Who’s Talking With Whom? Communication and Public Health in Senegal

Talia Katz - Senegal

March 7, 2013

Ask the Senegalese what the national language of their country is and the responses are often mixed. While the government and all reliable media sources assert with black and white precision that it is French, a little grassroots observation displays something quite different. While French may be the national language of Senegal, the amount of Senegalese on the streets who speak fluent French (or even have the ability to communicate in French), use French in the home, or who even willingly chose to communicate in French when both parties speak another language in common is questionable.  Over eight ethnic groups and thus over eight distinct languages exist in a country roughly the size of Tennessee- a feat which surely creates an added dimension of cultural richness. Yet in terms of the national public health system, the plethora of local languages has created a large communication burden which complicates the structure and its ability to effect change.

Through a long series of capricious events, I’ve come to study four different local languages throughout my time in Senegal- tongues which have served as integral components of my experience. Wolof proverbs found me additional apprenticeships and opportunities, warm Pular greetings gifted me delicious bananas and avacados, Malinke conversations granted genuine access into a world which otherwise would be hidden from my foreign eyes, and most recently Serer has helped me more quickly integrate into a region exhausted by ignorant, yet well intentioned tourism. I am a huge believer in the importance of preserving and utilizing local languages, yet through my apprenticeships with rural health posts around the country I’ve come across some critical tensions between the efficiency of the health care system and the state of language at large in Senegal .

In the Senegalese public health care system, doctors, nurses, and midwifes complete trainings of various lengths in order to receive their qualifications. Once certified, the state assigns each of its new professionals to work in a specific region. Upon arrival, health bureaucrats of the regional level allocate the health workers positions in hospitals, health centers, and posts. From there, employees spend a minimum of two years on site, with the option (depending on availability) to change locations upon termination of the contract. Theoretically, differences of local language should not hinder productivity because French should serve as the lingua franca and national languages of the state. However in practice, the practice of sending health workers to rural sites works much differently.

Take for example a Wolof midwife who finds herself in the Malinke village of Tomboronkoto. The trained midwife arrived with fluent French and Wolof skills, yet still lacks the ability to communicate directly with the Malinke and Pular villagers. One of the midewife’s tasks is to consult women on family planning strategies and options, an incredibly touchy and private concept requiring a sense of utmost confidentiality between the professional and patient. When the Wolof midwife calls in a translator (usually a male) to help explain birth control options to the woman in question,  the midwife often finds that her patient closes up and refuses to divulge intimate details for fear that the entire village will know her personal business within a matter of minutes, or even just that the translator will judge her choice. Thus her request for family planning mysteriously turns into a backache or headache the moment another person opens the creaking door to the consultation room.  The Malinke villager, mother of six, then leaves with Tylenol rather than the information or prescriptions she really needs. This problem repeats itself with other diagnosis such as Sexually Transmitted Infections, pregnancy, Tuberculosis, etc…

Moreover, take the National Meningitis Campaign which Senegal ran with funding from numerous international partners such as the World Health Organization in November. In order to support the efforts of the local teams, the national government sent volunteers to zones with challenging infrastructure- zones located usually farther away from Dakar, farther away from the coast. Volunteers coming from institutions of higher learning in Dakar or other urban cities normally lack the ability to communicate in the minority languages found in the most isolated, rural sites.  Therefore much information regarding the purpose of the vaccine and instructions as to what to do if someone demonstrated a side effect were lost- even the basic instructions as to who was eligible for the vaccine proved stressful and complex to communicate.  Take into account that ethnicity and language in Senegal tightly intertwine, bringing into account issues of racism and closed mindedness when volunteers speak another local language, rather than that of the village within the vaccination site. With a shortage of qualified professionals originating from the state’s most isolated locations, disconnected city workers take on tasks that local groups could potentially tackle with much more efficacy.

Additionally, local language structures themselves can complicate attempts of medical professionals to educate about public health issues and disease prevention. Another fellow recently noted the frustration in explaining diarrhea to a patient. How can one tactfully insert western medical terminology into a language lacking a foundation for them?  How does one try to scientifically elucidate a concept which for millennia tribes referred to simply as “the stomach that runs?” Doctors write prescriptions in French (local languages have only recently become alphabetized), unintentionally allowing patients to slip into frequent misunderstandings in a country with an adult literacy rate of around 50%.

Even with all of the above issues, the Senegalese health care system serves as a model not only for its West African neighbors, but the continent at large. Pilot programs and precedents set here carry a large impact. Thus the interconnected role of local language, communication, and the public health sector will be subjects that many African states (specifically those with multiple ethnic groups within their borders) must closely look at if they wish to maximize the impact of their health sector.

Talia Katz