Language of Medicine in Bangladesh - Way For A Better Access To Health Care by Dr. Badrul Alam Et Al of Bangladesh

Language of Medicine in
Bangladesh:
Way for a Better Access to Health Care
Language of Medicine in Bangladesh | 1
Language of Medicine in
Bangladesh:
MURDHONNO
Way for a Better Access to Health

Care
Ishrat Jahan Urmi
First Published : November 2016
Badrul Alam
Abu Sayed Hasan
Tajrian Rahman
Published by :
Sanjoy Majumdar
Murdhonno
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Foreword
Copyright Authors
All rights reserved.

Price : Taka 200.00 US $ 10.00 only
ISBN 978-984-504-23....
Dedication
Abba
Amma
Manal &
Mahiar
With Love and
Gratitude
Language is a very important factor in

providing health services all over the world. If
the language is not understood properly,
patients may suffer seriously from the health
services they receive from the doctors and
other health service providers. It is obviously a
burning issue for Bangladesh.
The authors have raised important language
issues hindering health system in Bangladesh in
their book titled Language of Medicine in
Bangladesh: Way for a Better Access to Health
Care. I found this book as a fantastic guideline
to address the language issues in practice of
medicine and providing health services in
Bangladesh. The policy makers can take
initiatives to address the language barriers and
the way out to overcome those problems, as
mentioned in the recommendations in this
book.
I think, similar type of research project can be
conducted in other developing countries to
make the health services better, more effective
and successful. I congratulate the authors of
this great book for their innovative initiatives
with a view to improve the health system in
Bangladesh.
Professor Padam Simkhada

Professor of International Public Health at Public
Health Institute
and Associate Dean (Global Engagement) for Faculty
of Education, Health and Community
Liverpool John Moores University (LJMU)
Liverpool, United Kingdom
overcome
language
barrier
in
providing
health
services
in
Bangladesh
Chapter-7: Discussion
Chapter-8: Limitations of the study
Chapter-9: Conclusion and Recommendations
Bibliography
TABLE OF CONTENTS
Particulars
Page No
Terms and Meaning

Chapter-1: Executive Summary
Chapter-2: Introduction
Chapter-3: Research Questions and Objectives
of the study
3.1: Research questions
3.2: Objectives of the study
Chapter-4: Research Methodology
4.1: Study design
4.2: Study duration
4.3: Study area
4.4: Study participants
4.5: Sample size
4.6: Study materials and apparatus
4.7: Data analysis
Chapter-5: Ethical considerations
5.1: Data Safety Monitoring Plan (DSMP)
5.2: Ethical approval
Chapter-6: Results
6.1: Socio-demographics of the
respondents
6.2: Perceptions of the respondents on
the language of medicine and health
services in Bangladesh
6.3: Attitudes of the respondents towards
6.4: If language is a barrier in practice of
medicine and providing health services
in Bangladesh
6.5: Suggestions from the participants to
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Terms
Meaning
L1
L2
Code mixing
First language
Second language
Transfer of linguistic elements
from one language to another
Code switching
Use of two languages in
same situation/sentence
Physician
A
physician
is
a
health
professional
who
practices
medicine. Normally a physician is
called as a doctor (or medical
doctor)
Kabiraj
Health service providers who do
not have institutional education
or training and who use raw
trees, tree roots and other
materials for treatment
Mortality
Number of death due to illness
Morbidity
Sufferings and consequences
caused by the diseases
Chapter
1
EXECUTIVE SUMMARY
Chapter
1
Executive summary
Bangladesh is a developing country and there
are lot of issues which are obstructing to get a
successful outcome from the health services
providing by the government organisations,
non-government organisations, private clinics
and different kinds of health service providers
including doctors. Surprisingly, to the best of
our knowledge, no researcher ever took
initiatives to address the language and
linguistic issues which is a key factor and
working as a barrier in practice of medicine
and providing health services in Bangladesh.
General thinking: if someone does not know the
language, how can he or she express
something? Whereas, we all know that the
language of medicine is a bit different from the
language we speak in our daily life. In that
case, where the literacy rate in Bangladesh is
only 57.7%, how can we expect that they will
understand the language which is being used
by the doctors, other health professionals and
hospitals? So, there is a definite possibility for
language to act as a barrier to have a
successful outcome of health services in
Bangladesh. Considering all these factors, we
thought, if we could conduct a research study
to address the language issue in terms of

practice of medicine and health services, it
would be a kick start in this research arena and
it would open a new era of research and
subsequently we would be able to overcome the
language barrier with a view to attaining
Bangladesh. On the basis of the study findings,
it can be scaled up in other parts of the world,
especially the countries which are facing
similar problems like Bangladesh.
The current study was conducted among
Bangladeshi people to gather their views if
language is working as a barrier in providing
health services in Bangladesh; and if the
language is a barrier, what are their opinions to
overcome this problem in order to get a
successful outcome from the practice of
medicine and existing health systems in
Bangladesh. Most of the respondents of this
study were educated to graduate level and
post-graduate level and most of them were
young adults (18-30 years old). Data was
collected through online, so the respondents
were restricted only to those who had got
internet access. So, the study findings do not
represent the view of all Bangladeshi people as
the study could not collect data from the large
population of Bangladesh who are illiterate and
who do not have internet access. But the
researchers wish to conduct research studies in
the future bearing these issues in mind in order
to explore all the language and linguistic issues
related to the practice of medicine and health
services which will be representative of all the
regional areas and all kind of people in

Bangladesh.
According to the findings of this study, 48% of
the respondents thought that language was a
barrier to get a successful outcome in providing
health services in Bangladesh. When they were
asked to suggest the way out of this problem,
most of the participants suggested that using
the mother tongue of Bangladesh (that means
Bengali language) at least during writing
instructions for the patients to take medicine
for illness would be helpful to overcome the
language barrier in the practice of medicine.
Some of the participants suggested to use both
English and Bengali languages; to be specific,
name of the medicine in English block letters
and instructions of taking medicine in Bengali.
Although all the respondents of the study were
able to read and write, only 84% of them read
the leaflets or instruction provided with the
medicine packs. Surprisingly whoever read the
instruction, 2% of them said they did not
understand the language there, although 12%
did not wish to answer this question. Though
the percentage of people unable to understand
the language of instruction in the leaflets and
prescription was very low, we can presume the
striking high percentage of people for whom it
would be difficult to understand language of
medicine and health services who are not that
much educated and who are less-advantageous
in terms of basic facilities in Bangladesh.
linguistics to practise medicine and to provide

health services in a more efficient way. The
researchers also wish to disseminate important
findings and recommendations of the study
through
presentations
at
national
and
international
conferences.
The
study
investigators also wish to publish journal
articles and more books from this research
project.
The researchers believe that the current study

explored the need of future research
opportunities in terms of language and
Chapter
2
Introduction
Chapter
2
INTRODUCTION
Bangladesh is a monolingual and developing

country situated in south-east Asia which has a
large number of population (around 154.7
million, according to the World Bank Report
2012; actual current population would be much
higher). Around 98% people in Bangladesh
speak in Bengali (also called as Bangla),
although there are more than 30 different local
languages spoken by 45 or more indigenous
groups of linguist minorities (Rahman, 2010;
Bangladesh Bureau of Statistics, 2010). The
main official language in Bangladesh is Bengali
and the second official language is English
(Kirkwood, 2013). The English language arrived
in Bangladesh as a result of colonisation since
1757. English language is mainly used by the
minority elite community in Bangladesh,
especially in private English-medium schools
and universities (Tripathi, 1998). According to
the Ministry of Education in Bangladesh,
English is a compulsory subject to be taught
both in primary schools (up to school class 5)
and secondary schools (from classes 6 to 10)
(Hasan, 2004). In Bangladesh, English is mostly
used
for
external
or
international
communication.
Language belongs to everyone as this is the

only medium to express something (Cook,
2013). Most people feel that they have a right
to hold an opinion about language; and when
opinion differs, emotion can run high (Diener,
2003). Arguments can start from minor points
of usage to major policies of linguistic
education. As language is a very public
behaviour, linguistic factors influence how we
judge personality, intelligence, social status,
educational standards, job aptitude, and many
other areas of identity and social survival
(Clark, 2006). The language used in practising
medicine and providing health services carries
a special attribute as it is different from the
general language we speak for our day to day
conversation (Fleischman, 2001). So, it is
important to know the language and linguistic
issues related to health services. It is also
important to know if language acts as a barrier
as there is a chance of miscommunication
among the layman and health service providers;
and if it happens, it is very difficult for a nation
to get a successful outcome from the health
services without overcoming the language and
linguistic barrier.
There are around 6,000 languages in the world
(Nettle, 2000). But, the modern language of
medicine globally is English in general, but it is
impossible to deny a huge impact of ancient
Greek medicine on medical terminology (Vera,
2007). So, a good command of ancient Greek
and Latin is essential to standardize the
language of medicine. Actually, the English
language used in practising medicine and
providing health care services is a bit different

from
general
English
(Budgell,
2013).
Moreover, the English language used in
medicine has its own conventions of grammar,
phraseology and discourse with a complex and
esoteric lexicon. So, sometimes the language
differences between physicians (qualified
doctors) and patients become a strong barrier
to achieve a successful outcome of treatment
(Seijo, 1991). There are also strong evidences
which proved that language, along with race
and ethnicity, plays a major role to create
disparity to provide health care services
(Fiscella et al., 2002). So, further researches
are needed to provide a unique health care
service for all overcoming the language and
linguistic barriers.
According to World Health Organization (2008),
patient and patients family is a core
component of health care. Collection of proper
data that are the basis for proper diagnosis and
prognosis; involving the patient in treatment
planning; eliciting informed consent; providing
explanations, instructions, and education to the
patient and patients family; and counselling
and consoling the patient and family requires
effective communication between the clinician,
the patient and the patients family. When
effective
communication
is
absent,
the
provision of healthcare ends or proceeds only
with errors and poor quality of health services.
The same organization also reported that low
literacy knowledge in terms of health is a
barrier for an effective communication. Low
health related knowledge is obviously a barrier
in Bangladesh. Though health care is a complex

system, it is not very easy to make all people
aware about health system but minimum level
of awareness deserves each and every people.
It should be the responsibility of both the
government and the people of the country. Both
sides have to be serious about this burning
issue. To get high quality treatment and to
achieve an obligation of free health care, the
communication gap between health care
professionals and patients should be abolished
(Katz, 2002). Many contemporary steps may be
taken through implementation of an effective
health care system so that people can overcome
the language & linguistics barriers and can get
the best result of treatment which they deserve.
An extensive literature review was performed
to search for relevant materials for the present
study. But unfortunately no language and
linguistic research was found incorporating
health services in Bangladesh. Even a little
work has been done in Bangladesh in terms of
language and linguistic research in general.
However, a number of researches were
conducted in other parts of the world which
addressed language and linguistic issues in
medicine.
One
study
conducted
in
Massachusetts found that even English
speaking patients in the United Sates found the
language of health service providers as a
barrier to get an effective health services (Ngo
Metzger, 2003). This study also reported that
the patients preferred to use professional
interpreters rather than family interpreters to
obtain health services. They also preferred
gender-concordant translators to maintain their

privacy. So from this study findings, we can
imagine what can be the situation in
Bangladesh where Bengali is mother tongue
(L1), but the doctors use mostly English (L2)
which is considered as the second official
language in Bangladesh.
One study conducted in the United States
examined the effect of limited English
proficiency (LEP) on mental health service use
among immigrant adults with psychiatric
disorders and found that LEP was a barrier to
mental health service use among Latino
immigrants with psychiatric disorders (Kim,
2011). This study came up with some
recommendations
including
provision
of
bilingual services providers and development of
awareness of such options all over the world.
Other studies conducted around the world also
reported similar findings and suggestions. From
this evidence, we can imagine the situation of
health service in Bangladesh where English is
the major language of medicine and majority of
Bangladeshi people are not competent in
English.
Although English is the second language (L2) in
Bangladesh, it is the main medium of language
to study medicine in Bangladesh (Rumnaz,
2005). After completion of their academic study,
the qualified doctors use both English and
Bengali as a language of communication for
treatment purposes (i.e. in practice of medicine
at private chambers and in hospitals). So, in
Bangladesh, English is a major language for
communication during medicine practice,
medicine dispensing and providing health care

services. However, there is a chance of
miscommunication between the health care
service providers and the health care service
seekers, especially during providing health
education and health advices. According to
Eisemon (1992), in developing countries, poor
foreign language proficiency is an important
cause of low achievement in scientific and
technological aspects. Another study explored
that unavailability of learning resources such as
English books, newspaper or learning software
are the major constraints to make learners
expert in English language (Hamid, 2011). So,
the evidences need to be explored in terms of
language and linguistic issues which are
obstructing for practising medicine and
providing health care services in Bangladesh.
A large number of people in Bangladesh cannot
read or write in English though it is the second
popular language in this country. Even some
highly educated people cannot speak in English
properly because of lack of practice or for some
other reasons. Bengali is widely used
everywhere in school, college, university, office,
home etc as the medium of language. Thats
why when there is a need to speak in English,
they become a little bit shy to speak in this
language and take time to the get the meaning
of what is being said. The picture is similar
even among the highly educated people. In this
context, we can realize the situation of
uneducated or illiterate people. While in
practice of medicine, most of the terms and
terminologies are in English and in Latin words,
it is very difficult to translate them in Bengali.

So, there is an obvious chance to create
barriers in practice of medicine as the language
and vocabulary used in the language of
medicine and health services are different from
the language used in Bangladesh for daily life
activities. To address those issues, the critical
circumstances should come forward and it
should
be
made
conspicuous
to
the
philanthropic people, policy maker, and of
course to the language and linguistic
researchers who can help the people to know
and overcome these invisible or obscure
burning issues.
It is evident through many research studies
that poor foreign language proficiency is a
barrier in developing countries and it is likely
to be more problematic for Bangladesh where
literacy rate is very low. In Bangladesh, a large
number of populations cannot read or write, not
even in Bengali which is their mother tongue.
So it is absurd for them to understand the
foreign languages and they would know almost
nothing with regards to the language of
medicine and health services. May be, it is a
utopian idea to make the illiterate people
proficient in a foreign language like English.
English is the lingua franca for international
communication and we need to know English
for all sorts of development of a nation. No
nation can improve their economical and sociopolitical situation without a good proficiency in
English in this era of globalisation. So the
countries are automatically deprived and
underprivileged which do not have a population
who are highly skilled in English. The scenario

is worse for Bangladesh for this reason and so
this country is suffering from some untoward
miserable conditions which has not been
explored yet. That is why countries like
Bangladesh needs to come forward in
conducting more language and linguistic
research to improve their socio-economic
condition. To get an effective manpower, a
country needs a healthy population and to get a
healthy generation all the barriers should be
addressed and overcome including language
and linguistic barriers (Wallace, 2012). For
Bangladesh, where language and linguistic
research works are less evident, it is mandatory
to conduct more and more language and
linguistic studies related to health services to
decrease mortality and morbidity caused by the
diseases.
Otherwise,
the
language
and
linguistic related issues in health services will
remain submerged and unaddressed which will
ultimately lead to failure of health system in
Bangladesh.
An effective communication between a doctor
and a patient is a vital factor to get a successful
outcome from the practice of medicine and
health services. A number of research works
have been conducted around the world,
although those are not evident for Bangladesh.
But those research findings would be helpful
for Bangladesh to attain an effective health
system. One research study reported that an
effective communication among doctors and
patients brought considerable improvement in
some health outcome measures such as patient
satisfaction, adherence to treatment, and

disease outcomes (Ferguson, 2002). It is also
reported through this study that provision of
adequate information, elicitation of patient
worries had all correlated with improved
effectiveness. All of these mentioned factors
depend on communication between doctors and
patients; and the communication among them
depends on language and linguistics. When the
communication is hindered because of the
language barrier, outcomes of treatment
automatically hampers and the satisfaction of
the patients goes down. The ultimate result is
the doctor patient relationship becomes bitter.
But we all know that the doctor-patient
relationship is the centre point for practising
healthcare and it is also essential for delivering
high quality healthcare in the diagnosis and
treatment of diseases. The quality of the patient
physician relationship is important for both
parties. The better the relationship in terms of
mutual respect, knowledge, trust and shared
values, the better will be relationship among
the health service providers and health care
seekers. If the conversation between a doctor
and a patient goes smooth, quality of time will
be there and it would be helpful for the doctor
to obtain history of the patients illness which
will be ultimately helpful to diagnose a disease
accurately. The patient will also be benefitted in
terms of mental satisfaction and improvement
of knowledge about self health condition. But if
miscommunication takes place among the
doctors and patients, all will go vain. This will
ultimately lead to a poor relationship among
them and physicians ability to make a full
assessment of patients is compromised and the

patient is more likely to distrust the diagnosis
and proposed treatment, causing decreased
compliance of the patients to follow the medical
advices by the health service providers. So it is
crystal clear that the language barriers hamper
the treatment and diagnosis of disease. To
overcome this language and linguistic barrier, it
is the right time to take initiatives for the
linguists and the policy makers to resolve this
problem.
The word patient derives from the Latin word
patior which means suffer (George, 2009). The
suffering of a patient can increase due to bad
relationship between a physician and a patient.
The
physicianpatient
relationship
varies
depending on the outcome of the treatment
provided but the doctors. We need to remember
that doctors advices written in any language is
also a part of the treatment. So it does not
matter if the patient understood the advices or
not, the outcome of the treatment will definitely
be hampered if the patient does not follow the
instructions provided in the prescriptions or in
verbatim. If there is a language or linguistic
gap among them, it could be unnoticed by both
the health service providers and heath service
seekers. The ultimate result is bad relationship
among the doctors and patients and breach of
trust among themselves. Nevertheless, when
this dependency does not work or the patients
cannot trust fully on doctors, then it may be
dire for both the sides.
Usually a patient goes to the private chamber
of a doctor for treatment depending on his/her
name and fame. On the other hand, the name

and fame of a doctor depends on the
professional
skills,
trustworthiness
and
communication skills. The more communicative
a doctor is, the more he or she is popular to the
patients. Again, communication skills mostly
depend on the understanding of the language
and the skilful handling of the language. If the
patients and doctors do not understand the
language of each other, it is worthless and the
main purpose will not be served. So, faith and
reliability of patients on doctors depend mainly
on communication skills along with other
attributes. Communication gap among them is
not only harmful for the patients but also
responsible for social balance in private
practice of medicine, in hospitals and even at
community level (Colombo, 2003). Sometimes
doctors experience physical violence by the
patients or by their attendants because of
failure of treatment. Most of the times these
unexpected insulting situations could be
overcome through an effective communication
skill where language is the major tool.
Sometimes due to language barrier general
people and the doctors come face to face in
some odd situations. All of them try to
encounter with logics they have with them to
take control of that situation. Doctors try to
provide arguments to the patients and their
relatives in favour of diagnosis of diseases and
treatment. On the other side, the patients or
their attendants blame doctors or nurses for
the mismanagement of the diseases. But none
of them ever thinks about the hidden culprit,
we mean language and communication gap,

which is responsible for the failure of the
outcome of health services. It is a humiliating
situation for both the parties which could easily
be overruled through an effective language
intervention. Mostly these types of problems
occur in case of indoor patients as doctors and
other health care providers remain mad busy in
government hospitals and the number of
patients there is usually overloaded as per the
capacity. It is true that sometimes the health
conditions of the patients are so bad that there
is nothing to do from the doctors side, but it is
quite natural for the relatives of the patients to
lose their temper if any fatality occurs. Here,
communication skills work better remedy than
treatment to control these critical and violent
situations. The language of the doctors and the
attendance of patients are very important in
this critical moment. Otherwise, situation
becomes worse and invites more and more
problems. Health care providers also need to
give sufficient time to placate and convince the
attendance of the patients as they remain
anxious about the outcome of the critical
illness. Nevertheless, the horrible irritating
violence could be prevented by taking control
on the main culprit, the language barrier. It is
evident through many studies conducted
globally that language barriers not only can
lead to miscommunication with health care
providers but also can have deleterious effects
on health care system (Kim, 2011).
available in Bangladesh; to be honest, there is

no evidence of such kind of research work in
Bangladesh. Only a small number of studies
have been conducted in Bangladesh in terms of
language and linguistics issues; but an
extensive search for literature indicated that till
date there is no study which revealed language
issues for practising medicine and to provide
health care services, especially in Bangladesh.
So, we felt a crying need for conducting this
research project to address the language issues
related to medicine and health care services in
Bangladesh. The language issues explored
through this present study and discussed in this
write up were never been addressed previously
by any other study in Bangladesh. The positive
thing is that the present study may be regarded
as the first major study in the arena of language
of medicine and health services in Bangladesh.
Data related to language and linguistic issues

of medicine and health care services are barely
Chapter
3
Research Questions and Objectives of
the study
3.1: Research questions
Chapter
3
RESEARCH QUESTIONS AND
OBJECTIVES OF THE STUDY
The research study was conducted to answer

the following research questions:
1. What type of language is used in the
practice of medicine and health services
in Bangladesh?
2. Is language a barrier in the successful
outcome
of
health
services
in
Bangladesh?
3. Do people understand the language of
prescription in Bangladesh? How do they
react to the language used by medical
practitioners?
4. What, according to the audience, should
be the effective use of language in
medical practices (both in private
chambers
and
in
hospitals)
in
Bangladesh?
3.2: Objectives of the study
The objectives of the research project were:
To explore the languages which were
being used in Bangladesh to practise
medicine and to provide health care

services
To explore the reception of audience in
terms of language of medicine and health
services
To find out how the language effect on
practising medicine and providing health
services
To gather the view of respondents if
language was a barrier in the practice of
medicine and in providing health services
in Bangladesh and the way of overcoming
the problems
To recommend future study opportunities
to improve health services in Bangladesh
linked to language and linguistic issues.
Chapter
4
Research Methodology
Chapter
Inclusion criteria:
Research Methodology
The respondents were eligible to be included to

participate in the study if they fulfilled
following criteria:
Adults male or female 18 years
4.1: Study design

A cross-sectional survey was designed for data
collection of this research project.
Able to provide
participation
valid
consent
for
Willing to participate in the study

Have got internet access
4.2: Study duration

The study duration of the project was between
July 2014 and November 2014.
Exclusion criteria:
The following criteria were used to exclude the
respondents from the study:
4.3: Study area
Age <18 years
Bangladesh was the target of the research

implementation. But no specific regional area
was selected for data collection. On the basis of
availability of internet access to respondents,
the questionnaire (along with website link of
the Google Forms) was sent to the respondents
and the responses were received online.
Unable to provide a valid consent
4.4: Study participants

The
study
participants
were
selected
purposively. For the enrolment of the
respondents, the following inclusion and
exclusion criteria were followed:
Unwilling to participate in the study

Do not have internet access
4.5: Sample size
Extensive literature review showed a wide
range of sample size (small to large number of
respondents) for the relevant research.
Considering the resources scarcity, time
constraints and feasibility, data was collected
from 50 participants.
4.6: Study materials and apparatus

A semi-structured questionnaire was developed
using Google Forms to collect both quantitative
and qualitative data. The questionnaire is
composed of twenty questions (variables) and
the questions were set on the basis of literature
review, research questions and objectives of the
study. Different approaches were applied to get
comprehensive
information
from
the
respondents. There were some options for the
study participants to write their comments as
they
thought
appropriate.
The
study
questionnaire was sent to the respondents
through email along with website link so that
they could respond online using the link if they
would face problem to open the questionnaire
from email. When the respondents clicked on
Submit after completion of the questionnaire,
the responses (data) were recorded online to
the system previously built by the study
investigators. We also collected the language
materials which were being used for medicine
practice and to provide health care services in
Bangladesh (e.g. leaflets, brochures and
pamphlets of pharmaceutical companies and
hospitals; tools of health education intervention
research etc.).
were checked and the data set was converted

to Excel file and SPSS (Statistical Package for
the Social Science) file for a convenient data
analysis and to formulate tables, graphs and
figures. When the study investigators felt happy
with the finalized data set, a final data analysis
plan was formulated. Quantitative data
analyses were performed using IBM Statistics
SPSS version 22. The reason behind choosing
quantitative data analysis is that an extensive
literature review noticed similar type of data
analysis (Alam et al., 2012; Budgell, 2013;
David, 1998; Doman, 2009). The textual data
analyses were performed for qualitative data by
creating themes and sub-themes, especially for
the questions (variables) related to the opinions
and suggestions from the respondents of the
study.
4.7: Data analysis

A suitable and convenient data analysis
framework was planned beforehand on the
basis of research questions and objectives of
the study. After data collection, data errors
Chapter
5
Ethical considerations
5.1: Data Safety Monitoring Plan (DSMP)
Chapter
5
Ethical considerations
Privacy, anonymity and confidentiality of the

information provided by the respondents were
strictly maintained. Information provided by
them was kept (and will be kept) confidential
and had not been used (and will not be used)
for any other purpose than the study.
Maintenance of confidentiality of the data was
strictly practised and restrictions on access to
data forms was enforced. Information provided
by the respondents will be used for research
purposes only and would not be shared
anywhere by the name of the participants.
5.2: Ethical approval
An ethical approval was taken from Liverpool
Hope University Ethics Committee based at the
Department of English, as because, this
research project was the part of Masters
dissertation
with
the
abovementioned
university in the United Kingdom. Informed
written
consent
was
taken
from
the
respondents during the data collection.
Participants were informed and assured in
terms of their confidentiality and anonymity.
They were also assured that nobody would have

the access of the data other than the study
investigators. The study itself did not involve
any physical, social or legal risks to the
respondents.
Chapter
6
Result
suffer from diseases (e.g. age related diseases;

chronic diseases like diabetes, heart diseases,
hypertension, bronchial asthma etc.)
Chapter
6
Result
The results of the study have been organised in
five sub-sections: 6.1: Socio-demographics of
the respondents, 6.2: Perceptions of the
respondents on the language of medicine and
health services in Bangladesh, 6.3: Attitudes of
the respondents towards the language of
medicine and health services in Bangladesh,
Bangladesh and 6.5: Suggestions from the
participants to overcome language barrier in
providing health services in Bangladesh.
6.1:
Socio-demographics
respondents
of
the
There were four age group categories in the

study questionnaire: 18 30 years, 31 44
years, 45 59 years & 60 years and above.
From Figure 1, we can clearly see that more
than half of the participants (52%) fall in the
young adult age group (18 30 years), whereas
44% of them fall in 31 44 years and 4% fall in
45 59 years age group. Surprisingly, there is
no respondent who fall in 60 years and over age
group, but practically they have more chance to
Figure 1: Proportion (%) of respondents in terms

age group
Eighty-eight percent of the respondents were

male and rest 12% were female who completed
the questionnaire and all of them received the
study questionnaire through email (Figure 2).
In our future research, we wish to balance
gender (by recruiting equal number of
respondents from male and female) so that it
does have any biasness in research project
implementation.
Figure 2: Proportion (%) of respondents in terms of gender
This research found that around half of the

respondents (46%) were educated to postgraduate level who completed their masters or
PhD degrees (Figure 3). Almost similar
proportions of respondents were from graduate
level
(28%)
and
professional
level
of
qualifications (22%). The highest level of
education of the 2% of the participants was
secondary school level which figure was the
same for higher secondary school level of
education. None of the respondents mentioned
their highest level of education as primary level
(up to year 5). So in the representation of the
study findings, no view could be reflected from
the participants who are less educated and
illiterate, as it should be difficult for them to
understand the language of the prescriptions
by the doctors and also the language of the
leaflets accompanied with the medicine packs.
Figure 3: Proportion (%) of

respondents in terms of their highest
level of education
6.2: Perceptions of the respondents on the

language of medicine and health services
in Bangladesh
When respondents were requested to give their
opinion in terms of the language was being
used
in
providing
health
services
in
Bangladesh, 28% of the respondents mentioned
that mixture of English and Bengali was used in
providing health services in Bangladesh (Figure
4). On the other hand, exactly similar
proportion of the participants opined that only
Bengali was used as the language of medicine
and health services in Bangladesh. A minimum
proportion of the participants (2%) mentioned
that English, Bengali and Latin languages were
mixed in providing health services.
Figure 4: Proportion (%) of respondents

gave opinion in terms of language is used in
health services in Bangladesh
But, when participants were asked about the

language which were being used in the
prescription provided by the doctors and other
health service providers in Bangladesh, the
highest proportion of the respondents (44%)
mentioned that English was the choice for that
purpose, while 10% of the total participants
mentioned Bengali only as the medium of
language in the prescriptions of the doctors and
other health service providers for the practice
of medicine in Bangladesh (Figure 5). From
the same table, we can see that only 2% of the
respondents opined that the language was
being used in Bangladesh was Bengali, English
and Latin mixed, whereas 26% of the
participants told that it was Bengali and
English mixed.

gave opinion in terms of language is used in
the prescriptions provided by the doctors and
other health professionals in Bangladesh
Among all the respondents, 70% mentioned

that they understood the language used by the
doctors or other health service professionals in
Bangladesh (Figure 6); while 6% of the
participants said that they did not understand
the language. The research study could not
evaluate why 20% of the respondents were not
sure to understand the language of medicine
and also why 4% of the participants preferred
not to say.
Figure 6: Proportion (%) of respondents on

the basis of their language understanding
Respondents were asked if they read the

leaflets or instructions that are included in the
medicine packs; and if they read what are the
languages used there and whether they
understand those languages or not. According
to their responses, 84% read the leaflets or
instructions after buying medicine and among
them 2% did not understand the language used
there (Figure 7 and Figure 8).
Figure 8: Understand the language in the

leaflets/instructions (%)
According
to
the
responses
from
the
respondents, Figure 9 illustrates the
languages used in the leaflets or instructions
along with the medicine packs. More than half
of the participants mentioned that both Bengali
and English were used as the language of
instructions accompanied with medicine packs
or boxes. However, 4% of the respondents told
that the language was Bengali and 2% of the
respondents mentioned that most of the
instruction was written both English and
Bengali, although few were written in English
only.
Figure 7: Read leaflets/instruction (%)

mentioned the languages used in
leaflets/instructions
When the respondents were asked if they

thought medical practitioners in Bangladesh
mixed between languages, 72% respondents
mentioned that the doctors and other health
service providers mixed between languages
(Figure 10). Twelve percent of the
participants were not sure about that.

thought medical practitioners mixed between
languages
6.3: Attitudes of the respondents towards

To explore the attitude towards the language of
medicines and health services in Bangladesh,
the respondents were examined in different
approaches. When they were asked if the
language affected in the treatment of patients,
78% of the respondents said that language
affected the treatment and 16% said that they
were not sure about that (Figure 11). So there
was a chance to increase the proportion of the
respondents who opined in favour of effect of
language on medicine and health services in
Bangladesh. Only 6% of the respondents told
that language did not affect in practice of
Bangladesh.
Opinion
The
language

thought that language affected treatment of
patients
To explore the attitudes towards language of

medicine and health services, the respondents
were asked to give their opinion on different
sets of statements using a four point Likert
scale: Definitely True, Probably True, Probably
False and Definitely False. The findings are
presented in the following Table 1. From the
table, we can see that 64% of respondents told
that the language used for studying medicine is
different from the general English we use for
day
to
day
conversation.
Among
the
respondents, 40% thought that the language in
medicine in hospitals and in private practices of
the doctors was not appropriate for all the
people; and 38% thought that the language
which was being used in Bangladesh for
medicine and health services could not be
understood by general people.
which
is
being
used
The
The
language in
language which
medicine in
is being used to
hospitals
study medicine
in
and
Bangladesh
private
for medicine
practice
and
health
in
English
globally
is
different
of
the
from
general
the doctors,
English we use
services can
is
for
be
appropriate
communication
understood
for
by
people
general
all
the
people
Definitely
8%
8%
20%
54%
42%
64%
20%
32%
14%
18%
18%
0%
True
Probably
True
Probably
False
Definitely
False
Table 1: Opinion of the respondents on different

set statements
More than half of the respondents (58%) opined

that it was not appropriate that the medical
practitioners were still using Latin in their
prescriptions, whereas 30% of the respondents
were not sure if it was appropriate or not
(Figure 12).

respondents gave opinion if it was right to
use the Latin language by the medical
practitioners in Bangladesh

Bangladesh
Figure 13 denotes the opinion of the
respondents if the language is a barrier to get
effective health services in Bangladesh. In total,
48% of the respondents told that language was
a barrier to get a successful outcome in
providing health services in Bangladesh. When
we analysed the data to see the distribution of
this opinion in terms of age group, we noticed
that around half of the participants of all age

groups was in favour of saying language as a
barrier, although the proportion of saying Yes
and No as same for the 45 59 years age
group.

mentioned the language as a barrier to get effective
health services (by age groups)
6.5: Suggestions from the participants to

overcome language barrier in providing
health services in Bangladesh
When the respondents were asked to write
their opinions with regards to what can be done
to overcome the language barrier to get an
effective health services in Bangladesh,
varieties of opinions came out. Most of the
participants suggested for the medicine
practitioners to use the mother tongue of
Bangladesh (that means Bengali language) at

least during writing instructions for the
patients to take medicine for illness. If we look
at the following statements of some of the
respondents, we will get an idea about this:
Using mother tongue i.e. Bengali can easily
overcome this problem
[Respondent # 5]
.. mother language should be used by the doctor
to communicate with patients
[Respondent # 10] {Here mother language

means Bengali}
Bengali language can be used, at least for
instruction for the patients
[Respondent # 13]
Better to use mother language
[Respondent # 16]
Write instruction in Bengali
[Respondent # 31]
Some respondents advised health care givers
(e.g. doctors) to take time in order to describe
all about the diseases and medicines to the
patients so that because of the language barrier
patients are not deprived of getting effective
health services. The following statement from

one of the participants clearly indicates that:
I think it's not possible to make the
patients understand the language of
doctors unless and otherwise doctors
make them clear about it. The doctors
can make the patients clear by
describing the prescription verbally.
[Respondent # 1]
Some other participants suggested providing
health education to the general people so that
they come to know some medical terminologies.
A small number of respondents gave opinion to
use both English and Bengali as the medium of
providing health services.
One of the participants gave an indicative
suggestion to overcome the language barrier in
providing health services in Bangladesh which
is stated below:
Language problem arise with people
who can't understand English, most of
them can understand Bangla, so doctors
should write the instruction in Bangla, so
that patients (who can't understand
English) can understand instruction.
[Respondent # 45] {Here Bangla means
Bengali language}
From Figure 14, we can clearly see that 84%
of the respondents said if the patients could
understand the language used by the health
service providers; it would improve the quality
of health services in Bangladesh. Whereas, only
4% of them gave their opinion that the patients

could understand the language.

respondents who thought that
understanding the language could
improve the quality of health services
Chapter
7
Discussion
Chapter
7
Discussion
This study provided a comprehensive scenario
of the effect of language on the practice of
Bangladesh. So far, no other study was
conducted in the past in Bangladesh which
explored language and linguistic issues to get a
Bangladesh. We do believe that the current
study would be a pioneer research to address
language and linguistic issues which is
obstructing the effective health services in
Bangladesh. So, this study will have potential
implications for the improvement of providing
health services linked to language issues. The
investigators believe that this study is a kick
start of language and linguistic research in
Bangladesh in the arena of health research and
it will create a new opportunity of doing further
research in this area. In this discussion section,
several language and linguistic theories will
also be discussed to correlate the findings of
this study, namely Diglossia Theory, Codeswitching Theory, Language Attitude Theory
etc.
Though Bangladesh is a developing country, in
the arena of education it is not that much
successful. According to the Statistical Pocket

Book 2013 of Bangladesh, the literacy rate is
only 57.7%.
So, around 43% people of
Bangladesh cannot read and write any
language (even not in Bengali). Among the
literate people, most of them are not competent
in English, instead they can read and write in
Bengali only. So, how they can read the
prescription of doctors which are written
mostly in English and mixture of other
languages like Latin and Bengali. This scenario
is true for about half of the literate people and
from this striking feature, we can predict the
situation among rest of the people of
Bangladesh who cannot read even Bengali. So,
when a valuable prescription is made for them
it is nothing but a written-paper if anyone does
not help them to read it out. Even sometimes,
reading out a prescription to them is not
understandable, they need to be described
properly especially for the rules of taking
medicines and instructions by the doctors and
other health service providers. In that case
they are very much hopeless and ingenuous and
they cannot maintain their privacy in terms of
illness as other people come to know those by
reading the prescriptions. Because of their
illness they are bound to be explicated to others
who help them to read out their prescriptions.
Sometimes they shun going to doctor and
taking another faulty way for cure from
diseases. Some people go to Kobiraj who
never write anything and the patient feel an
utterly relief from the embarrassing situation
which occur with the prescription (Alam et al.,
2012).
Doctors write the prescription mostly in

English, sometimes they provide advice in
Bengali for patients help but the name of the
medicine and doses are written in English
which have no other choice. So the patients
cannot read the name of medicine properly,
even sometimes the drug sellers (chemists)
cannot read it out properly. For this language
problem, sometimes the patients are not able to
notice that they are given wrong medicine
instead of the giving the right medicine which
are written on the prescription. It may cause
serious harm to their health as some of the
medicines have serious side effects. It is also
hazardous for the drug sellers because they
give those wrong medicines unintentionally and
they are also blamed along with the health
service providers. So the ultimate result is the
sufferings of the patient and bad impression
about the doctors who do not know anything
about these misinterpretations, whereas the
language barrier is mainly responsible for this
untoward harmful situations. So the obscure
culprit is the language which is known as the
sword. The perfect use of it could make an
unprecedented success and wrong use of it
makes a dire situation.
In general, doctors in Bangladesh are trying in
many ways to make the language easier in the
prescription as they know the literacy condition
of general people in Bangladesh; and some of
the doctors try to describe their prescriptions
verbally to the patients. In some cases, the drug
sellers (known as chemists) also describe the
rules of taking medicine and the patients or
their attendants also try their level best to

explore the details about the prescription. So,
in most of the cases, this is a hard work for
both the care-giver and the care-seeker to get a
fruitful outcome from the health services. Even
sometimes educated people remain in dark
about the language of prescription because of
abbreviations
and
medical
terminologies
(Doman, 2009). General people are very much
curious about the disease which is diagnosed
but unfortunately they cannot understand most
of the medical terminologies. So, they want to
know and try heart and soul to know about the
details of the disease which is written on
prescription. Patients go to different people
and different doctors and get various types of
information and they become puzzled. In these
cases, both patients and attendance are plunge
in frustration. The obscure languages of
doctors make them wilt.
On the other hand, doctors want to make them
placate by using different type of words which
is not always medical terms (Johnson, 2002). In
Bangladesh, more relatives and attendances of
the patients sometimes make it tough for the
doctors to make them clear because of their
curiosity. Everybody wants to know what is the
condition of the patient, what is going on, what
is the fate of the disease etc. It is very much
embarrassing for the doctors to explicit the
exact condition of the patient to everyone but
they are helpless and sometimes may be
hopeless to give the plausible explanation about
the improvement of the disease because
medical terms are not easier to explain to the
people. Sometimes doctors want to say one

thing and the attendances understand another
and they discuss it among them in their own
ways which is wrong and create problems with
the patients health condition. They wrongly
blame the doctor and doctors are sometimes
annoyed with them and it makes a total mess.
Everything may be occurred for the language
problem. A study conducted among the
underserved urban Hispanic community found
that the patients were not fully satisfied as they
could not understand the language of the
health service providers (David, 1998). The
current study also found this frustration among
the respondents of Bangladesh.
Another site of creating difficult situation for
the patients is the use of symbol in
prescriptions. The symbols used by the doctors
in Bangladesh are mostly adopted from Latin
language (Martin et al., 2014). For example,
Rx means you take the following medicines;
S.O.S means use the medicines when it is an
emergency; Stat means use this medicine
instantly. So, it is impossible for the layman to
understand these symbols as they do not have
any idea about these terminologies.
Another problem comes forward in terms of the
guidelines and doses of the medicines as
difficult medical terms are also used there.
Again, language barrier is the main problem
here. Sometimes patient cannot understand the
advice about taking medicine and it makes
confusion to them. For these reasons,
effectiveness of the drug/medicine becomes
lower and sufferings of patients go higher.
Unfortunately, doctors are being blamed in this

situation although they are not always
responsible for the adverse effect of the
medicines (Lawton, 2002). So, here the doctors
suffer because of the language barrier which
could easily be overcome. Patients are also
dissatisfied and their family members are
unhappy as well, where again language barrier
is the main problem. But no one is guilty here.
Patient and their family members are right in
their own way. Doctors are static in their
position, sometimes they do not know what
their fault is and they are being blamed. So
they become annoyed with the whole system. It
is the human nature to be happy and delighted
to being praised. On the other hand, when they
are criticised or vilified by someone, they feel
embarrassed and disgraced. As per our general
believe, we know that the doctors are very
philanthropic and generous, but at the end of
the day they are human being. So sometimes
they might be hot-tempered which can have a
negative effect on diagnosis and treatment of
the patients. Most of the times, it is not
expected as the doctors are believed to have
their strong patience because of their training
and professionalism.
Although in Bangladesh, there are rules for the
pharmacists to have a minimum qualification,
but the rules are not followed strictly.
Sometimes they are just able to read and write
up to a minimum level. Most of them are only
SSC (secondary school certificate) or HSC
(higher secondary certificate) passed. They do
not have qualification or degree on drugs and
dispensing medicine. They are not qualified

pharmacist or chemist, but they have got
licence to sell the drugs/medicines. It is also
harmful for the patients and for the general
people, because they are not very much
conscious about their limitations. So when they
cannot understand or read the name of
medicine which is written by the qualified
doctor, they just give another medicine by
listening to the patients complaints. In this
case, they use their personal experiences or the
knowledge they gathered by working under a
qualified doctor as an assistant. From these
experiences, they give medicine to the patients
from their shops even sometimes without
prescription of a doctor. It could never be
happened if the patients could read the
prescription
or
could
understand
the
importance of the prescription or the difference
between the pharmacy-man and the doctor. For
the ignorance of the patients and the
attendance, pharmacy-man can exploit them,
and dishonour the prescription of the qualified
doctors. Even then, sometimes they give the
low-quality products to the patients. It may be
same generic name of the medicines but from
different pharmaceutical company which is not
that much authentic. The pharmacy-man gives
those medicines because of their dishonesty
and to make money only. Sometimes they take
bribe from these low quality companies to sell
their products. This ignorance causes so many
harmful health injuries to the patients, for
instance, causes damage of kidney. This
research study feels the need of conducting
another study to explore the language and
linguistic issues of the drug sellers in order to

save the life of the patients in Bangladesh. So
far, no study was conducted to address this
issue before, but we must do something to
develop the awareness among the patients.
May be, it is not too late as we know that it is
better late than never.
Most of the respondents of this study
mentioned that doctors or other health service
providers mixed between languages in the
prescriptions (Figure 10). Mixed language is a
language that arises through the fusion of
usually two or more source of languages,
normally in situation of bilingualism (Matras,
2003). It is difficult to classify the resulting
language as it belongs to either of the language
families that were its sources. Although the
concept is frequently encountered in historical
linguistics from the early 20th century, attested
cases of language mixture, as opposed to code
switching, substrata, or lexical borrowing, are
quite rare. Furthermore, a mixed language may
mark the appearance of a new ethnic or
cultural group (Fishman, 2010). A mixed
language also combined the grammatical
elements of one language and the lexical items
of another language (Auer, 1998). Although this
study explored that the doctors and other
health service providers were mixing between
languages in Bangladesh, the type of languages
and its contents were not explored by the
current study. This is another opportunity for
the future researchers to address this linguistic
issue.
According to Ferguson (1959), the basic

definition of Diglossia is the use of two
languages/varieties of a language in one speech
community but in different situations. In
Bangladesh, the doctors definitely speak in
Bengali
(mother
tongue)
in
general
conversation with family members and friends.
But when they write prescription, then they use
mostly two languages, English and Bengali
which coincides with the Diglossia Theory.
Diglossic situations involving two different
(genetically unrelated) linguistic codes: one
with greater international prestige dominates
(H domains) and another one is with regional
dialects (L domains) (Fergusion, 1959). H
domains are acquired through schooling and L
domains are learned first as mother tongue
which is spoken at home. According to this
Diglossia Theory, English is the dominant
language used by the doctors as a symbol of
international prestige and so it falls under H
domains. On the other hand, as the doctors in
Bangladesh first learn Bengali during childhood
and start speaking this language at home, form
the Bengali falls under L domains although
sometimes some doctors use it to write
instructions for the patients.
The study findings also correlate with Codeswitching Theory. Code-switching means use of
two languages in one situation or sentence (AlAzami, 2005; Fasold, 1984). This study found
that the doctors and other health service
providers mixed between languages in the
same prescription, even sometimes in one
sentence. They used most of the words in
English (specially to write name of the

medicine) and the rest in Bengali (especially
the advice) and sometimes Latin was also used
(Figure 5). So it is very difficult for the
patients to know the meaning of the mixed
languages, especially Latin words. This study
also found that it was very difficult to
understand the language of prescription even
for the people who were educated to postgraduate level. If we look at Figure 6, we will
notice that 6% of the respondents said they
could not understand the language of
prescriptions
though
they
were
highly
educated; and 20% said they were not sure.
There might be possibilities for the respondents
who said Not sure, they were not quite able
to understand the meaning or may be some
times they could understand and sometimes
they could not. Again, 4% of the participants
preferred not to say which goes in favour of not
understanding the language of prescription. It
is quite surprising that among the highly
qualified participants, a large proportion of
them could not understand the prescriptions.
From that scenario, we can predict what will
happen for the people of Bangladesh who are
illiterate. If we look into the status of education
for the whole population of Bangladesh, the
literacy rate of Bangladesh is only 57.7%;
among them 43.1% can read and write only. So
from these statistics, we get the picture to
understand the real situation about what is
going on in terms of language of medicine and
providing health services in Bangladesh. This
study tried to explore how the nonunderstanding of language of medicine could
cause a serious problem and sometimes might

be dangerous for our life. There is no dispute
that for many people, prescriptions are
beneficial, even life saving in many ways but for
some mistakes these life-saving prescriptions
may turn into life-threatening conditions. So we
have to be cautious in these language and
linguistic issues. Till date, there was no study
conducted in Bangladesh to address this
serious issue and there is a dearth of relevant
data. So the findings of the current study will
be helpful for the policy makers to obtain an
effective health system in Bangladesh.
Along with language of prescriptions, this study
tried to explore if the respondents could
understand the language of leaflets and
instructions provided with medicine packs. The
leaflets of medicine we gathered for this
research were mostly written in both English
and Bengali, but the position of English
language is high in pharmaceutical companies
as they mostly use English for all sort of
communication. But around half of the
respondents could not say that properly,
whereas 24% of the respondents said it was
written only in English and 4% opined that it
was written in Bengali only (Figure 9). From
this finding, this study presumes that the
participants were a bit confused about it. The
reason behind this confusion could be the lack
of
awareness
of
reading
leaflets
and
instructions. There is no one in this world who
does not become ill in his/her life-time. So, the
language of medicine and the health services is
very much important in human life. Therefore,
we should have to learn more knowledge about

medicine and its language. For the sake of our
childrens life, our near and dear ones life and
also for our very own life, we have to be aware
about this crucial agenda. Human being has got
just one life as a gift from the almighty; no one
wants to spoil this valuable life for any silly
mistake. There is no time to be aloof from this
burning question. About the leaflets, we can say
its an important detail about the specific
medicine but it becomes worthless most of the
time because of language barrier. Though they
are written in both English and Bengali in
Bangladesh, sometimes the translations in
Bengali are harder than the English word.
There are so many words in medical terms
those become ridiculous when translated in
Bengali, not only ridiculous but also like Greek
to people. Some English words of medical
terminology rather popular to common people
like: heart attack, bleeding, gastric, injury,
stroke etc. Even less educated or uneducated
people are also familiar with those words. If we
translate those words into Bengali, those
become difficult to understand. So because of
misunderstanding of the language of the
leaflets, sometimes it becomes dangerous or
even life-threatening. This study opens a
window to conduct lots of research work in this
arena. Future studies can explore the easy
ways to make the general people aware about
reading the leaflets as it contains doses of
medicine, indication to take medicine and
adverse effects of that particular medicine.
Research activities can also be conducted to
find out the way of use of language on leaflets

suitable for all type of people.
From figure 13, we can clearly see that
around half of the respondents from all age
groups thought that language was a barrier to
get effective health services in Bangladesh. If
language is a barrier in providing health
services, we should find out the ways to save
our valuable lives. This study also gathered
opinions from the respondents to overcome this
language barrier. Most of the study participants
suggested to use the first language (L1) of
Bangladesh (which is Bengali) to solve this
problem. They also suggested that if Bengali
cannot be used entirely at least the instructions
to the patients should be written in Bengali.
Some of the respondents opined to use
computer print-out for the prescriptions by the
doctors. Some other said that if the doctors use
English for writing the name of medicines,
those should be written in capital letters so that
all can read it easily. A number of respondents
suggested the doctors to describe their
prescriptions to the patients. The investigators
of the study find the opinions quite logical and
effective measures to overcome the language
barrier in practice of medicine in Bangladesh.
This study also suggests taking health
education intervention projects through which
general people will be oriented in common
medical terminologies and the languages of the
health service providers and leaflets contained
with medicine packs.
Shortage
of
doctors
or
other
health
professionals may be one of the reasons for
giving less time to the patients as they have to

treat a huge number of patients. For around
every four thousand people there is only one
medical doctor in Bangladesh. If we want the
doctor or healthcare provider to make the
language of prescription clear to the patient, it
would take a long time, which they do not have.
But increasing the number of doctors and to
aware them about the language barrier in
terms of practising medicine could be a
solution.
Though in Bangladesh, the nurse-doctor and
medical technologist doctor ratios are among
the poorest in the world, but there is a large
population in this country. If we can make the
people to man power, then it would be amazing
for the state. According to The World Bank
Economic Review, while the majority of people
live in rural areas, the majority of health
professionals work in urban areas (Chaudhury,
2004). The author
also
reported
that
Bangladesh has a serious shortage of doctors,
paramedics, nurses and midwives. To manage
this wide gap, the country has to develop
nationwide network of medical colleges,
nursing and paramedical institutes. It has
started to work but still there is a huge gap to
overcome this problem. Along with this
initiative, the government of Bangladesh can
incorporate the language issues which are
working as a barrier in providing health
services.
Bangladesh has achieved success in many
sectors, but main problem is that it has got
worlds highest population density. Every
citizen has the basic right to adequate health

care and the state and its government are
constitutionally obliged to make sure proper
health care for its citizen. But to ensure proper
health care this country does not have such
wealth or man power, to be honest, qualified
manpower to attain this. To ensure an effective
health care system we need more money, more
qualified manpower, more policy making and fix
the mission to get the target. To fulfil
everything, firstly we need to be aware about
this problem and work together as needed.
People of the country have the demands but
they have no way to achieve this target. If it is
possible to make them aware about this
problem and show the way to overcome it, and
ultimate gain of them, then they will be
inspired. May be all the plans will be needed a
long-time process, may be one generation will
just work to achieve this goal, but the next
generation will get a successful result.
This study also suggests that Bangladesh can
take initiatives to create a group of people who
will be able to explain the prescriptions or
instructions written by the doctors or by other
health care providers. It is not an easy task to
make the whole population of a country
educated, but it is possible to make some
people apt in a subject who can actively help
the patient or his or her family members. One
person from every family can be selected for
this purpose, or at least one person from a
small geographical area can be educated in this
area. It would not be easy to implement this
project and it may make the people wearisome.
But to get mammoth success, some people have

to sacrifice for the sake of good health of
human being.
Level of education of a country is a big issue to
overcome language barrier. As in Bangladesh,
around half of the people are illiterate, what
does it matter whether the language of
prescriptions or leaflets is in English or
Bengali? Though language is the main way to
communicate with others, but every place of
Bangladesh has its own collocation, nobody
knows the all collocation of different places. So
it is difficult to make uneducated people clear
about the language of medicine. Just for an
example we can say KAOLA. This word means
jaundice which is a clinical feature of some
diseases. In some areas of Bangladesh people
say this word. They never know jaundice. It is
only an example, so many words like this are
being used by Bangladeshi people of different
areas, especially who are uneducated. To
overcome this situation, the state should be
more serious about education. All educated
person more or less knows to the same type of
words which are being used in general talking.
Moreover, it is easier to make understand
something to educated people than uneducated
people. In that sense, education is a vital factor.
We do not expect that all people will become
highly educated within a short period of time or
we do not expect the state will attain the
education rate to 100 % within a few years. But
we can expect that the work will be started to
achieve the goal. By the hard work, sincerity,
patriotism and sacrifice of one generation can
make a country stronger, better, well-educated

and financially sound; and can adorn the life of
future generation. Ultimately this can lead to
overcome the language barrier to get a
successful outcome from the health system.
Some participants of the study said doctor and
health providers can write the prescriptions in
both English and Bengali. Like that: health
providers can write the medicines name in
English and the instructions in Bengali. That
may be the standard way at least for the
literate people now. And if the state can take
the steps to make a group of people who can
actively help other people to read out the
prescriptions. In this case, least education and
minimum knowledge about health care can be a
great help and Bengali written instruction can
be easier for the helper. Another step can be
taken by the government of Bangladesh in
terms of making strict rules about the
qualification of pharmacy-man or pharmacists
or chemists or druggists. One should have a
reasonable qualification and knowledge about
medicine and diseases when they want to run a
dispensary. If this rule can be passed and
implemented, then the prescriptions in which
medicines name is written in block letters can
be understandable to them. If the pharmacists
become really qualified, they can help the
patients to make clear about the language of
prescriptions and leaflets. In that case doctors
and other health care providers could get some
relieves from this time consuming process.
Most of the cases pharmacists come from local
area and people can easily get them and can
share their inner thoughts which is also

supported by the Language Attitude Theory
(Breckler, 1989). In fact, language has a
powerful influence over people and their
behaviour (Al-Azami, 2007). But with the
doctors sometimes they become uneasy to
share their inability to read or write. In that
case, drug-sellers are more reliable to make
them clear about prescriptions as per their
thinking.
There may be a debate in terms of suitable
policy to be adopted. But this study proved it
clearly that language is a definite barrier in
practice of medicine and providing health
services in Bangladesh. In order to get a
successful outcome of the health systems of
Bangladesh, there is no other alternative except
overcoming the language barrier in this
context. So the investigators of the study
believe that this is a milestone study in
Bangladesh in terms of language issue in
practising medicine and in providing health
services.
Chapter
8
Limitations of the study
Chapter
8
Limitations of the study
The major limitation of the study is that the

findings of the study represent only the people
from Bangladesh who are educated and who
use internet. Due to time and resource
constraints,
we
designed
our
study
questionnaire using Google Forms and we sent
the questionnaire (along with the web link) to
the respondents through email. So, we could
not collect data from the Bangladeshi people
who do not use email or internet and also who
are illiterate. Logically, they should face more
difficulties to follow the prescriptions by the
health
service
providers
and
the
leaflets/instructions in the medicine packs. On
the other hand, we could not distribute the
study
questionnaires
with
an
equal
consideration of all the geographical areas of
Bangladesh. So, the findings of this study
cannot be considered representative of
Bangladesh in its entirety.
Unfortunately, this research project did not
receive any response from the old aged-group
people (60 years and above) who usually suffer
from more diseases, especially age related
diseases and some other chronic diseases like:
diabetes mellitus, heart diseases, lung diseases,
hypertension (high blood pressure), stroke,

paralysis, vision problems etc. So it is likely
that they will go more frequently to doctors,
other health service providers and hospitals to
seek treatment and logically again language
issues should come forward. So, this is another
limitation of the study which could not explore
the views of old aged people of Bangladesh.
providing health services to overcome language

barrier.
Another limitation of the study is that the

respondents were only adults (18 years and
above), whereas children consist of a large
number of population in Bangladesh and death
rate and morbidity due to different kind of
diseases is high among children in Bangladesh.
Again language could have a great impact to
attain a successful outcome of practice of
Bangladesh. But the study could not explore
this issue.
So, the researchers wish to conduct a
comprehensive research study in the future
considering these limitations of the current
study in order to explore the language barrier
and the possible ways to overcome this barrier
in practice of medicine and to provide health
services in Bangladesh. In future studies, the
researchers wish to collect data by appointing
data collectors using a printed questionnaire
which will be able to get more appropriate
responses from all types of respondents (all age
groups & irrespective of the level of education)
and that potential study will be able to provide
a complete picture of whole Bangladesh in
terms of language and linguistic research in
Chapter
9
Conclusion and Recommendations
Chapter
9
Conclusion and Recommendations
This study addressed the language issues for

the first time in Bangladesh in medicine and
health services. According to most of the
respondents of the study, language was acting
as a barrier to get a successful outcome from
the health system of Bangladesh. The study also
explored the view of the participants in order to
overcome this language barrier. If the policy
makers give attention to the study findings and
the suggested recommendations from the study,
we believe that at least the obstacle caused by
the language problem in health services will be
resolved and ultimately it will play a great role
to obtain a better outcome from the existing
health system in Bangladesh and also from the
level of individual health service providers
including private practitioners. By conducting
this research project, the investigators think
that cultural and linguistically appropriate
health services in Bangladesh may lead to
improve the quality of health care system in
Bangladesh.
On the basis of the conducted research, this
study came up with following recommendations
in order to obtain a successful outcome of
health services in Bangladesh:
1. Doctors and other health service

providers in Bangladesh should consider
the language constraints in providing
health services. So they should describe
their instructions properly to their
patients so that the patients do not suffer
because of misunderstanding of the
language
2. Doctors and other health service
providers can write the name of the
medicines in English block letters and
they can write the instructions in Bengali
which would be understandable by all the
patients who are capable to read
6. Policy makers can take initiatives to

address the language barriers and the
way out of it in order to get a successful
outcome of health services
7. Further language and linguistic research
can be conducted in all over the
Bangladesh (rural and urban areas) to
explore further language and linguistics
problems at all levels (all age groups and
irrespective of level of education) and the
way of overcome these problems to
attain a successful health care system in
Bangladesh.
3. If feasible, the health service providers

and
the
hospitals
can
provide
prescriptions or discharge certificates
through computer print-outs in both
English and Bengali languages
4. For illiterate patients, the health service
providers or the pharmacists can
describe verbally all about the disease
conditions and the rules of taking
medicine. Along with this, they can
explain everything to the attendants or
relatives of the patients who can help
them actively at home
5. Sign languages or illustrated language
information
with
photographs
or
cartoons can be provided to convey
health related instructions or health
education materials for the people in
Bangladesh who are not able to read and
write
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Language of Medicine in Bangladesh - Way For A Better Access To Health Care by Dr. Badrul Alam Et Al of Bangladesh

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Language of Medicine in

Language of Medicine in Bangladesh | 1

Language of Medicine in Bangladesh | 2

Way for a Better Access to Health

Ishrat Jahan Urmi

First Published : November 2016

Language of Medicine in Bangladesh | 1

Language of Medicine in Bangladesh | 2

All rights reserved.

Language is a very important factor in

Language of Medicine in Bangladesh | 1

Language of Medicine in Bangladesh | 2

Professor Padam Simkhada

Language of Medicine in Bangladesh | 1

Language of Medicine in Bangladesh | 2

Terms and Meaning

Language of Medicine in Bangladesh | 1

Language of Medicine in Bangladesh | 2

to address the language issue in terms of

regional areas and all kind of people in

linguistics to practise medicine and to provide

The researchers believe that the current study

Language of Medicine in Bangladesh | 2

Language of Medicine in Bangladesh | 1

Bangladesh is a monolingual and developing

Language belongs to everyone as this is the

providing health care services is a bit different

in Bangladesh. Though health care is a complex

gender-concordant translators to maintain their

medicine dispensing and providing health care

it is very difficult to translate them in Bengali.

who are highly skilled in English. The scenario

satisfaction, adherence to treatment, and

assessment of patients is compromised and the

name and fame. On the other hand, the name

we mean language and communication gap,

available in Bangladesh; to be honest, there is

Data related to language and linguistic issues

Language of Medicine in Bangladesh | 2

The research study was conducted to answer

Language of Medicine in Bangladesh | 1

Language of Medicine in Bangladesh | 2

medicine and to provide health care

Language of Medicine in Bangladesh | 1

Language of Medicine in Bangladesh | 2

The respondents were eligible to be included to

4.1: Study design

Willing to participate in the study

4.2: Study duration

4.3: Study area

Age <18 years

Bangladesh was the target of the research

Unable to provide a valid consent

4.4: Study participants

Unwilling to participate in the study

4.6: Study materials and apparatus

were checked and the data set was converted

4.7: Data analysis

Language of Medicine in Bangladesh | 2

Privacy, anonymity and confidentiality of the

Language of Medicine in Bangladesh | 1

Language of Medicine in Bangladesh | 2

They were also assured that nobody would have