If a doctor referred to you as a “little criminal”, would you trust them?
Cas suspect or “suspected case” is just one example of a problematic term used in French across the Ebola response. In a highly multilingual context, local residents might interpret it literally as someone with the symptoms of Ebola who is a bad person (“suspect”) with little worth (cas sounds like ka, a diminutive in the local Nande language).
Fifteen months into the Democratic Republic of Congo’s latest Ebola outbreak, we are still asking people to overcome the fear of an indiscriminate disease and accept an intimidating medical process while communicating in a way that often creates confusion and frustration.
People long for information in a language they are familiar with. And they want to communicate with positive messages about the “last mile to zero” as the number of cases dwindles. As a humanitarian community, we should and can do this.
The good news is that there’s growing recognition about the importance of engaging with communities in the languages they speak and understand.
The current response plan includes greater focus on community engagement, recognising that two-way communication fills a vital, lifesaving function. A number of organisations are making a concerted effort to source response teams locally with the right language skills. Responders are also engaging with local media to ensure key messages are shared in accessible languages and formats.
Yet, we are still failing to systematically take into account the languages that people speak and understand, and their communication needs and preferences. This makes it much harder for responders to listen, understand, and provide trustworthy information and services to help people protect themselves and their families from the disease.
Language barriers persist
Research by the UK-based Social Sciences Research Group shows that responders are perceived as outsiders who speak different languages and don’t understand the local communication dynamics.
When they are not adapted to local language use and literacy levels, the existing communication materials on the risks of contracting Ebola are not fully understood.
This disproportionately affects women and older men, and marginalised language speakers. These groups may have had fewer educational opportunities and be less likely to speak or read the official national languages.
Health communicators also often fail to understand the vital information they are expected to relay, and carry the burden of translating this information into local languages unsupported.
More recently, Translators without Borders found that people in Beni – the epicentre of the outbreak – report improved knowledge of Ebola. However, many people still don’t have clear answers to their questions about the disease in a language they are comfortable in.
Ebola-specific terms like EDS (“safe and dignified burial”) and “swab” are in French or English and are not consistently translated and explained in local languages. People consider many of these terms inappropriate, and some react negatively to them.
Health communicators soften them by explaining and replacing key terms with descriptions that are not always accurate. This creates confusion and frustration for both community members and health communicators. It also breeds fear as many words like “suspect” and vainqueur (“victor”) are associated with ideas of criminality and violence.
Current and future efforts to control the spread of Ebola will be more effective if responders actively address language and communication issues.
“We are still failing to systematically take into account the languages that people speak and understand.”
Getting language right
What tangible actions can organisations take to get language right in the Ebola response in eastern Congo?
First, we need to proactively remedy the mistrust created by communicating poorly. Responding organisations should routinely collect data on the languages and formats local communities prefer, and act on it. Communication materials should also be field-tested to ensure they meet the needs of the people who use them.
Second, we need to limit the use of jargon and words with negative connotations. Responders should work with communities to promote the use of accurate, unambiguous, and less stigmatising words, in the languages people speak and understand.
While the use of violent words might be well intentioned, we need to further explore the use of language that respects and empowers people, in all communication channels, including the media.
Third, we need to better train and equip field teams. Regular training and updated communication materials can support them to relay accurate and up-to-date information in plain, accessible language.
While such initiatives might appear marginal, their impact can be significant. During the 2014-15 Ebola outbreak in West Africa, a similar shift toward communication in the relevant local languages was critical to ending the epidemic.
Prioritising simple content communicated in local languages through trusted sources helped responders and communities alike implement effective strategies to support sick people and prevent transmission.
Unless we adapt our communications to the needs and preferences of those affected by Ebola, the last mile in eastern Congo could be a very long one.