Teaching when #English is the #Second #Language for the Entire Class #ESL

Pre-emptive announcement:

This blog is directed to my videshi readers. I am pointing out the need for videshis to adapt to the culture of Nepal.  I invite comments but I will only publish if they are respectful. 

Give yourself time to click on every blue link. 

Update: I am told by multiple persons that “code switching” is what I am talking about. I confess my ignorance in not knowing what every else knew! There are ample links about code switching, and anthropologists have popularized this term. I will write an entire blog on code switching in my context,  once I digest them all. Global Health Nurses! Learn to code switch! Here is a ten-minute video from a linguist. 

Update #2 Here is a article specific to code-switching on Nepali TV. Gives good examples!


My first trip to Nepal was in 2007 and I come here almost every summer. Since 2011 I have my own project to teach critical care skills to nurses and doctors, but I often run into other western health care people trying to teach this or that skill, or spending time here as part of their professional development. I don’t hang around with mountain climbers in Thamel or EBC.

I am fortunate to enjoy a good reputation for my sessions. Here is  a Nepali-language sample of feedback from a person who took my training:

Travel Back in Time

Seven years ago I once wrote a blog titled “Twelve Steps to Prepare for Global Health Nursing” which made the case for easy ways to learn about the culture of whichever country a nurse might think of going. I re-read it recently and it withstood the test of time. There is one area to add, though, specifically on the topic of teaching nursing in an English-speaking low income country.

Imagine yourself in a classroom with this guy as the teacher:

Now imagine that these guys are your students and this is the level of English they speak.  I have taught many of my sessions outside KTM Valley where this is the level of English possessed by much of the class.

Now imagine this is the lecture you are trying to deliver to those guys:

The American guy in the video obviously knows his stuff. The speaker is knowledgeable, speaks clearly, makes his points including nuances. Tell me honestly,  will they get it? 

The answer is obvious. 1) he talks too fast 2) he uses too many big words 3) he uses complex grammar. 4) not enough time for students to write notes 5) complicated graphics. 5) no pauses for people to process.

He is a terrific lecturer for America audiences but he would be frustrated in Nepal.

There are many Nepali people with excellent English, don’t get me wrong:


English is not pronounced in Nepal the way you think it is.  Here is some info about  the way words are sounded out:

The language of instruction is English,” I have been reminded in about two dozen locales of Nepal, by various and sundry. This is said of Nepal (which was never conquered or colonized), but it also applies to such places as India, Nigeria, Jamaica,  Guyana, Singapore and other former colonies of Britain.

Um, no. It is not. To truly become successful you must understand the idea of hybrid English, also known as “Pidgin.”


The language of instruction in Nepal is English as a Second Language (“ESL“), not English. There are lots of Americans ( and Brits and Aussies)  who don’t know the difference.  ESL implies that the student’s grasp of English  has very specific limits. In USA these days any given nursing school will always have a subgroup of ESL students, and they often need coaching as to how to grasp “medicalese” – (when you get down to it, most medical professionals don’t speak English either!).

Because of the Medicalese issue, I learned long ago in USA to treat my entire classroom of beginner nursing students as if I was teaching them a foreign language. Think of all the  abbreviations a practicing nurse or doctor will use in daily work. I am very proud to say that my current employer ( a community college) devotes resources to the success of these students.


Last spring there were some Latina students in my USA lecture class who formed a study group and made this video:

Back to Nepal and “Foreign Lands”

The ideal of course, is for every American volunteer abroad to speak and teach in the local language.

When learning the local language is not possible, it is very important to adapt your own language so that it mirrors the English the students speak.  Assess the level of language skill of your listeners very carefully, and reserve your most erudite English only for those at the top tier of English proficiency.  Switch your style to fit the audience.

There are people who get it, and others who keep the same speaking style they use in USA, telling themselves something like “I’ll help people more if I model my mastery of the language and elevate the English comprehension of the listeners.”

Nope. That lasts about a minute. The audience will be lost and confused. They will politely listen because after all, you are a foreigner and you have come such a long way. But if somebody asked them what you just said, they are unable to describe it.

International Conference in Kathmandu

I saw this in the ballroom of Kathmandu’s Hyatt Regency a few years back when a distinguished cardiac surgeon from USA was speaking to two hundred people about developments in mitral valve surgery. I thought it was interesting. But, most Nepalis in my vicinity sat politely, looking at FaceBook on their mobile. The conference was funded by the University in USA that sent the surgeon; they subsidized the conference registration fee for most of the listeners; but the points sailed right over the heads of the people in the chairs.

The Nepalis themselves put on better conferences organized by Nepalis for their own colleagues.

International Conference on USA East Coast

A few years back I also attended an event for Global Health Nursing in which the keynote speaker recycled a scholarly paper to present to an audience that included many academics from USA interested in Global Health, but also many nurses from outside USA. My assessment? She too, failed to read the audience. The nurses from Haiti and Africa in attendance did not quite get it. I wonder, when we send doctorally-prepared nurses abroad, do they use this level of  language? If so, are they really imparting anything of value?

Does Incrementally Erudite Scholarly Presentation lead to cognitive comprehension? 

There is need in global health nursing to use plain language for the benefit of all concerned.

In an ESL classroom, the focus is on the learner and what they comprehend, not on the teacher. It’s a spectrum I suppose, but I am proposing that we slide the marker to the right a bit…… tilt it more toward the learner.

Book culture in Nepal

Back to Nepal. the day-to-day culture here is not one that reads a lot of books. In nursing school here, people don’t study an English-language textbook by themselves. Five students gather round. The person with the best English reads it out loud, then they discuss what they just heard, in Nepali.

Here is a video I found from India, it’s a YouTube summary of a scholarly paper on this as applied in India ( a neighboring country whose language has similar origins to that of Nepal). This makes me want to read the original article! The video is 37 minute long, but it dives in to the subtleties of how English  is spoken in India and ways you can use “code talk.” The examples this person gives are in Hindi, similar in many ways to Nepali (um, Nepali is much more musical and beautiful if you ask me).

This teacher has other videos.


Here is a video about the amalgam of Language in Singapore (Um, Not Safe for Work!) . There are surprising parallels to the way English is spoken by many in Nepal, and I know one Nepali nurse whose father was deployed with Gurkhas to Singapore, so her English is almost exactly like that of this narrator:

Online you can find dictionaries of Singlish words.  Specific to India, there is the phenomenon known as “Hobson-Jobson.” In my two books I tried to convey the way certain phrases persist among staff of Nepali mission hospitals.

Hawaii and Maine

I have always loved Pidgin languages. I lived in Maine a long time, famous for a peculiar accent,  and a vocabulary that mixes archaic words from Elizabethan England into English. I can easily speak like a native Mainer and certainly my two daughters are fluent. I also lived in Hawaii, where there is an even more distinct pidgin (you need to click on that link!) that incorporates many  phrases and grammar of Hawaiian language as well as Filipino, Japanese, and Chinese.  I am unable to imitate this at all, due to the inflection and musicality. I totally loved and respected the way this is a living language and the politics of it are fascinating to me. The musicality of an Asian language, and the grammatical differences tend to accentuate the difficulty in hearing what is being said.


Listen to this one.If you can’t somehow get it, you need to tune your ear:

Some of the points about preparation in my original article reinforce this, such as spending time with the local Nepalis in USA before you depart for Kathmandu, but I think this ESL issue needs emphasis so that you have a clear goal when you are speaking with your American-based Nepali friends and preparing yourself for cultural awareness. It’s about more than just food and prayer flags.

Future blog on this subject?

there are many things I consciously do in my classroom to address this specific challenge, some I have been doing so long  I realize I take them for granted. Here is one specific example:

day Bir 2 a

the actual ten steps of defibrillation are the same whether you learn them in English or in Nepali. I always start each of my own classes by telling the group “you can be expert at resuscitation even if you speak no English whatsoever”

Bullet Points?

In a future blog I will give a list of bullet points for things to focus on when preparing for your own global health teaching experience. Until then, looking forward to your feedback.

In Summary

Add training and study of ESL principles, and even some guided practice, to your to-do list before going to teach nursing outside the boundaries of USA. Even if it is to a country where many speak English, you still need to study the language.  You will be glad you did!

About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011.
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