clinical practice
Communication
breakdown
Health workers need to be
wary of mixed messages when
talking with Indigenous patients
from remote communities.
Robert Amery interviewed by Dallas Bastian
H
e chucked his guts up.”
Writing in the Medical Journal of
Australia, Dr Robert Amery, head of
linguistics at the University of Adelaide, said
he’d used this term when teaching a short
course in medical interpreting to a group
of Yolngu students and soon realised the
problem with such a turn of phrase.
“The Yolngu students interpreted this
idiom literally, thinking he ripped out
his intestines and threw them in the air,”
Amery said, and added this is an example
of the communication gap between health
professionals and Indigenous Australians
living in remote communities.
Amery said while many speakers of
Indigenous languages living in remote
areas can converse in English about
everyday matters, they often have a
poor grasp of the language when it
comes to health communications.
Miscommunication isn’t just about
24 | nursingreview.com.au
language, he added. “Some of these
difficulties also arise from the interface of
communication and culture, which are often
derived from differences in worldview.”
Nursing Review sat down with Amery to
find out more about the misunderstandings
between health professionals and
Indigenous Australians living in remote
areas, and how they can be overcome.
they answering this question according to
English or Indigenous norms?
If we think about worldview, we’re
thinking in one set of terms about disease
causation – viruses, bacteria, some organ
failing. They’re thinking from a very different
perspective about disease causation.
They’re thinking about sorcery. Indigenous
people often say to me: “Medicine tells
us how we get sick, but it doesn’t tell us
why we get sick. Why one person gets
cancer and another person doesn’t. Why
one person gets meningitis and another
person doesn’t.” But their explanation about
sorcery certainly does explain that.
In northeast Arnhem Land there’s a term
that means ‘wild, untamed disease’. And,
when I first heard this term, I thought it was
something serious – cancer, leprosy or
something. But actually, these are trifling
ailments: a sniffle, a little diarrhoea, nothing
too serious. These are ailments which are
just going around of their own volition.
They’re untamed. They’re wild. They’re
not under the control of a sorcerer. But if
that sniffle was to develop into something
serious, say pneumonia, then there would
be some sorcerer behind it. There would
be some cause. People are thinking about
the same thing in very different ways. We’re
coming at it from very different perspectives.
NR: In what ways are the conversations
between health professionals and
Indigenous Australians in remote
communities not hitting the mark? What impact might this
miscommunication be having on the
health of Indigenous people?
RA: Well, when we use language, we
often use metaphors and idioms without
thinking. We might say: “You’ve got high
blood pressure, you better be careful.”
From the viewpoint of the doctor or nurse,
that means you should get your blood
pressure checked regularly or ensure you
take your medication every day. But from
the viewpoint of the Indigenous patient,
it may mean something else. [Writer and
Indigenous rights campaigner] Richard
Trudgen has suggested that perhaps they
think they might have to avoid hot drinks,
because maybe that’s what’s sending their
blood pressure up, or something else. So
it’s best if we talk in clear terms.
We need to avoid double negative
questions. If we say, “You didn’t take all
those tablets, did you?”, an English speaker is
going to answer no if they didn’t take them
all. Whereas from an Indigenous language
perspective, the answer is yes to the
proposition that “I did not take all the tablets”.
And if you have someone who’s
reasonably bilingual, you never quite
know where they’re coming from. Are Often we’re not aware of this
miscommunication. Both on the Indigenous
side and the health professional side,
people might think they’re communicating
perfectly. But if this communication is not
good, then people are misunderstanding
what their condition is, and I know Richard
Trudgen uses this example of where
a patient wasn’t familiar with the term
‘tumour’. And the health professional tried
to explain it by likening the tumour to a big
boil, which put the patient’s mind at ease.
“Oh, nothing to worry about. It’s just a boil.
We’re familiar with those.” So they didn’t
understand the seriousness of the situation.
If people don’t understand their condition,
and if they don’t understand the action of,
say, antibiotics, from my experience the
entire course of antibiotics are often not
taken. People feel okay after taking the
antibiotics for two or three days. Okay, yes,
they’ve been told they should take the entire
course, but if they don’t know why, they
throw away the antibiotics. But if they knew
how those antibiotics worked, they might be
more likely to finish the course.