"Masiari!"

" Ndaa!" My companion for the day, a second-year Nursing student, raised his arm to the old man who had greeted us. "

What does that mean?" I asked. "

"It's a greeting - like good afternoon."

" Un-dah," I attempted.

"No, no! You don't say 'Ndaa'. That's the male greeting. You're a woman. You say 'Aa'."

Somehow I was not surprised that even in greeting a person there was a complicating factor of which I was unaware. Language had turned out to be one of the most complicated and inexplicable things about my life here.

When I arrived in this area at the far edge of the Northern Province of South Africa, less than 100 kilometers from the border with Zimbabwe and Mozambique, I was under the impression that most people had a reasonable working knowledge of English, and that I would therefore have no trouble communicating.

Within a few weeks I discovered that although this really was not incorrect, it was, like so many first impressions we have of other cultures, an oversimplification of the actual situation. I now knew that most people spoke anywhere from two to five languages, with widely varying degrees of ability, including not only English but also Afrikaans, Venda, Xhosa, Northern Sotho, Shaangan, Sepedi, Tsonga and Tswana.

I had hoped quickly to pick up some basic phrases in the local language, but instead found myself struggling with eight, never knowing what a person might be speaking at any given time. I knew that although I might triumphantly master the appropriate response to the Venda greeting masiari, the next three people I met would probably greet me in Xhosa, Afrikaans and Shaangan.

Luckily, my initial impression was to some extent correct, and people frequently switched to English when they realized I had no clue what they were saying. However, because many people from the smaller villages did not know much English, I often had to get help from people such as the student I was with on this day.

My guide was one of a group of nursing students who were fulfilling part of their degree requirement in community health. Their class had been paired with a small village about a 30 minute's drive from campus and they were expected to visit the village, interview the residents, and assess their unmet healthcare needs.

As the students progressed in their training, they would later decide on a focus project to help develop facilities or services to meet some of these needs. I was impressed with the far-sightedness of educators who had included this as a required part of the nursing curriculum, and with the enthusiasm with which the students were carrying out their assignment, but I wondered if they would find success in alleviating the impoverished village's needs.

Other than enthusiasm, the Northern Province has very little working in its favor. Neglected by the previous government, its mainly rural population has a nearly 50 percent unemployment rate. Eighty percent of the people make less than $550 per year. Added to the already substantial problems of poverty has come the massive burden of a growing AIDS epidemic. It is difficult to assess the rate of HIV infection in this area because of the incredible stigma associated with the disease, but the overall rate for South Africa is nearly 20 percent. I would not be surprised if it were higher in this province, where fear and lack of education combine with the South African government's indefensible apathy toward the crisis.

As a final year medical student at the University, I had decided to take a year off before beginning my residency in order to study environmental health in the Northern Province as well as to help teach nursing students at the traditionally black University of Venda.

After four years of training in a field that puts so much emphasis on efficiency and time-consciousness, I initially found days such as this one frustrating. The cultures of southern Africa value group solidarity and sharing far above efficiency, and my students insisted on conducting group interviews, with no less than five students interviewing each village resident.

It is hard to imagine that American undergraduates, given a similar assignment, would not quickly decide to split up the work, since any one student could interview a villager in the same amount of time as five could. Despite my exasperation at what I perceived to be an inefficient use of time, today I did not intervene.

Although I was not sure of the reason for their different approach to the assigned task, I already had found through previous experience that there was nonetheless probably a good one. For all I knew, it might be that villagers found one-on-one interviews more intimidating than chatting with a group of friendly faces. The culture of group consciousness was something I had to accept as important even if I did not always think it seemed useful.

In fact, later in the same day, I was reminded that many benefits to group-awareness exist. When I shared some candy with a preschool-aged girl in the village, she brought it back to her group of friends and carefully broke it up into pieces so that each child could have some. I tried to think of an American preschooler who would not have kept the candy for herself, and had to laugh. Is it better to be selfish and efficient, or generous and slow?

The more I interact with those different from myself, the more I realize that I do not have to choose between one and the other. Instead I can incorporate the good I see in other cultures into my own. Learning to accept and appreciate differences may be the most valuable, and the most difficult, lesson to learn when working or studying abroad.