[lg policy] South Africa: Speaking the language of the patient: indigenous language policy and practice

Sun Sep 13 21:34:38 UTC 2015

Research Article | open accesscreative commons

All authors
Margaret Matthews a & Jacqueline Van Wyk b
Corresponding author<s>

Margaret Matthews | University Language Board, Nelson R Mandela School of
Medicine, University of KwaZulu-Natal
DOI
10.1080/20786190.2015.1083718
Published 11 September 2015

Abstract

South Africa faces numerous challenges in healthcare, with the result that
communities in many rural provinces are grossly underserved. These problems
are compounded when doctors are unable to communicate with their patients.
IsiZulu is spoken by most people in KwaZulu-Natal. Older and rural patients
often present as monolingual isiZulu speakers. The need and ability to
speak an indigenous language is emphasised in communication, identified as
a core competency for doctors. The benefits of language-concordant health
care have been documented, and policies at national, regional and
institutional level provide for language diversity. As first-language
English users, medical students have to be trained to become competent in
speaking isiZulu. This mixed-method study assessed the knowledge, attitudes
and perceptions of third-year students who had received isiZulu-training
during their first year at the University of KwaZulu-Natal. The results
indicated an improvement in students’ communicative competence. In general,
positive attitudes were held by the students towards the language, but
there was a perceived need for additional input in order for the students
to become competent.
Main text
Introduction
IsiZulu is spoken by the majority of the population in KwaZulu-Natal (78%).
This region is one of the poorest and most densely populated (10.3 million
people) provinces of South Africa. Older and rural patients often present
as monolingual isiZulu speakers. Even peri-urban patients increasingly
prefer isiZulu, while many medical students are first-language English
users and are not proficient in isiZulu.
The benefits of language-concordant health care include improved health
outcomes, whereas communication challenges have been associated with the
use of expensive diagnostic tests and poor patient follow-up.1 The South
African Constitution recognises patients’ rights to access health care in
their preferred language, and policies at national,2 regional3 and
institutional level4 support language diversity. Communication, a core
competency for all healthcare professionals,5 is being taught in most
Bachelor of Medicine and Bachelor of Surgery programmes. While aligning
teaching and learning with national and regional priorities, training is
being moved to decentralised platforms, where there is increasing emphasis
on the need for doctors to become competent in the language of their
patients.
IsiZulu language teaching is offered as a year-long module in the first
year at the University of KwaZulu-Natal. The module was evaluated through
an observational, analytical, cross-sectional study, in which approximately
one third of the third-year cohort, who were not able to speak isiZulu at
the start of the programme in 2010, was sampled. The cohort was assessed
after receiving language and communication training, and additional
assessments in isiZulu in their second and third academic years. The study
was conducted to determine students’ perceptions of their ability to
communicate in isiZulu, and to measure their knowledge of, attitudes to,
and use of, the language.
Method
Quantitative data was collected using a knowledge, attitudes and practice
survey using a five-level Likert scale, a written test, and a third-year
oral assessment during the objective structured clinical examination. Six
of the 86 students were no longer registered in the third year, and 61 of
the remaining students (76%) completed the questionnaire. Qualitative data
on the students’ experiences and recommendations was gathered in an
open-enquiry section. The quantitative data was analysed using an
appropriate statistical method and analysed thematically.
Results
The results demonstrated that students’ knowledge in both the written
(Table 1) and oral assessments had improved. Students held positive
attitudes to learning isiZulu. A Likert score analysis for attitude
reflected a mean of 3.96 [95% confidence interval (CI): 3.79–4.14, p
0.000)]. Although the students perceived their isiZulu communicative
competence to have improved, their ability to communicate with their
patients had not improved sufficiently for it to be used practically. A
Likert score analysis for practice reflected a mean of 3.18 (95% CI:
2.94–3.41, p 0.000)].
Table 1: Written test results for the study cohort (2010 and 2012)
Display full size CSV
Students noted some benefits: “The course was very helpful, and gave me
confidence when communicating with Zulu-speaking patients”. Others found
language acquisition to be challenging: “Learning a language at an older
age is much more difficult than (having) grown up with it”. Students
perceived a need for additional input in order to achieve an appropriate
level of communicative competence.
Conclusion
Although the results showed an improvement in the knowledge and positive
attitudes of learners with respect to learning isiZulu, the benefits gained
did not translate into their practical ability to communicate with
patients. In response to this need, efforts are being made to improve
language learning by emphasising communicative language teaching methods in
the first year of study, and by providing additional input. For example,
videos of consultations in isiZulu are being integrated into teaching in
the second and third years of study. An ongoing interdisciplinary
terminology development project has been launched in the College of Health
Sciences at the University of KwaZulu-Natal. It is envisaged that these
efforts will enhance the existing favourable language policy framework and
ultimately translate into patient satisfaction and improved health outcomes
in the region of KwaZulu-Natal.
References

    1. Hasnain-Wynia R, Yonek J, Pierce D, et al. Hospital language
services for patients with limited English proficiency: results from a
national survey. Chicago, IL: Health Research and Educational Trust; 2006.
    2. Republic of South Africa. Use of official languages act 2012 (Act
No.12 of 2012). Pretoria: Ministry of Arts and Culture; 2012.
    3. KwaZulu-Natal Legislature. KwaZulu-Natal Provincial Languages Bill.
Pietermaritzburg; 2012.
    4. University of KwaZulu-Natal. Language policy and plan of the
University of KwaZulu-Natal, Durban: 2006 revised 2014.
    5. Undergraduate Education and Training Subcommittee of the Medical and
Dental Professions Board. Core competencies for undergraduate students in
the clinical associate, dentistry and medical teaching and learning
programmes in South Africa. Pretoria: 2012.

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