For our ninth meeting on Tuesday 6 September 5.00-6.30pm Gambian Time, we had asked our attendees to read a few excerpts from—as far as we know—the only academic research article on the topic of Gambian language use in healthcare settings. This article was:
ARTICLE: Kayode, O.S., Ibitoye, B. and Olanrewaju, M.K., 2013. Roles of Local Languages on Effective Public Healthcare Delivery in the Gambia: Implications for Psychological Assessment. Texila International Journal of Public Health [you can download at the top of this page; the excerpts we asked attendees to focus on can be found on the meeting page).
Around a dozen people attended the meeting and we had a mixture of healthcare professionals and academics from The Gambia and beyond. Liz Jacobs (Vice President for Research, MaineHealth) and Allison Squires (in absentia, Research Associate Professor, Dept. of General Internal Medicine, Grossman School of Medicine, New York University) had agreed to support our meeting due to their expertise in language issues in multilingual health settings. They shared with us some useful resources you might want to consult (see end of the summary).
The meeting focused on the four questions below:
1. When is English used in healthcare settings? When are Gambian/local languages used in healthcare settings?
2. p. 2. The authors talk about ‘local language discordant encounters’. How do such kinds of encounters manifest in The Gambia? See below for a definition of language discordant encounters: “Language-discordant encounters occur when patients and healthcare providers speak different first languages, which may manifest as differences in proficiency and experience and therefore hinder the ability to communicate nuances critical for understanding [7]. Language concordance is a particularly important foundation to gain trust, optimize health outcomes and advance health equity in diverse patient populations.” The above quote is from: Molina, R.L. and Kasper, J., 2019. The power of language-concordant care: a call to action for medical schools. BMC medical education, 19(1), pp.1-5.
3. Research shows that using a language patients understand/local languages boosts patient satisfaction, improves the rate of compliance with medical instruction and therefore health improvements, reduces anxiety for the patient, etc. and reduces cost. What are the barriers to local language healthcare provision in The Gambia?
4. How could local language communication in healthcare settings be improved? (See recommendations in the article)
Our discussions highlighted a few important points regarding the language situation in healthcare settings in The Gambia.
First, it was highlighted by several health practitioners (including a registered practicing nurse in The Gambia) that spoken interactions between patients and health practitioners mostly happened in Gambian languages, particularly the two languages of wider communication of The Gambia: Olof and Mandinka. In keeping with conversations we have had in other reading group meetings, we were reminded that many Gambians speak Olof and/or Mandinka fluently. The strategies used by practitioners to determine which language to speak with their patients were discussed at length. We notably honed in on specific strategies they use to determine what might be patients’ first language. Some practitioners shared that if they have access to it, they use the surname of patients (and other indicators too such as what they might wear) to determine patients’ ethnic origin and therefore the language they might be able to speak. Others waited to see which language patients would use when they initiate the conversation (after exchanging the common Muslim greetings in Arabic).
Second (and related to our first point), English was said to be used in spoken interactions in health settings in a relatively small number of circumstances such as instances when patients may not be Gambian and therefore would be unable to speak the aforementioned languages of wider communication and when healthcare practitioners might be posted to areas in The Gambia where they don’t speak the local languages. The specific case of Cuban health practitioners who came to The Gambia in the noughties and could not speak Gambian languages (and at times could not speak English either) was also taunted as an example of communication challenges in healthcare settings in The Gambia. However, it was also emphasised that anything which had to do with writing in healthcare contexts would be done exclusively in English since Gambian languages are not commonly read and written.
Third, the fact that most healthcare practitioners can only speak one of the two languages of wider communication—Olof and Mandinka—was presented as one of the key challenges, especially when they are posted in areas where their language is not spoken. This was said to be frequent in the Upper River Region of The Gambia (The Gambia is divided into 6 administrative regions based on their position relative to The Gambia River).
Fourth, in language discordant situations, i.e. situations where the patients and health practitioners do not speak the same language(s), we discussed two important topics which time did not allow us to fully explore: (i) the use of community interpreters (e.g. adults or children in the patient’s family) and (ii) healthcare practitioners’ ad hoc learning of the languages of communities they might be posted in. The latter point echoed discussions we had in previous meetings where we discussed teachers being posted in communities they do not speak the language and learning by themselves the local language(s) by immersing themselves in these communities.
Liz Jacobs concluded the meeting by emphasising that the kinds of communication discussed during the meeting were universal. Drawing on their experience of working in a wide range of geopolitical South and African contexts, they expressed their satisfaction that many encounters in healthcare contexts in The Gambia were language concordant, i.e. patients and healthcare practitioners are often able to communicate in a language they fully understand. However, they also reminded us that there are many things which can be done to support healthcare contexts such as The Gambia’s, where the language of spoken and written interactions isn’t the same. Ensuing conversations included discussions around opportunities for in-service or pre-service health practitioners to participate in training in medical interpreting and/or attend language courses to learn the two languages of wider communication and other Gambian languages.
Resources recommended by Allison Squires and Liz Jacobs:
US National Council for Interpreting in Health Care: www.ncihc.org. They have excellent training resources and many of their webinars are recorded.
Hull, M. (2016). Medical language proficiency: A discussion of interprofessional language competencies and potential for patient risk. International Journal of Nursing Studies, 54, 158–172. https://doi.org/10.1016/j.ijnurstu.2015.02.015
mac Donnacha, J. (2000). An Integrated Language Planning Model. Language Problems & Language Planning, 24(1), 11–35. https://eric.ed.gov/?id=EJ621497
Please email clyde.ancarno@kcl.ac.uk if you can’t access the articles above.