Browsing by Author "Levin, M E"

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    Different use of medical terminology and culture-specific models of diseaseaffecting communication between Xhosa-speaking patients and English-speakingdoctors at a South African paediatric teaching hospital
    (2006) Levin, M E
    Background. Language and cultural differences between patients and health care providers may have adverse health consequences. Red Cross War Memorial Children’s Hospital is a paediatric teaching hospital in Cape Town where staff communicate mainly in English or Afrikaans, while many patients speak Xhosa as their first language. Objectives. To examine whether differences in the definitions of common respiratory medical terminology by patients and doctors cause miscommunication and to explore culturespecific models if used by parents in their definitions. Design. In-depth, semi-structured interviews were conducted with three speech communities, viz. 8 English-speaking doctors and 33 Xhosa-speaking parents, educated to grade 12 level or less and recruited from two areas in the hospital, the short-stay ward (Xhosa s-s) and the allergy clinic (Xhosa allergy). The sum of both groups of Xhosa-speaking patients are referred to as ‘Xhosa all’. Definitions were elicited for common respiratory terminology in both Xhosa and English. Contrastive linguistic analysis was used to identify the semantic properties for each group in order to condense the groups’ definitions into representative ‘core definitions’. Differences in the definitions of terminology were identified and words were classified as concordant (used in the same way) or discordant (used in different ways) by the three speech communities. Results. Parents experience difficulty in understanding terms used by doctors and words in common use were understood differently by these two groups. Most Xhosa words were not in the doctors’ vocabulary, and some common English words were not in the parents’ vocabulary. Where words were in the vocabulary of both groups, significant differences existed in the number and range of definitions, with many clinically significant discordances of definition being apparent. Some common examples relevant to paediatric respiratory problems are presented. Three culture-specific explanatory models of respiratory illness, ingqele, xakaxa and idliso, are illustrated.
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    Language as a barrier to care for Xhosa-speaking patients at a South Africanpaediatric teaching hospital
    (2006) Levin, M E
    Background. Disease is closely linked to the social context in which we live. Difficulty with communication, cultural incompatibility between patients and health care providers and socioeconomic obstacles are important barriers to quality care when doctors and patients come from different backgrounds and speak different languages. Red Cross War Memorial Children’s Hospital (RCH) is a paediatric teaching hospital in Cape Town where staff members communicate mainly in English or Afrikaans, while many patients speak Xhosa as their first language. Objectives. The study aimed to identify barriers to optimal care for Xhosa-speaking parents of patients at RCH. The contribution of language difficulties was assessed as a possible barrier to health care for this group. Design. A questionnaire was developed and administered to 53 Xhosa-speaking parents of children admitted to the shortstay ward at RCH. The questionnaire examined parents’ perceptions of barriers to their children’s care, using openended questions, closed-ended questions and selection from lists. Results. Parents experienced significant structural and socioeconomic barriers to access of health care for their children. Language and cultural barriers were cited by more parents as a major barrier to health care than structural and socioeconomic barriers. Parents did not have access to same language practitioners, as only 6% of medical interviews were conducted partly or wholly in the patient’s home language. Of the 94% of interviews where no Xhosa was spoken by medical staff, 21% were conducted with the aid of an interpreter (formal or ad hoc) and in 79% no interpreter was used. Parents experienced difficulties with understanding the doctors (64%), making themselves understood (54%) and asking questions (38%). Sixty-nine per cent of parents were dissatisfied with communication between themselves and their doctors and 45% were concerned about negative effects of poor communication on them or their children. Parents tended to blame their own linguistic limitation rather than those of the doctors.
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    Overcoming language barriers
    (2006) Levin, M E
    Patients experience significant barriers to accessing quality medical care. Foremost among these are socioeconomic, structural and cultural/linguistic barriers. Studies also focus on the potential implications of alternative explanations for disease. In the African setting these alternative explanatory models are often regarded as a cause for decreased assessment of severity,1 late presentation,2,3 non-adherence to medical treatment4 and the use of potentially dangerous traditional remedies.5,6.