Language change could help health
Experts say a refusal to take Aboriginal languages seriously can harm medical outcomes for Indigenous Australians.
As well as leading to less than optimal medical outcomes for Indigenous Australians, the lack of language flexibility also leads to “mistrust and disengagement with the health sector and noncompliance with treatment regimens”, according to the author of a Perspective published in the Medical Journal of Australia.
Dr Robert Amery, head of Linguistics at the University of Adelaide, writes that although data is not available about the life expectancy of native speakers of Indigenous languages as a group, the gap in life expectancy exceeded 16 years for Indigenous people living in the Northern Territory, “70 per cent of whom live in remote areas, and 60 to 65 per cent speak an Indigenous language at home”.
“The communication gap as a contributor is under-rated and under-researched,” Dr Amery writes.
Miscommunication can be subtle and hidden, outside the awareness of both parties who may think that they understood each other, but in fact came away with very different understandings.
“While many speakers of Indigenous languages living in remote areas can engage with outsiders and converse in English about everyday matters, they often have a poor grasp of English when it comes to health communications and other specialised areas,” he said.
Miscommunications are not just about language, however. Dr Amery says that difficulties also arise from the “interface of communication and culture, here derived from differences in worldview”.
“For traditionally oriented Aboriginal people living in remote areas, understanding of disease causation is fundamentally different. Serious diseases, even accidents, are often attributed to sorcery. Germ theory and the immune system are foreign concepts.”
Dr Amery says there were simple steps health care professionals can take to ensure optimal understanding between themselves and their Indigenous patients.
“Silence plays an important role in Indigenous cultures. Indigenous people often respond to questions after a prolonged pause, a concept foreign to those doctors who see silence as impolite in their own cultures. They compensate by filling the silence and disrupting Indigenous patients’ thoughts. There is a simple solution — pause and allow the patient to think.”
He also suggested avoiding use of “intangible” conceptual English words and vague sentences, instead focusing on factual communication. The use of demonstration and simple diagrams was also recommended.
“These examples may seem plain and obvious, but astoundingly, despite the many hours dedicated to communication in medical education, such concepts are not taught,” Dr Amery writes.
“An investment of time in the consult will have immense payoffs over the long term. We cannot expect our medical students and colleagues to adapt without teaching.
“Concepts are simple to grasp with knowledge of the languages and cultures. Is effective establishment of the Aboriginal patient–doctor relationship not one of the more teachable aspects of communication for generations of doctors?
“Education is the way forward to a practical and high impact population of medical staff who contribute to the health and pride of the people who are Australia’s national treasures.”