Language and the role of interpreting in South African psychiatry : a study of institutional practice in the Western Cape

• Main Author: Drennan, Gerard
• Other Authors: Swartz, Leslie
• Format: Doctoral Thesis
• Language: English
• Published: University of Cape Town 2014
• Subjects: Psychology
• Online Access: http://hdl.handle.net/11427/9662

Bibliography: p. 195-216. === This dissertation describes three studies aimed at documenting the impact of language diversity on psychiatric service provision in institutional settings in the Western Cape province of South Africa. Speakers of indigenous languages other than Afrikaans invariably require the assistance of an interpreter to access services as there are very few mental health professionals (excluding psychiatric nurses) who speak a black African language. However, there are no official interpreters in state services and so ad hoe solutions are employed. The full extent of the need for interpreting services and the volume of use of inappropriate people to interpret in a particular health sector had never been empirically investigated. Questionnaires were therefore used to document clinical interviews that required the assistance of an interpreter at two local psychiatric institutions (Valkenberg Hospital in 1993 and Lentegeur Hospital in 1994). The analysis of these data show the impact of inadequate language resources on service provision to be profound. Semi-structured interviews were conducted with questionnaire respondents at Lentegeur Hospital to assist in the interpretation of the questionnaire data. The analysis of the interview data addresses the inter- penetration of societal discourses and discourses of public psychiatry around race, identity, alienation and community. A third study, conducted at Valkenberg Hospital in 1997, employed rapid assessment techniques and focused ethnographic methods to evaluate the effectiveness of interpreters provided to the hospital-by a non-governmental organisation. Questionnaire data replicated the earlier quantitative studies, but archival data, semi-structured interviews with hospital staff and interpreters, and observation were used to explore in more detail the impact of language diversity in particular clinical settings. The effectiveness of the designated interpreters was limited by the extent of the need for interpreting and the absence of change in the overall approach to patients requiring interpreting. Multiple implicit and explicit roles for interpreters are identified and shown to express unrealistic expectations on the part of hospital staff regarding the capacity of interpreters to solve a thicket of problems that constellate around language issues. Obstacles to communication were found to be paradoxically visible and invisible in clinical work, being determined in large measure by the circumstances of institutional practice. Complex negotiations of identity in South African institutional settings are illuminated through an examination of the position of the African nurse as a culture broker. The theme of identity is explored further through the consideration of the socio~political dimensions of being 'known' in institutional contexts for black patients. Socio-political factors in the transformation of institutional identity in a post- apartheid health care environment were illuminated through a consideration of the role of language and this is also explored. Recommendations are made regarding the role of language in the development of culturally competent mental health care.