Browsing by Author "Chirwa Kajombo, Marion"

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    Communicating taboo topics in gynaecological consultations in Malawi : a sociolinguistic study on effective strategies used in a conservative culture
    (Stellenbosch : Stellenbosch University, 2022-03) Chirwa Kajombo, Marion; Mongie, Lauren; Southwood, Frenette; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of General Linguistics.
    ENGLISH ABSTRACT: The clinical gaze, which is the combination of doctor expertise and information obtained from and on the patient, is the basis of diagnosis and prognosis (Foucault 1975). As such, open doctor-patient communication becomes a prerequisite for successful medical consultations. However, in a generally conservative Malawian cultural context, gynaecological topics are considered taboo, especially when discussed across genders. Despite the conflict between biomedical requirements of openness and sociocultural requirements of silence about gynaecology-related topics, consultations with male gynaecologists, who outnumber female gynaecologists in Malawi, are conducted. However, the nature of communication in these consultations was not known. This study therefore investigated the nature of gender-discordant communication about topics related to sex, women’s bodies, reproduction, and infertility in Malawian gynaecological consultations. This qualitative study is embedded in a sociolinguistic theoretical framework, making use of Situated Discourse Analysis (Gee 2011), Interactional Sociolinguistics (Gumperz 1982, 2015), and X-phemism Theory (Allan & Burridge 2006) to study Chichewa-dominant interactions between male gynaecologists and their patients in a public hospital in Blantyre. The study hospital is a district and referral hospital treating emergency cases referred by other, smaller healthcare facilities. There were two participant groups (all Chichewa-speaking Malawians), namely four gynaecologists practicing at the study hospital, and 12 women who had consulted a gynaecologist at least once in the 12 months prior to data collection. Individual interviews were conducted with the patient participants. They were asked questions about their communication experiences in gynaecological consultations (such as, which terms they found appropriate, whether and, if so, how culture influenced their communication, what discourse strategies they have experienced gynaecologists using), using an audio-recording they had listened to at the beginning of the interview as prompt. This scripted audio-recording was of a simulated gynaecological consultation in Chichewa. The gynaecologists were also interviewed individually, amongst others on discourse strategies used and the influence of culture on Malawian gynaecological practice. Eight simulated gynaecological consultations also took place, with eight patient participants each consulted one participating gynaecologist on a medical condition of her choice. (Each gynaecologist was therefore involved in two simulated consultations.) The interviews and simulated consultations were audio-recorded, transcribed and analysed thematically; by means of Interactional Sociolinguistic methods (Gumperz 1982, 2015) and Situated Discourse Analysis (Gee 2011). Further, taboo referring expressions were analysed using the X-phemism Theory (Allan & Burridge 2006). From the perspectives of former patients and practicing gynaecologists drawn from the interviews and simulated consultations, it was found that: (i) communicating about culturally taboo topics was indeed a challenge, which (ii) could be overcome by establishing relationship boundaries and identities of interlocutors and by using negative politeness strategies; (iii) sociocultural principles were involved in acceptability judgements on Chichewa terms used to refer to sex-related matters; and (iv) the current practice in gynaecological consultations was deemed successful but could improve. In short, this study found that despite cultural restrictions on discussing topics such as sexual health and reproduction, sociolinguistic strategies are used to achieve the goals of gynaecological consultations in the culturally conservative Malawian context.