Reaching for New Levels of Understanding in Chinatown

A student dentist confronts language barriers in the community and the clinic
Members of Tufts University School of Dental Medicine’s Asian Dental Organization pose in a garden.
Irene Lang, D21, front row, far right, and other members of Tufts University School of Dental Medicine’s Asian Dental Organization, shown here in September 2018, have worked to earn the trust of community members. Photo: Courtesy of Irene Lang
May 25, 2021

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There’s an expression in Cantonese: “like a chicken talking to a duck.” It refers to the difficulty people who speak different languages—or dialects of the same language—have in understanding each other.

This “chicken and duck talk” would sometimes result when students from Tufts University School of Dental Medicine made oral health presentations to older adults in Boston’s Chinatown. Most of the senior citizens who showed up were Cantonese-speakers. But most of the student presenters, if they knew Chinese at all, only knew Mandarin.

“If you speak Cantonese to someone who speaks Mandarin, they wouldn’t understand at all,” says Irene Lang, D21. So during her time in dental school, Lang tackled several projects that focused on what she calls “linguistic care”—finding ways for students and patients to connect across a language barrier.

Over the past half-dozen years, dental student volunteers have provided screenings and oral health instruction at the Greater Boston Chinese Golden Age Center. When Lang became the community service representative for TUSDM’s Asian Dental Organization (ADO) in her second year of dental school, she wondered if those presentations were as relevant as they could be.

“We should not only be giving the community what we think they need, but what the community feels is important to them,” Lang says, “And presenting it in a way that is acceptable to them.” She devised a needs assessment, and talked with the older adults and manager at Golden Age, asking, “What do you want from us? What are you interested in?”

The most straightforward request was: We want the presentations in Cantonese.

Traditionally, Cantonese has been the predominant language for those who settled in Boston’s Chinatown. It is the dialect prevalent in Hong Kong and the provinces of southeastern China. Mandarin, however, is the official language of China today, and the dialect spoken by the majority of the population.

Sandra Khuu, D22, Irene Lang, D21, and Emerly Hsu, D21, talk about dental nutrition at the Greater Boston Chinese Golden Age Center in February 2019. Photo: Courtesy of Irene Lang

For several past semesters, the ADO had relied on a single Cantonese-speaking student, who had since graduated. Most of the volunteers, Lang included, had learned Mandarin growing up—or in some cases, weren’t fluent in Chinese at all and assisted in other ways, such as handing out toothbrushes and floss. The lack of Cantonese speakers also meant the ADO was limited in how many outreach events it could do each year.

Lang set about recruiting more students who knew Cantonese. “Empowering more people to volunteer was a question of sustainability. More people also meant more flexibility in scheduling, and therefore a lot more presentations,” she says. But she knew she would be asking a lot. “Going up in front of a bunch of Asian elders might be something that’s quite scary, because as Asian people, we really revere our elders. And it’s not easy using the conversational Cantonese that you’ve learned at home to discuss complex dental topics.” Plus, the students needed to have time in the schedules.

Eventually, six to eight Cantonese-speakers signed on. “Even though those individuals had varying Cantonese skills, it meant we were able to schedule more sessions,” Lang says. “Seeing our faces several times a year built more of a relationship. The seniors started to recognize us and trust us. They started to ask us how to become a patient at Tufts or find dental care.”

Since the advent of COVID, the in-person presentations have been on hiatus, but Lang says the ADO has been working with leadership at Golden Age and TUSDM on ways to continue programming. “Sustainability and a steady relationship really matter to me,” she says.

Lang became involved with the ADO toward the end of her first year in dental school, as she observed the Tufts culture of active citizenship. “How can I best use my own perspective and my placement to benefit the community?” she asked herself. “And I really couldn’t have planned it any better, that I was in Chinatown and that I am Asian American.” Lang’s mother is originally from mainland China; her father is from Taiwan and he later moved with his family to Brazil, where Lang was born. She grew up in Texas and Massachusetts.

This past academic year, Lang turned her attention to two other language-related projects. One was working with TUSDM administration to expand the use of digital interpretation carts within the predoctoral dental clinics. The carts are basically an iPad on a moveable base through which a student dentist can connect remotely to a professional interpreter.

The other project was helping to organize classes in elementary Mandarin and Cantonese for TUSDM students. The classes were intended to introduce any student to some simple Chinese dental terminology, but especially to fill the language gap that young Americans of Chinese heritage can encounter with immigrants. “The thing is, a lot of us don’t speak Cantonese or Mandarin,” Lang says. “People have this assumption that we all know how to speak Chinese, but a lot of the time that’s not the case.”

Just knowing some simple greetings can make all the difference, Lang says. “It can make patients feel more comfortable when somebody can reach out a bit in the same language. I’ve noticed it leaves people feeling a little less alone.”

Helene Ragovin can be reached at helene.ragovin@tufts.edu.