Speaking the language of the patient: indigenous language policy and practice South African Family Practice is co-published by Medpharm Publications, NISC (Pty) Ltd and Cogent, Taylor & Francis Group S Afr Fam Pract ISSN 2078-6190 EISSN 2078-6204 © 2016 The Author(s) RESEARCH South African Family Practice 2016; 58(1):30–31 http://dx.doi.org/10.1080/20786190.2015.1083718 Open Access article distributed under the terms of the Creative Commons License [CC BY-NC-ND 4.0] http://creativecommons.org/licenses/by-nc-nd/4.0 Speaking the language of the patient: indigenous language policy and practice Margaret Matthewsa* and Jacqueline Van Wykb a University Language Board, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, Republic of South Africa b Clinical and Pedagogical Education, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, Republic of South Africa *Corresponding author, email: vanwykj2@ukzn.ac.za 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’ com- municative 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. Keywords: communication, isiZulu, language, policy, practice, rural patients 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 pro- ficient 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 Med- icine and Bachelor of Surgery programmes. While aligning teach- ing 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 lan- guage 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 assess- ments 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 knowl- edge 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 regis- tered 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-en- quiry section. The quantitative data was analysed using an ap- propriate 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 abil- ity to communicate with their patients had not improved suffi- ciently 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)]. 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 addi- Table 1: Written test results for the study cohort (2010 and 2012) Test Range (%) Mean (%) Standard deviation 2010 (n = 61) 0–47 7.31 11.972 2012 (n = 60) 22–95 61.77 18.061 mailto:vanwykj2@ukzn.ac.za http://orcid.org/0000-0002-2225-0524 31 S Afr Fam Pract 2016; 58(1):30–31 tional input in order to achieve an appropriate level of commu- nicative 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 com- municate with patients. In response to this need, efforts are being made to improve language learning by emphasising communica- tive 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 develop- ment 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 Univer- sity 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. Received: 10-06- 2015 Accepted: 08-08-2015 Introduction Method Results Conclusion References