There is extensive prerequisite knowledge from the biomedical domain which is essential for making sense of any information relating to health issues within the context of Western service delivery.
Similarly, there is extensive prerequisite knowledge from the Yolŋu domain necessary for making sense of Yolŋu experience from their perspective..
For example, a shared understanding of the function of the heart and the nature of the circulatory system including the components and function of blood, for example, is essential for many of the discussions about renal issues to make sense. As such shared understanding does not exist for many of these concepts, effective communication cannot be achieved in so much of the interaction between staff and patients.
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Not only specific topics and terms are a source of difficulty: the use of metaphor which is common - but very different - in both biomedical and Yolŋu discourse is also important in contributing to miscommunication. Western biomedical theory, and especially quantification itself, is saturated in metaphor.
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The use of metaphor is a powerful and widely utilised communicative tool. The difficulty comes from a lack of recognition of the extent to which the metaphors employed in biomedical discourse are culturally specific and not necessarily meaningful to patients from a different cultural background - even if they may use and understand the individual words. In Australia, health staff make extensive use of a machine metaphor when talking about the body and its functions, comparing the body to 'some sort of machine prone to breakdown but capable of repair by injections, manipulations, incisions, and replacing and mending parts' (Pauwels, 1995, p.172).
The solution to these potential areas of miscommunication is not to list all possible health beliefs and associated metaphors for different cultures. Due to the many variations within any culture, such an attempt risks overgeneralisation and cultural stereotyping. Health staff do need to be aware of, and sensitive to, potential differences and to reflect on how their own use of language may be open to different cultural interpretations (see Pauwels,1995).
However, as part of a careful educational process an understanding of the cultural dimensions of metaphor can also enable much more effective communication between cultural groups if metaphors from the target culture are used to help explain concepts from the other culture (e.g. ARDS AIDS Education).
Just as this strategy can be effectively used in education approaches about biomedical concepts with Yolŋu, there is also potential in using a similar approach to assist health staff to better understand Yolŋu concepts.
Such a process can only be effectively realised through a close collaboration between members of both groups, with a constant awareness of the ontological and epistemological diversity within groups - both for health staff and Yolŋu.
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