Covid-19: Communication needed in a language people understand

In South Africa, most of the information can be obtained in English only, say authors

The need for multilingual information about Covid-19 and self-help plans to curb the pandemic

12 May 2020

On 21 February 2020, International Mother Language Day, AfriForum announced the findings of a survey conducted among members by its research institute. The purpose of the survey was to determine the language needs of people when consulting healthcare practitioners. Of the 1 024 participants in the survey, 83% preferred consultation and treatment in their mother language.

An alarming 19.5% indicated that they had experienced misunderstandings because they could not communicate with healthcare practitioners in their mother language. This included not being able to explain symptoms adequately, not understanding the side effects of medication, and not being able to understand the diagnosis or treatment procedure properly. Of this group, 13% experienced life-threatening consequences, 13% took months to recover and 8% have been left with life-long adverse effects.

The findings of AfriForum’s survey are consistent with the experience of participants in similar studies worldwide. An article published on GHD Online in 2017 (https://www.ghdonline.org/uploads/ Bridging_the_Language_Gap.pdf) highlights that people with limited English language proficiency who receive medical treatment in an environment where only English is used, often experience problems, like having to undergo unnecessary tests. There is an abnormally high incidence of misdiagnoses and repeated hospital admissions among them. Another study published in the Canadian Respiratory Journal in 2014 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4128525/) found that poor communication exacerbates patients’ levels of anxiety and pain. Consequently language is directly responsible for impairing their recovery.

Therefore, unambiguous communication about healthcare in the language of the audience is essential.

Currently, the Covid-19 pandemic is causing great anxiety and tension worldwide. Unprecedented radical measures are being taken in the effort to save lives. In order to understand the complex nature of the pandemic and to ensure that the public will buy into steps taken against it, the provision of information in the mother language of as many communities as possible is of paramount importance. It is interesting to compare the ways in which some countries where the majority of residents are English, handle this challenge.

In the US, the approach varies from city to city and state to state. Sometimes the need for multilingual support is understood. One of the best examples is the city of Boston, where English is the home language of 63% of the residents. The remainder, in other words 37%, speak other languages. Please note, we are talking about a minority of residents and about their home language, not whether they are proficient in English at all, yet information on the pandemic is distributed in eleven languages, namely Somali, Chinese, Arabic, Vietnamese, Russian, English, Spanish, Haitian Creole, French, Cape Verdean Creole and Portuguese. This is done by means of text messages in all of these languages, and leaflets in most of them.

In the UK, the National Health Service (NHS) also deals with many communities whose mother language is not English. A list is therefore posted on the NHS website comprising other reputable sites that provide information on the pandemic in additional languages. This also includes information on other health conditions, such as cancer and diabetes.

The Community Broadcasting Association of Australia (CBAA) reports that community radio stations play a key role in providing reliable information about Covid-19 there by means of multilingual community service announcements (CSAs) made available by the Australian Department of Health. The CBAA emphasises that it is “incredibly important” to make information accessible to community members who speak languages other than English.

They therefore inter alia offer a variety of CSA packages in the languages of Australian First Nations, developed in partnership with speakers of the languages. Currently, the announcements are also available in fourteen other languages, including Farsi, Hindi and Italian, and the undertaking is given that more languages will be added continuously as required. Brochures in numerous languages on relevant topics (such as the prevention of flu during the pandemic) can also be downloaded from the Australian Department of Health’s website, where resources are available in 36 languages.

New Zealand seems to pay less attention to multilingualism. Posters with information about the coronavirus can be downloaded from the website of the Ministry of Health in three languages (English, TeReo and Simplified Chinese). In addition, information is also available in sign language ‒ an important initiative that seems to receive less attention in other countries.

Publications of the Canadian government, as is the case in Australia, accommodate many languages. For example, information about the virus and the importance of hand sanitising is available in 25 languages, about how to isolate yourself at home in 21 languages, about vulnerable communities in 22 languages, and about preventing Covid-19 in the workplace in 30 languages.

In South Africa, most of the information can be obtained in English only, although according to the National Census of 2011, it is the mother language of less than 10% of all South Africans. To find information in any language other than English on the official website, sacoronavirus.co.za, involves quite a complicated search. There are no prominent links to multilingual information, although, for example, information has been posted in the form of frequently asked questions in Sepedi and isiZulu, among others, and the WhatsApp helpline service offers replies in five languages (English, isiZulu, isiXhosa, Sesotho and Afrikaans). Public announcements by ministers are usually in English only, with smatterings of isiZulu included sporadically.

The South African company BreadCrumbs has a unique approach, namely to make posters with essential information available in twelve languages, with a specific behavioural linguistics approach to ingrain the twenty-second-hand-wash habit into the readers’ daily routine. The posters can be downloaded free of charge from their website (https://thebreadcrumbs.co.za/covid19poster.html). They compiled the information using principles approved by the British NHS, which indicates the lack of a similar approach in South Africa.

Against this backdrop, AfriForum decided to make simple patterns for making masks and an easy recipe for the manufacture of hand sanitizer available for free in various indigenous languages.

The challenge of providing in the needs of communities with diverse socio-economic circumstances makes it even more relevant that any instructions provided should not require expensive materials or specialized machinery, but should allow for the masks and sanitiser to be made by anyone at home, even where people have no access to either running water or electricity. All that is required, is that people should be able to download the information and that the manufacturers must have basic materials such as a cotton t-shirt, scissors, needle and thread. The instructions are presented succinctly, so that little data is required to download it. It is currently available in Afrikaans, English and isiNdebele, but soon will be available in all of the other official languages of South Africa as well.

AfriForum and the Vulamehlo Kusile Organization (VUKO) have teamed up to empower the Ndebele community with this information. Local traditional leadership structures and other community institutions will disseminate the instructions and coordinate the project. According to Elias Mahlangu, Deputy Secretary of VUKO, his organization sees this joint project as a milestone in the protection of all South Africans, regardless of their language, culture and economic status.

In conclusion, a Twitter message from an interpreter in the US is perhaps the best illustration of the importance of access to medical services in one’s mother language. The interpreter was summoned to assist after a Nigerian-born patient who tested positive for Covid-19 was admitted to a hospital. He appeared to be extremely agitated and the hospital staff could not communicate with him at all. They therefore could not determine whether he was suffering from serious psychological problems or was delirious due to fever. When the interpreter arrived and addressed him in his own language, he immediately burst into tears with relief and settled down. He did not hallucinate or have any problem other than simply not being able to understand the healthcare service providers. The anxiety and emotional isolation of a sick person in these circumstances tug at one’s heartstrings.

The South African government has the obligation to follow the examples of AfriForum and BreadCrumbs as soon as possible in order to make as much information and self-help plans available in at least all eleven official languages in order to prove that they are serious about human rights and about curbing the spread of Covid-19.

By Alana Bailey, Barend Uys& Johan Nortjé, AfriForum, 12 May 2020