ESL and the Right to Health

Last night, I taught English class for the first time. When I was in high school, I had tutored math and science, but this is a completely different ball game. I have to write my own lesson plans rather than rely on the homework assigned by another person and there’s no textbook to flip through if I forget something (or don’t know how to explain something). My students are (probably) all older than me (a few of them didn’t make it to class yesterday, and one man seems to be about my age), and some of them have been in this country longer than I’ve been alive. But they are all driven by a ferocious desire to learn—every single one thanked me for teaching after class had finished. I didn’t know how to respond.

One of my students is a woman who’s been here for over twenty years, and yet has learned very little English. After class, she pulled me aside. “My husband speaks English very well,” she told me in Spanish. “He used to work, but now…” she trailed off, gesticulating to a man seated in a wheelchair in the other room. “I used to just stay around the house, but now I have to learn English.”

Her husband appears to be quadriplegic. In class, as we took turns telling brief life stories to practice different tenses, he told us “I used to be a painter. One day I will try to walk again. Right now, I am sitting in this chair.” Simple sentences, and perhaps mis-ordered, but powerful nonetheless. I remember feeling infinitely grateful that he had revealed this truth to me in the context of an English class, where I could praise his use of three tenses and move on to the next person, rather than grapple with his thoughts and feelings about his disability and my fundamental incomprehension as an able-bodied person.

I don’t know what kind of healthcare this man and his wife have access to. Obviously they have something, because this man was conversing with us despite having severed his spinal cord. But his wheelchair is manual, not electric, which means he is incapable of going anywhere unless someone pushes him. He will require extensive (and in this country, expensive) rehabilitation if he is ever to walk again. His health has powerful ramifications for that of his family as well. His wife is learning English in order to find  work to cope economically with the loss of the primary household provider and any bills incurred by her husband’s accident. An event like this could drive a family into poverty even without a private, free-market healthcare system (never mind the impact of poor English comprehension and usage in either the healthcare or work setting). Viewing health as human right demands that we provide care for this man and his family, regardless of their ability to pay, regardless of how long his rehabilitation takes, and regardless of their status in this country (I don’t know if they are here legally or not).

But this case also demands that we set parameters for rehabilitation of disabled patients. Does health care as a human right require that we provide basic treatment so that he is “functional” in a wheelchair, or does it require the most advanced treatment we can provide, holding his goal—to someday walk again—as our mandated end of treatment? Part of me says that providing the best possible treatment isn’t feasible. But part of me says that to do anything other than that would automatically set up divisions between people, and force us to value one disabled person over another so as to decide who gets cutting edge treatment. And that fundamentally undermines any claims of the intrinsic human rights-ness of health.



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