Language, context, politics and health

Language, context, politics and health


Posted 00:12am (Mla time) Mar 18, 2005
By Michael L. Tan
Inquirer News Service



Editor's Note: Published on page A15 of the March 18, 2005 issue of the Philippine Daily Inquirer


WE often wish we could figure out what's in people's minds. Parents with teenage kids, for example, complain constantly, "Ano ang nasa kukote niya?" [What's in that kid's skull?]

Well, you'd know if you'd just listen to what the kid's saying, or isn't saying. Even those grunts they use to answer our questions have meanings: "Can't you see I'm growing up? I'm happy. I love you, but leave me alone."

I digress. My point is that we can learn about people's values, ethos, world views by listening to what they say (and, again, don't say). Anthropologists do this all the time, and it's a skill I've been trying to pass on to physicians and health professionals. To help them become more effective, I've urged them to listen, not just to what their patients are saying to them, but also to what they are saying to their patients and their patients' families.

It's a matter of listening in context. For non-health professionals, a "bukol" can be a bump on the head. Or it can be used to refer to a growth on the breast -- "bukol" used here sometimes in denial of a more serious problem. Now, when a doctor says they've found a "bukol" on a patient, that pronouncement can cause hysteria because it's immediately interpreted as a deadly cancerous growth.

This example only underscores cultural differences that exist even among people who think they share a common culture. Doctors and patients may use Filipino and yet misunderstand each other because there are different interpretations of the same words. In a sense then, even Filipino spoken by Filipinos needs to be "translated."

’Gamot, lason’

Because words are so powerful, we have to be conscious about how they're used. Last Wednesday, I wrote about how pesticides are now often referred to as "gamot" [medicine], which both reflects and reinforces Filipinos' cavalier attitude toward these dangerous chemicals. If pesticides are gamot, then they can be kept inside the house, often even next to food. The risk of poisoning is all too real, as may have happened in Mabini, Bohol, resulting in the deaths of 28 schoolchildren.

I urged a return to the term "lason" [poison] to refer to pesticides, the term evoking a mental image of a skull and crossbones. "Lason" is a powerful word that tells us, "Danger." I've also been using the term when talking with drug dependents, a way of reminding them that they're poisoning themselves. I do this because "drugs" and "bawal na gamot" [prohibited drugs] have actually taken on positive connotations, words that carry notions of danger but in an alluring and challenging way. "Drugs," in the context of contemporary Filipino society with every other celebrity now hooked, evokes "Try me" rather than "Avoid me."

‘And then there's 'agas'

Context is so important here. Anthropologist Malot Ingel, who lives in Vigan, Ilocos Sur, texted me after reading my column to point out that in Ilokano, "gamot" actually means poison. The Ilokano word for medicine is "agas." So, I asked her how the words are used in her area and, hold your breath, here's what they have: "gamot" is used to refer to substances like rat poison, which is fine in the Ilokano context because gamot there means poison. But stuff used to spray plants, as well as termite control chemicals, are "agas" or medicine.

Now why should rat poison be called poison and pesticides medicine? I don't have certain answers here, but maybe it's because the effects of rat poison (which we also call "lason" in Filipino) are more visible. We see the dead rats, but we don't see the dead insects killed by pesticides. Even several hundred dead termites don't quite have the impact of one dead rat (especially the ones that have grown obese from feasting on urban garbage).

My advice to Malot, who works with nongovernmental organizations, is to encourage a semantic shift -- a change in meanings -- of pesticides from "agas" [medicine] to "gamot" [poison]. It's really reversing an earlier shift. Filipino farmers were calling pesticides "lason" well into the 1980s, much to the dismay of government farm extension workers and pesticide distributors who wanted farmers to use more of these chemicals. The word "gamot" (as medicine) may in fact have come from people who wanted to boost sales of the chemicals. They were too successful, I'm afraid.

'Ligtas buntis'

Let me move to another example of the often-thorny issues around health and language: the current controversy around the Department of Health's “Ligtas Buntis” program.

The first time I heard the term, I knew the DOH was going to get into trouble. It was too vague a term. I was at a meeting when the term was used and everyone asked what the campaign was going to be all about.

The DOH now explains that Ligtas Buntis means "Safe Pregnancy," with family planning advocacy linked to maternal health. Anti-family planning groups, including the Catholic bishops, saw it differently, translating "Ligtas Buntis" into "Safe from Pregnancy."

It's not a mistranslation, when you think about it. Even Donald Dee of the Employers' Confederation of the Philippines, a strong family planning advocate, said on a television talk show that "Ligtas Buntis" meant "safe from pregnancy" and added that the choice of the name was unfortunate, implying people needed to be saved from pregnancy.

Not surprisingly, the wrath of anti-family planning groups has descended on the health department, with groups like Couples for Christ dissociating themselves from the campaign.

I'll save (note that "ligtas" would not be appropriate here) for future columns other examples of unwise language choices in medical consultations and in public health campaigns. Suffice it to say, for now, that words are especially volatile in relation to health. We value health and fear illnesses, so words are all too quickly reinterpreted and misinterpreted.

We learn to associate certain meanings with certain words based on our experiences and those of people close to us. Thus, "bukol" takes on ominous meanings because we hear of how so-and-so died a week after being diagnosed with a "bukol." The actual context disappears, submerged by our own experiences.

There's politics here as well. Whatever the health department may have called its current maternal health campaign, the inclusion of family planning, even if marginally, would have raised the conservatives' hackles. If they had their way, there would be no family planning at all in the Philippines, natural or "artificial."

Despite the limitations of dealing with dogmatic ideologues, I'd still say we need to be careful with words when used in health care. Whether a mother or a health secretary, an NGO worker or a rural health unit midwife, what we say and do as we provide health services and combat illness will go a long way, around our social circles and across generations.