Language of Medicine in Bangladesh by Dr. Badrul Alam Et Al

Language of Medicine in Bangladesh | 1
Language of Medicine in Bangladesh:

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

Way for a Better Access to Health Care
Ishrat Jahan Urmi

Badrul Alam
Abu Sayed Hasan
Tajrian Rahman
MURDHONNO
First Published : November 2016
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ISBN 978-984-504-238-3
Dedication
Abba
Amma
Manal & Mahiar
With Love and
Gratitude
Foreword
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
Particulars
TABLE OF CONTENTS
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 the language
of medicine and health services in Bangladesh
6.4: If language is a barrier in practice of medicine and
providing health services in Bangladesh
6.5: Suggestions from the participants to overcome
language barrier in providing health services in
Bangladesh
Chapter-7: Discussion
Chapter-8: Limitations of the study
Chapter-9: Conclusion and Recommendations
Bibliography
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42
45
46
49
63
66
69
Terms
Meaning
L1
L2
Code mixing
First language
Second language
Transfer of linguistic elements from one
language to another
Use of two languages in same
situation/sentence
A physician is a health professional who
practices medicine. Normally a physician is
called as a doctor (or medical doctor)
Health service providers who do not have
institutional education or training and who
use raw trees, tree roots and other materials
for treatment
Number of death due to illness
Sufferings and consequences caused by the
diseases
Code switching
Physician
Kabiraj
Mortality
Morbidity
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 successful outcome of health services in 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.
The researchers believe that the current study explored the
need of future research opportunities in terms of language and
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.
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 (NgoMetzger,
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 socio-political 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).
Data related to language and linguistic issues of medicine and
health care services are barely 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.
Chapter
3
RESEARCH QUESTIONS AND
OBJECTIVES OF THE STUDY
Chapter
3
Research Questions and Objectives of the study
3.1: Research questions
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
4
Research Methodology
4.1: Study design
A cross-sectional survey was designed for data collection of
this research project.
4.2: Study duration
The study duration of the project was between July 2014 and
November 2014.
4.3: Study area
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.
4.4: Study participants
The study participants were selected purposively. For the
enrolment of the respondents, the following inclusion and
exclusion criteria were followed:
Inclusion criteria:
The respondents were eligible to be included to participate in
the study if they fulfilled following criteria:
Adults male or female 18 years
Able to provide a valid consent for participation
Willing to participate in the study
Have got internet access
Exclusion criteria:
The following criteria were used to exclude the respondents
from the study:
Age <18 years
Unable to provide a valid consent
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.).
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 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.
Chapter
5
Ethical considerations
Chapter
5
Ethical considerations
5.1: Data Safety Monitoring Plan (DSMP)
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
Chapter
6
Result
The results of the study have been organised in five subsections: 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, 6.4: If language is a barrier in practice
of medicine and providing health services in Bangladesh and
6.5: Suggestions from the participants to overcome language
barrier in providing health services in Bangladesh.
6.1: Socio-demographics of the respondents
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 suffer from diseases
(e.g. age related diseases; chronic diseases like diabetes, heart
diseases, hypertension, bronchial asthma etc.)
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 post-graduate 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

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.
Figure 5: Proportion (%) of respondents 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 7: Read leaflets/instruction (%)
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 9: Proportion (%) of respondents 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.
Figure 10: Proportion (%) of respondents thought medical

practitioners mixed between languages
6.3: Attitudes of the respondents towards the language of

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 medicine and providing
health services in Bangladesh.
Figure 11: Proportion (%) of respondents 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.
Opinion
The
language
The
language
The
English
which is being
in medicine in
language which is
used
in
hospitals and in
being used to study
for
private practice
medicine globally is
and
of the doctors, is
different from the
appropriate
general English we
Bangladesh
medicine
health
services
can
be
understood
by
for
all the people
use
for
communication
general people
Definitely True
8%
8%
20%
Probably True
54%
42%
64%
Probably False
20%
32%
14%
Definitely False
18%
18%
0%
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).
Figure 12: Proportion (%) of respondents gave

opinion if it was right to use the Latin language by the
medical practitioners in Bangladesh
6.4: If language is a barrier in practice of medicine and

providing health services in 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.
Figure 13: Proportion (%) of respondents 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.
Figure 14: Proportion (%) of 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 medicine and providing health
services in Bangladesh. So far, no other study was conducted in
the past in Bangladesh which explored language and linguistic
issues to get a successful outcome of health services in
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, Code-switching 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 Code-switching Theory.
Code-switching means use of two languages in one situation or
sentence (Al-Azami, 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
non-understanding 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.
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 medicine
and providing health services in 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 providing health services to overcome language barrier.
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
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
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.
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Language of Medicine in Bangladesh | 1

Language of Medicine in Bangladesh | 2

Language of Medicine in Bangladesh:

Language of Medicine in Bangladesh | 3

Language of Medicine in Bangladesh:

Ishrat Jahan Urmi

First Published : November 2016

All rights reserved.

Language of Medicine in Bangladesh | 5

Language of Medicine in Bangladesh | 6

Professor Padam Simkhada

Terms and Meaning

Language of Medicine in Bangladesh | 9

Language of Medicine in Bangladesh | 10

The current study was conducted among Bangladeshi people

prescription was very low, we can presume the striking high

Language of Medicine in Bangladesh | 13

Language of Medicine in Bangladesh | 14

job aptitude, and many other areas of identity and social

education to the patient and patients family; and counselling

Bangladesh where Bengali is mother tongue (L1), but the

linguistic issues which are obstructing for practising medicine

their economical and socio-political situation without a good

outcomes of treatment automatically hampers and the

follow the instructions provided in the prescriptions or in

culprit, we mean language and communication gap, which is

discussed in this write up were never been addressed

Language of Medicine in Bangladesh | 24

Language of Medicine in Bangladesh | 25

To gather the view of respondents if language was a

Language of Medicine in Bangladesh | 27

Language of Medicine in Bangladesh | 28

Language of Medicine in Bangladesh | 29

Language of Medicine in Bangladesh | 31

Language of Medicine in Bangladesh | 32

Language of Medicine in Bangladesh | 33

Language of Medicine in Bangladesh | 34

Language of Medicine in Bangladesh | 35

Figure 1: Proportion (%) of respondents in terms age group

Eighty-eight percent of the respondents were male and rest

Figure 2: Proportion (%) of respondents in terms of gender

This research found that around half of the respondents (46%)

proportions of respondents were from graduate level (28%)

Figure 3: Proportion (%) of respondents in

6.2: Perceptions of the respondents on the language of

participants (2%) mentioned that English, Bengali and Latin

Figure 4: Proportion (%) of respondents gave opinion in

But, when participants were asked about the language which

Language of Medicine in Bangladesh | 38

Figure 5: Proportion (%) of respondents gave opinion in

Among all the respondents, 70% mentioned that they

Figure 6: Proportion (%) of respondents on the basis of

Respondents were asked if they read the leaflets or instructions

Figure 7: Read leaflets/instruction (%)

Figure 8: Understand the language in the leaflets/instructions (%)

According to the responses from the respondents, Figure 9

Figure 9: Proportion (%) of respondents mentioned the

When the respondents were asked if they thought medical

Language of Medicine in Bangladesh | 41

Figure 10: Proportion (%) of respondents thought medical

6.3: Attitudes of the respondents towards the language of

Language of Medicine in Bangladesh | 42

Figure 11: Proportion (%) of respondents thought that

To explore the attitudes towards language of medicine and