Interesting, the issue in my opinion is more pronounced in Middle eastern countries as mentioned in this article the example of South African nurses in Saudi, I am sure we have the same issue in Libya with non Arabic speaking nurses and doctors. In North America training programs/residency allows physicians to slowly transition into the culture, language and way of thinking, so it makes is less of a problem once they start practice. However I encountered the issue when I practiced family medicine in Canada I was out of medical school from Libya and there was no training, it was helpful to have Libyan colleagues to guide you through that, to understand the needs and expectations of patients in Newfoundland.