats were so tin-eared that they might have watched the programme later and not realised they were being ridiculed.    

The “Where are you from?” question is common in language classes.  An introductory spiel round the table is almost de rigueur.  “Ich komme aus Glasgow und ich wohne in Stirling.”  So far so good.  In Gaelic, people might say, “Who are your people?  Ah yes, I know them.”  Again, context is everything.  But even here, difficulties can arise when one’s resumé continues to unfold.  Marital status – Married/single/divorced/separated/widowed/it’s complicated/no comment!…  Children/ no children…  Student/employed/retired/unemployed…  It can be quite intrusive.  Some textbooks actually remind you that you’re simply practising language and there is no need to tell the truth.  But this I think can backfire.  Rather than saying, “Single, retired, no children, I am a sad old git…” you might be tempted to construct a phantasy world that will spill over into other areas of your life.  At this time of year, for example, you might be tempted to send out a Round Robin circular with the Christmas cards: “Jack loves Gonville and Caius as much as Ophelia does Brasenose.  Letitia had time to scale Everest during her Nepal gap year…”    

The trouble with “Where are you from?” is that it can be code for “You are not one of us, are you?”  I remember when I was a medical student in Edinburgh a consultant physician asked me, “What does your father do?”  I had no idea at the time that he was trying to place me, socially.  I guess he chose a reasonable surrogate for potential social mobility, or immobility.  According to Sir Paul Collier, Professor of Economics and Public Policy at the Blavatnik School of Government, and Fellow of St Antony’s College, Oxford, who gave the annual Bowman Lecture at Glasgow University last week, the two most powerful indicators of life chances are where you live, and what your parents did.  In the UK, to have any chance at all, your parents had better have gone to University, and you had better live in the South East of England, or the East of Scotland.  I don’t think he was referring to Hastings, or Thurso; rather London and the Home Counties, and Edinburgh, the centres of power. 

Sir Paul’s special area of interest is in regions of extreme poverty across the world.  (He included his own home town, Sheffield.)  Why can’t they escape the cycle of poverty?  Incidentally, Sir Paul’s own life chances may not have looked particularly rosy when he were a lad.  Not only did he come from Sheffield, both his parents left school aged twelve.  Now he is an academic in Oxford, advising such august bodies as the IMF, the World Bank, and the Minister for Levelling-Up.  He attributed his own success to the post-war Prime Minister Clement Attlee, a modest man, according to Churchill, “with much to be modest about.”  I have a notion Churchill also described him as “a sheep in sheep’s clothing.”  Yet Attlee’s government founded the welfare state, despite the fact that post-war Britain was bankrupt. 

Sir Paul’s graphs depicting the gap twixt rich and poor in the UK were startling.  It occurs to me that in our society, that question, “Where are you from?” is being asked all the time.  This is what an interview for a place in medical school is all about.  They want to know if the candidate is “doctor material”.  In other words, is he, or she, one of us?  Did they go to the right school, have they prepared a faultless “personal statement”, were they groomed to pass the UK-CAT test, have they got umpteen A* A-levels, did they find a cure for cancer during their gap year, above all, do they, at interview, sound like a doctor?  Yet the end product of this exhaustive and exhausting process is a health service on the edge of collapse, with burnt-out professionals leaving the sinking ship in droves. 

Talking of sinking ships, Sir Paul compared the UK to a sailing dinghy.  A sailing dinghy has two conditions of equilibrium – one when it is sailing, and one when it is capsized and upside down.  Sir Paul considers the UK to be in the latter state.  He did not mince his words. 

Yet he was not without hope.  Even if the antiquated institutions of the UK are no longer fit for purpose, if they ever were, people needed to be empowered to solve problems at a local level.  I thought of this when I heard a lady on Friday’s Any Questions, a nurse of 40 years’ experience, ask the members of the panel, given the dire state of the NHS, what they would do about nurse recruitment and retention.  After the panel had had their say, the chairperson returned to the questioner and asked what she would recommend.  Answer: a £500 bonus, bursaries, a pay deal in line with inflation, on-site nursery facilities, subsidised meals, and subsidised car parking.  As a doctor, nine times out of ten, all you need to do is sit and listen, and the patient will hand you the diagnosis on a plate.  I hope the government was listening.       

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