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Case 4: Healthcare in multilingual world

In this video, Dr Theresia Shivera talks about the importance of languages in her work and describes the experience which led her to become a doctor.
Text on Screen: Can you describe the importance of language in your work? My home language is Rukwangali, and then I did Afrikaans, my primary school was in Afrikaans and then my high school and tertiary education was in English. And then I also lived in a different area from my home area, so I also speak Otjiherero, that’s one of the local languages here. As a doctor are languages important to you? I think so, very much. In what ways? How do you see the importance of languages in your work?
I think first of all, the patients feel much more comfortable with you as a doctor, and then they are able to express themselves much more clearly, and with that you get to really understand what the patient really wants from you. If you can speak their language. Yes, if you can speak their language, or they express themselves in their language, and I think at the end of the day, you are able to give a better service to them. Whether it is treating their illness, or giving them advice, or educating them about their illness, so I think a patient walks away much more satisfied.
Text on Screen: When did language become important in your life? Well, I think at the time I was 16 years old so I had malaria and my school, my boarding school was a few kilometres from the health centre, health facility. I got there, and at that time most of the doctors working at the health facilities were not from the area, were not Namibian, because it was immediately after independence so most of them were from other African countries or overseas.
So I got to sit in the waiting area and unfortunately I could hear the conversation between the doctor and the previous patient that was before me, and then it was actually shocking to hear how much information was lost through, because the nurse was translating so the doctor would ask a question, the nurse would ask the patient and through that whole three conversations or four conversations, there was so much information that got lost. At the end, actually the patient got treated for something that they didn’t have.
So for me that was quite a - sort of like an awakening, so it helped me realise what I really wanted to do, because at that time I was really figuring out what I wanted to do, but that was for me was the awakening of what I wanted to do in life.

Translation can provide an important support for doctors and patients, playing a key role in achieving better medical treatment and therefore improving individual well-being and public health.

This is particularly important in environments which are intensely multilingual or linguistically diverse (scholars sometimes talk of ‘superdiversity’). Namibia, with its mixture of African languages, post-colonial languages and lingua francas, is a case in point.

In this video, Dr Theresia Shivera talks about the importance of languages in her work and describes the experience which led her to become a doctor.

Health Care in a Linguistically Diverse World

Dr Nelson Mlambo describes the context in which medical professionals work:

The Namibian case of multilingualism in health communication is an interesting case study in a globalized and linguistically diverse world.

*As a country, Namibia has about 13 standardised languages which are officially regarded as “national languages”, namely, Oshikwanyama, Oshindonga (these two closely related languages are at times also considered as one under the name Oshiwambo), Khoekhoegowab, Otjiherero, Rukwangali, Silozi, Rumanyo, Thimbukushu, Ju’hoansi, Setswana, Afrikaans, English and German.

In addition to these 13 languages, there are 16 more African languages which do not have a literacy tradition and therefore also no recorded orthography. Namibia’s complex language map and its linguistic diversity make it particularly difficult to differentiate between certain languages and dialects, which explains why estimates of the indigenous languages in Namibia range between 10 and 30.*

This linguistic diversity in a country of just over 2 million people means that there is an acute need to understand the role of translation, particularly in the health sector, so that the wealth of languages can be used as a resource in health communication, rather than being perceived as a problem.

*Globalization is a worldwide phenomenon. One of the ways in which it touches Namibia is the country’s reliance on expatriate healthcare professionals (or HCPs). We need to understand how the multilingual expatriate HCPs develop and use their linguistic repertoires, how they perceive their communicative needs, and the strategies they employ in their work place communication. Even local doctors, however, are not familiar with all the languages spoken in the country.

Additionally, their professional training mainly takes place through the medium of English. So we need to understand the multilingual strategies of Namibian health specialists too. And we definitely need to know how translation works – for expatriate as well as local HPCs, and also for their patients – in such a complex context.*

‘Translation’ takes many forms in the medical field. Above, we mentioned the need to understand linguistic repertoires and how multilingual professionals use them. Specialist tools are also a vital resource – but these are not limited to providing technical terminology.

The short article below describes a current research project carried out at the University of Namibia, which involves the creation of the first Oshiwambo-English dictionary of medical terms.

Creating an Oshiwambo-English Dictionary of Medical Terms

Namibia is a multilingual country with diverse cultures. It is a country with many tongues but few people. Any medical professional whether he/she is a Namibian or non-Namibian, needs to possess the basic knowledge of the language and culture of their patients. It is important for a medical professional to communicate with patients in the language of the patient in order to diagnose and treat illness accurately.

Oshiwambo is one of the most widely spoken African languages in the country. The Oshiwambo-English dictionary of medical terms is intended for medical professionals who need to learn some basic Oshiwambo expressions, phrases and words related to the medical field. By learning these expressions, they will hopefully be able to make their patients feel more comfortable and will have a more adequate understanding of their needs.

It is a truism that medical problems occur when doctor-patient communication is not adequate. Poor communication between the doctor and the patient may even result in incorrect medical treatment. The bilingual Oshiwambo English dictionary of medical terms, Embwiitya lyOshiwambo lyiitya nomatumbulo guunamiti, is being compiled with the aim of facilitating communication between the doctor and patient. It also aims to establish Oshiwambo medical vocabulary which the doctor and the patient can share and understand.

The dictionary is intended for doctors, nurses, pharmacists and clinicians who work with Oshiwambo speakers. It was compiled with the involvement of the target users in order to include vocabularies and phrases that they use on a daily basis. It is hoped that the users will find it useful in facilitating the day to day communication between the health professionals and the patient, especially during consultations. The book also provides the patients with rudimentary understanding of the medical environment and issues, so that they may take precautionary measures in health related issues.

The dictionary also includes non-medical phrases. This is essential to enable the users to communicate with their clients in a polite and culturally-sensitive way. The dictionary thus includes greetings, introductions, and polite requests. These non-medical phrases may help to create a relaxed atmosphere during medical consultations and this, in turn, may enable a patient to feel more at ease when explaining the nature of his/her illness.

The plan is for similar dictionaries to be produced in all Namibian indigenous languages, such as Otjiherero, Setswana, Rukwangali, Khoekhoegowab, Silozi, in order to make all indigenous languages of Namibia accessible to the medical profession in Namibia.

Dr P.A. Mbenzi (University of Namibia)

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Working with Translation: Theory and Practice

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