Is there a better way to say "opportunistic infection"?

After more than a quarter of a century of the AIDS pandemic, there is an extensive lexicon of jargon associated with HIV infection, but this has not made it any easier for doctors to communicate with their patients.

Linguists at South Africa's University of Stellenbosch are beginning to analyse the interactions between patients and doctors at selected sites in the country's Western Cape Province, and have found that many doctors are uncomfortable talking about deeply personal subjects such as sex and sexuality.

After recording conversations between doctors and their patients, linguist Christine Anthonissen and her team found that physicians were sometimes vague, omitted difficult topics, or spoke in a manner aimed at reducing any tension a patient might have been feeling during the visit.

Speaking on Wednesday at the opening of the 6th annual Communication, Medicine and Ethics Conference (COMET) in South Africa's southern city of Cape Town, she said part of the obfuscation by doctors was to mask their own discomfort.

"Some doctors are still very awkward at dealing with something that's not about pills or fixing a broken arm, but about moving closer to a patient and talking about things like lifestyle," said Anthonissen, who suggested it could be helpful to require all South African physicians to have some training in HIV counselling.

Help needed

Some doctors are still very awkward at dealing with something that's not about pills or fixing a broken arm

Further research by the university has shown that more than a decade after apartheid, many South African doctors continue to consult primarily in English or Afrikaans; at best, these are the second languages of most South Africans.

To bridge this gap, doctors often leaned on already overburdened nurses who might be able to speak one of the country's other nine official languages, but nurses were reluctant to add additional and unpaid duties to their workloads, Anthonissen said.

At one Western Cape clinic, the problem has been solved by using HIV-positive counsellors from a local non-governmental organisation. Berna Gerber, another Stellenbosch researcher who analysed a small set of interactions between doctors, clients and these counsellors, found that most patients thought them a positive addition to the clinic.

Gerber said the counsellors not only translated the doctors’ comments from English into isiXhosa, but were also able to provide counselling to patients while they translated.

Using community-based counsellors as translators could alleviate the shortage of professionally trained translators in government health facilities, while providing patients with additional access to HIV and AIDS services, such as support groups, Anthonissen suggested.

"The truth is, there are not going to be enough trained interpreters in the near future, and this may be the way to go," she said. "It's an employment opportunity for them, and they do an incredible job."

llg/oa/he