As the last cars raced home and before the cats began to yowl, I recorded a series of voice prompts to help vaccinated people in India share their post-vaccination adverse events. This pilot project, funded by JHPIEGO, was designed to use an Interactive Voice Response System to collect data about possible adverse events from covid-19 and other routine vaccinations.
I was doing this experimental work for a client as a part of their larger AI-for-pharmacovigilance project, but I didn’t sound like myself.
The project was aimed at multilingual Indian people who did not speak English as their first language. Given my experience, I had to tap into my Indian roots and speak with an Indian accent. Still heavily Anglicised but Indian nonetheless.
Think of a Hindi film industry actor speaking in English. Yup, that’s what I sounded like because that’s where I picked up the accent. And I was also sticking to my natural speaking voice in India, so I didn’t sound like I was “putting on” an “Indian” accent.
What was the problem?
At a time when vaccine hesitancy is on the rise, along with distrust in Big Pharma companies, language makes a huge difference in how healthcare is accepted. Language is not a sterile, objective thing. It’s dynamic, and it comes with unique and often opposing perspectives that must be acknowledged. And where possible, be acknowledged and catered to. Largescale research requires generalisability, so the nuances of language are set aside for projects that are better suited to capturing them.
According to Pillar and Zhang (1), non-English speakers were largely left out of the global conversation and exchange of information about the Covid-19 pandemic. They also were not able to access updated, high-quality, credible information about the virus, the societal impacts, or the vaccines at the same time as those who could speak English and connected to the internet.
I wrote a three-part mini-series on how and why digital literacy is vital to health communication in the modern world, so if you want to learn more, you can read them here:
Since this IVRS project is ongoing, I won’t be able to tell you everything about it.
But here’s what I can tell you:
Language was a problem in two major ways.
First, English isn’t local.
Second, Hindi isn’t everyone’s second language.
But they needed an example of the kind of narration that could work, so there I was, recording it for them.
Why was it essential to the country and the world?
This project was super interesting because I love combining linguistics with health communication. How we speak and what we value determines how well the message works. And this IVRS project had to straddle accessibility to the general public and achieve a level of sophistication and authority that encouraged responses.
Although there’s no official TFQ record of this narration being used in the project, I’m told it was a helpful start to guide the team in preparing the script in other Indian languages.
From a health perspective, this project was important because adverse events could be identified much faster than if the vaccinated person had to return all the way to the health centre to report it to a nurse.
From a language perspective, this project had the potential to showcase and overcome the language barrier. Remember, in a multilingual country like India, language isn’t the only issue; dialect is too. For example, the Kannada spoken in Bangalore and Belgaum are wildly different. While I struggled to understand Belgaum Kannada, I could easily speak in English or Hindi with the same people. So that's what we stuck to in the end: a generalisable language (English) that is accessible and credible as a starting point for the IVRS script. The project sought to expand into Hindi and other regional languages over time using the English script as the primary example.
Why does language make a difference?
Simply put: one size does not fit all.
Language isn’t a sterile, objective concept. It’s a living, dynamic aspect of individual and collective identities. Language affects our epistemologies (ways of thinking) and ontologies (ways of being). The ways we think determine how we approach health (taboo or not), and this directly affects who we approach for healthcare, why we do it, and when.
Studies show that when healthcare professionals (HCPs) speak to their patients in their language and dialect, healthcare outcomes are better than “language-discordant encounters”.
Here are a few ways language improves healthcare:
Reduces the number of readmissions
Improves staff-patient relationships and builds trust in the healthcare system
Improves healthcare outcomes (2)
Reduces the acceptance and spread of medical misinformation
Two of my favourite examples of language for health communication in action
I love love love this channel because Dr Tanaya speaks to the modern Indian woman in a great mix of Hindi and English. I’ve learned how PCOS affects women, how smoking affects reproductive health, ways to overcome societal taboos about discussing these topics, and so much more!
While this is in English, race representation matters in healthcare. Health and disease present differently on melanated skin types, compared to the usual examples of the same on caucasian skin types, and I love how Ibe brings that conversation to the fore with facts and brilliant medical illustrations. I feel seen. More importantly, I feel better educated about what to look for.
If you know other people who are making multilingual healthcare content that is also credible, please drop them in the comments below!
References
(1) Piller, I., Zhang, J. and Li, J., 2020. Linguistic diversity in a time of crisis: Language challenges of the COVID-19 pandemic. Multilingua, 39(5), pp.503-515.
(2) Diamond, L., Izquierdo, K., Canfield, D., Matsoukas, K. and Gany, F., 2019. A systematic review of the impact of patient–physician non-English language concordance on quality of care and outcomes. Journal of General Internal Medicine, 34, pp.1591-1606.
A little note from me
Hey there, this week’s blog is a quick and dirty one. I’m down with the flu, but I refuse to cancel the blog. I am determined to keep this habit-building writing exercise, so if the quality is a bit wobbly this week, please accept my apologies.
Thank you for staying with TFQ’s writing journey. I can’t wait to bring you a fresh post next week!
Until then, stay safe, stay sane, and stay true,
Shraddha
Absolutely fascinating. It always amazes me how slight changes in a language policy can affect accessibility in health and education on such a large scale.
(Slight tangent, from profesh to profesh - this week I was lecturing my Linguistics students about the rise and decline of Indian languages in South Africa! Most of it was focused on Bhojpuri, but Kannada and Malayalam had honorable mentions 😁)