Is ad-hoc interpreting acceptable in an oncology context in urban South Africa?
By Mbweli Ndachi & Kim Wallmach
While effective patient-centred communication is key for all clinical encounters, this is even more true for cancer care, where the diagnosis can be life-threatening, the treatment arduous, and the effect of psychosocial factors on the patient substantial (Kissane et al. 2012; Surbone 2009).
Educational efforts regarding cancer prevention and treatment have increased in South Africa, but obstacles to communication are still significant (Bezwoda et al. in Mullin, Cooper and Eremenco 1998:73-74).
The language barrier in South African public hospitals, better documented for other areas of specialisation rather than for oncology, has been shown to cause frustration for both medical staff and patients as well as errors in diagnosis and treatment (Schlemmer and Mash 2006; Penn, Watermeyer and Evans 2011), with doctors having to “request more tests, hospitalise patients more often and frequently delay initiation of treatment” as a result (Deumert 2010: 54).
Non-compliance and treatment default are also a factor when patients do not understand doctors and therefore neither understand their conditions, nor their treatment options (Deumert 2010:54). To bridge communication barriers, the services of ad hoc untrained interpreters (such as relatives, doctors, nurses, cleaners, porters and other patients) are used, since there is no statutory interpreting service in South Africa.
However, the use of ad hoc untrained interpreters has been shown to lead to more complications, including breach of patient confidentiality, distortion and/or omission of information (Leanza 2007:11-12; Lesch 2007).
This study, conducted at the Department of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital, attempts to ascertain the impact of the language barrier specifically in the oncology setting, from a trained interpreter’s perspective. In the first part of this study, semi-structured interviews were conducted with 100 patients and questionnaires were distributed to 78 medical staff members in order to obtain a clear picture of their linguistic profiles.
Thereafter, the interpreting performance on video of a trained interpreter is contrasted with that of an ad hoc nurse interpreter through the use of Conversation Analysis (CA).