Communicating taboo topics in gynaecological consultations in Malawi : a sociolinguistic study on effective strategies used in a conservative culture

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dc.contributor.advisorMongie, Laurenen_ZA
dc.contributor.advisorSouthwood, Frenetteen_ZA
dc.contributor.authorChirwa Kajombo, Marionen_ZA
dc.contributor.otherStellenbosch University. Faculty of Arts and Social Sciences. Dept. of General Linguistics.en_ZA
dc.date.accessioned2022-03-10T13:34:15Z
dc.date.accessioned2022-04-29T09:33:55Z
dc.date.available2022-03-10T13:34:15Z
dc.date.available2022-04-29T09:33:55Z
dc.date.issued2022-03
dc.descriptionThesis (PhD)--Stellenbosch University, 2022.en_ZA
dc.description.abstractENGLISH 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.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Die kliniese blik, wat die kombinasie is van doktersdeskundigheid en inligting wat vanaf en op die pasiënt verkry is, vorm die basis van diagnose en prognose (Foucault 1975). Daarom is oop dokter-pasiënt-kommunikasie 'n voorvereiste vir suksesvolle mediese konsultasies. In die meestal konserwatiewe Malawiese kultuur word ginekologiese onderwerpe egter as taboe beskou, veral as dit met persone van die teenoorgestelde geslag bespreek word. Ondanks die botsing tussen biomediese vereistes van openheid en sosio-kulturele vereistes van stilte oor ginekologieverwante onderwerpe, vind daar inderdaad in Malawi konsultasies met manlike ginekoloë, waarvan daar meer as vroulike ginekoloë in Malawi is, plaas. Die aard van kommunikasie in hierdie konsultasies was egter nie bekend nie. Hierdie studie ondersoek die aard van geslagsdiskordante kommunikasie oor onderwerpe wat verband hou met seks, vroueliggame, voortplanting en onvrugbaarheid in Malawiese ginekologiese konsultasies. Hierdie kwalitatiewe studie is ingebed in 'n sosiolinguistiese teoretiese raamwerk, en maak gebruik van Interaksionele Sosiolinguistiek (Gumperz 1982, 2015), Gesitueerde Diskoeranalise (Gee 2011) en X-femisme-teorie (Allan & Burridge 2006) om Chichewadominante interaksies tussen manlike ginekoloë en hul pasiënte in 'n openbare hospitaal in Blantyre te bestudeer. Die studiehospitaal is 'n distriks- en verwysingshospitaal wat noodgevalle behandel wat daarheen deur ander, kleiner gesondheidsorgfasiliteite verwys word. Daar was twee deelnemersgroepe (almal Chichewa-sprekende Malawiërs): vier ginekoloë wat in die studiehospitaal praktiseer, en 12 vroue wat minstens een keer in die 12 maande vóór data-insameling 'n ginekoloog geraadpleeg het. Individuele onderhoude is met die pasiëntdeelnemers gevoer waartydens vrae gevra oor hulle ervarings met kommunikasie in ginekologiese koontekste (bv. watter terme hulle gepas vind; of en, indien wel, hoe kultuur hul kommunikasie beïnvloed; watter diskoersstrategieë hulle ginekoloë gebruik het), aan die hand van ‘n oudio-opname waarna hulle aan die begin van die onderhoud geluister het. Hierdie oudio-opname was van 'n gesimuleerde ginekoloog konsultasie in Chichewa. Die ginekoloë is ook individueel ondervra, onder meer oor die gebruik van diskoersstrategieë en die invloed van kultuur op die Malawiese ginekologiese praktyk. Agt gesimuleerde ginekologiese konsultasies het ook plaasgevind: Agt pasiëntdeelnemers het elk een ginekoloogdeelnemer geraadpleeg oor 'n mediese toestand van haar keuse. (Elke ginekoloog was dus by twee gesimuleerde konsultasies betrokke.) Die onderhoude en gesimuleerde konsultasies is opgeneem (met slegs klank) en getranskribeer en is tematies ontleed; deur middel van Interaksionele Sosiolinguistiese metodes (Gumperz 1982, 2015) en Gesitueerde Diskoersanalise (Gee 2011). Taboe verwysende uitdrukkings is geanaliseer deur van X-femisme-teorie (Allan & Burridge 2006) gebruik te maak. Uit die perspektiewe van voormalige pasiënte en praktiserende ginekoloë in die onderhoude en gesimuleerde konsultasies is gevind dat: (i) kommunikasie oor kultureeltaboe-onderwerpe inderdaad 'n uitdaging is, wat (ii) oorkom kan word deur die daarstelling van verhoudingsgrense en identiteite van gespreksgenote asook deur negatiewebeleefdheidstrategieë te gebruik; (iii) sosiokulturele beginsels betrokke is by aanvaarbaarheidsoordele oor Chichewa terme vir seksverwante sake; en (iv) die huidige praktyk in ginekologiese konsultasies as suksesvol beskou word, maar kan verbeter. Kortom het hierdie studie bevind dat ondanks kulturele beperkings op die bespreking van onderwerpe soos seksuele gesondheid en geslagsvoortplanting, sosiolinguistiese strategieë suksesvol gebruik word om die doelwitte van ginekologiese konsultasies in kultureel konserwatiewe Malawi te bereik.af_ZA
dc.description.versionDoctoralen_ZA
dc.format.extent216 pagesen_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/124802
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.rights.holderStellenbosch Universityen_ZA
dc.subjectDoctor-patient communication -- Malawien_ZA
dc.subjectTaboo gynaecological topicsen_ZA
dc.subjectMalawian gynaecological consultationsen_ZA
dc.subjectSituated discourse analysisen_ZA
dc.subjectInteractional sociolinguisticsen_ZA
dc.subjectX-phemism theoryen_ZA
dc.subjectUCTDen_ZA
dc.titleCommunicating taboo topics in gynaecological consultations in Malawi : a sociolinguistic study on effective strategies used in a conservative cultureen_ZA
dc.typeThesisen_ZA
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