The Communication Barrier in Eye Exams in Nigeria

It has been established by research that communication barriers are quite a challenge in the multicultural diversity of societies. This does not only come through language disparities but also through literacy disparities. Nigeria is not excluded from this due to the multicultural diversity of the nation and lack of formal education in a significant amount of the population. The language barrier has been reported not only to reduce the quality of care delivered but also prevents would be health seekers from visiting health centres.

What does this mean for the Nigerian optometrist?

As a primary eye care provider, this barrier can be very challenging. In the training tools used in and out of optometry school, symptoms of certain ocular conditions are expressed with english words and phrases like burning, itching, blurry distance/near vision, dryness and many more. The optometrist on taking the symptoms during the case history session may suspect some oculovisual conditions and pattern the eye examinations to probe in that direction. In partially literate communities, they do not use words like burning, itching and so on. I have seen some call blurry vision, "darkness or blackness" and calling itching, pain. Others lack words to they use phrases like "my eye dey do me wan kind" or "e be like say something dey cover my eye" and sounds with gestures which may be interpreted as overtly silly by some.

Why this is a challenge is that some signs of oculo-visual conditions are really not so obvious not forgetting that not all clinics have some instruments like the biomicroscope or the visual field machines to probe further. The mild dry eye syndrome is a typical example of this. There are also other conditions whose signs cannot be appreciated with optometric clinical tools examples of which are losses in visual fields and binocularity problems. The later in my experience is most challenging with the partially literate. These challenges are encountered not only during the case history sessions but also during the procedural examination. 

 How can we meet this challenge?

We could take a cue from how this is met by the CLAS (Culturally and Linguistically Appropriate Services) standards, developed by the Office of Minority Health of the U.S. Department of Health and Human Services. There is a stressing on been more culturally aware and the recruiting of health care providers from the various ethnic groups that make up the society. Been culturally aware for the optometrist refers to been abreast with the cultural values and traditions as well as the oculo-visual challenges usually encountered among specific ethnic groups. This should be a point of focus during meetings of optometrists living and working in certain regions of Nigeria. Added to this, there should also a platform for the experienced optometrists to share their experience with this communication barrier and how they met it. You can add the rest in the comments section below.

References

  

 1.    Frazier M & Kleinstein RN 2009, Access and Barriers to Health Care,

<http://webpages.charter.net/oldpostpublishing/oldpostpublishing/Section%25204,%2520Access%2520and%2520Barriers%2520to%2520Eye%2520and%2520Health%2520Care/Sect%25204,%2520Access%2520and%2520Barriers%2520by%2520Frazier%2520and%2520Kleinstein.pdf&ved=0CCAQFjAB&usg=AFQjCNFRPsKDme5oYlUaD8Ri2WZebOSMPA&sig2=KlmRNeAZvTIGc4DWX6m6kA>

2. Prevent Blindness America 2012, Focus on Eye Health and the Culturally Diverse Population, viewed 27 February 2015.

<http://www.visionproblemsus.org/downloads/2167_MultiCultiCompanion_v08_web.pdf>

3. Transitions 2009, Cultural and Linguistic Considerations for Vision Care, viewed 27 February 2014.

<http://www.docet.info/download.cfm?docid=90247b8d-4105-4022-98cee09071477501>