Learning to Care with Forked Tongues: Communication and Migrant Peoples' Health Care
This paper focuses on learning how to deliver effective communication between a multilingual, migrant patient population and multilingual health workers. I argue for increased health care accessibility through effective communication. Often translation is seen as a solution to overcome language barriers. Translation may be technically effective. However, it is an increasing concern that effective cross-linguistic/cross-cultural communication still needs to be learned. Borne out of practical necessity, learning to communicate effectively occurs in situ. Several data sources (diarised reflections, edited communication transcripts) serve to inform this paper. I situate my practice as a speech pathologist/audiologist in the United Arab Emirates, South Africa and the United Kingdom. Inspired by my practice reflections I provide a combined response to the following: (i) how do we account for effective communication even when health workers and patients are language-matched? (ii) what may we learn from communication with patients who have speech, language and/or hearing impairments and (iii) how do we respond to international conventions that implicate language in the protection of migrant workers’ rights? This paper consists of a theoretical-practical set of micro-level and macro-level considerations for this in situ learning. At a micro-level the nature of both mediated/translated and unmediated interactions are considered for how the very notion of communication is managed. Specifically, communication is re-positioned as an ‘autopoietic’ activity where the object of communication is simultaneously the way (method) we learn to communicate. Three critical learning phenomena are highlighted (i) certainty/uncertainty, (2) conflict and (3) moralism. Macro issues regarding the nature of medical knowledge and health care policy (especially as it relates to migrants’ rights) are also reviewed.
Keywords: Migrant Workers Rights, Multi-Communication Literacies, Language and Power, Language as a Human Right, Language and Health Care Access, Translation in Health Care
Dr. Mershen Pillay