_______________________________________________________________________________ Publications of the Institute for Asian and African Studies 6 _______________________________________________________________________________ LANGUAGE POLICY IN HEALTH SERVICES: A SOCIOLINGUISTIC STUDY OF A MALAWIAN REFERRAL HOSPITAL Gregory Hankoni Kamwendo _______________________________________________________________________________ Helsinki 2004 _______________________________________________________________________________ Gregory Hankoni Kamwendo LANGUAGE POLICY IN HEALTH SERVICES: A SOCIOLINGUISTIC STUDY OF A MALAWIAN REFERRAL HOSPITAL ACADEMIC DISSERTATION To be publicly discussed, by due permission of the Faculty of Arts of the University of Helsinki, in auditorium XII, Unioninkatu 34, on the 13th of November, 2004, at 10 o’clock Publications of the Institute for Asian and African Studies 6 ISBN 952-10-0495-9 (printed) ISBN 952-10-0496-7 (pdf) ISSN 1458-5359 Helsinki University Printing House Helsinki 2004 ACKNOWLEDGEMENTS This dissertation marks the end of a long academic journey that started when I registered as a part-time Ph.D. student at the University of Malawi. The immense pressure of work at the University of Malawi’s Centre for Language Studies (where I worked as Senior Research Fellow and Deputy Director), the paucity of relevant and up to date literature, and the lack of adequate access to computer and Internet facilities all impacted negatively on my academic work After nearly two years of seeing no real light at the end of the tunnel, salvation came from Harri Englund. He generously took me on board his project, “Translating Human Rights in Africa” - a project based at the Institute for Asian & African Studies at the University of Helsinki, and funded by the Academy of Finland. Under the new arrangement, I transferred my Ph.D. work from the University of Malawi to the University of Helsinki, and Harri Englund became my new supervisor. With funding from Harri Englund’s project, I was able to conduct fieldwork at the Mzuzu Central Hospital from April to August 2002. In September of the same year, I moved to the University of Helsinki where the Academy of Finland, through Englund’s project, paid my salary for two full years. I am most grateful to the Academy of Finland for its generosity. I should also acknowledge with gratitude the financial support I received from GTZ whilst I was in Malawi. With funds made available by GTZ, I was able to make a one-week orientation visit to my research site (Mzuzu) in December 2001. Through GTZ’s funding, I was also able to present papers at a number of international conferences outside Malawi. I highly commend GTZ for supporting scholarship in African languages. I have had opportunities to attend courses within and outside the University of Helsinki. For example, I benefited immensely from two courses on human rights/language rights which were offered by the Institute for Human Rights at the Åbo Akademi University in Åbo/Turku. I thank the Director and staff of the Institute for Human Rights at Åbo for giving me eye- opening short courses. I also thank Norfa for funding my participation in those courses through its Mobility Scholarship. I would also like to express my gratitude to the Nordic Africa Institute for the support it has given me. I was a beneficiary of a Study Grant during the month of February 2003. Through this grant, I was able to conduct library research at the Institute’s library in Uppsala, Sweden. The Nordic Africa Institute came into the picture again in October 2003 when it funded my participation at the Nordic Africa Days Conference. I would also like to register my profound gratitude to the University of Helsinki (the Rector’s Grant) for providing me with monthly salaries from August to October 2004. I should also acknowledge with gratitude that I was a beneficiary of the Chancellor’s Travel Grant that enabled me to attend an international conference at Linköpings University, Sweden, in June 2004. In Harri Englund I had a dedicated, resourceful and time-conscious supervisor. He ably captained the ‘ship’ and steered it into safety. I would like to echo the saying that if I have seen far, it’s because I stood on the shoulders of a giant, and that giant is no other than Harri Englund. Without him, I would not have made it. Zikomo kwambiri achimwene Harri. Mulungu akudalitseni. I would also like to express my profound gratitude to the two pre-examiners, Professor H. Ekkehard Wolff (Leipzig University, Germany) and Professor Karsten Legère (Göteborg University, Sweden) for giving me valuable and highly constructive comments. These two iii eminent scholars are, in no way, responsible for errors that remain in the thesis. I take full responsibility for that. My Custos, Professor Arvi Hurskainen deserves thanks for a job well done. The support and encouragement he gave me during my two years’ stay at the University of Helsinki will always be remembered with appreciation. There are many other institutions and individuals who gave me a helping hand, but due to space limitations, it is impossible to mention them all. However, within this space constraint, I wish to acknowledge the generous support I received from the following institutions and individuals: first, staff and clients of the Mzuzu Central Hospital for generously giving me data. Without their support and co-operation, I could not have made it. I also thank other institutions and individuals who gave me data in one way or another; and in this regard, I wish to recognise the special contributions made by Mr. A. Thole of the Mzuzu Museum, Mr Heinz Kaposa of the National Archives Office in Mzuzu, and others. I also thank Professor Al Mtenje (my Director of the Centre for Language Studies, for creating a conducive atmosphere under which I was able to purse my academic goals); Pascal Kishindo (a fine language scholar, a former thesis supervisor, a colleague and a friend); Matthews Mugala (my hard-working and cooperative research assistant); Frank Nantongwe Jr. and Matthews Msokera (the men who computerised data from the questionnaires); Tarcizius Nampota (a friend who has now turned into a brother); Joachim F. Pfaffe, Wanjiku Janet Ng’ang’a (a very supportive colleague from Kenya) and Sergei Repin (I happily shared an apartment with him in Vantaa). I am thoroughly convinced that if I have survived and succeeded in this world, it is partly due to the support and loving care I have received, and continue to receive, and will continue to receive, from my dear wife Yasinta (Juliet). She has been the solid rock on which I have stood during moments of frustration and despair. Her contributions towards the successful completion of the dissertation are too many to cite here. It is to Juliet and our beloved three “guests” - Tamanda Agatha Kamwendo, Titus Kamwendo and Martin Cleophas Kamwendo - that I dedicate this dissertation. iv LIST OF ABBREVIATIONS ABC African Bible College AFORD Alliance for Democracy AIDS Acquired Immunodeficiency Syndrome AIIC International Association of Conference Interpreters CA Conversational Analysis CASAS Centre for the Advanced Studies of African Society CDA Critical Discourse Analysis CCAP Church of Central African Presbyterian CHAM Christian Health Association of Malawi CLACA Chitumbuka Language & Culture Association CODESRIA Council for the Development of Economic and Social Research in Africa. EAP English for Academic Purposes EFL English as a Foreign Language ESL English as a Second Language EMP English for Medical Purposes ESP English for Specific Purposes EU European Union FGD Focus Group Discussion FTA Face Threatening Act GDP Gross Domestic Product GTZ Deutsche Gesellschaft fur Technische Zusammenarbeit HIV Human Immunodeficiency Virus IMF International Monetary Fund JCE Junior Certificate of Education KCN Kamuzu College of Nursing LCH Lilongwe Central Hospital L1 First Language MACRO Malawi Aids Counselling and Resource Organisation MANEB Malawi National Examinations Board MBC Malawi Broadcasting Corporation MCP Malawi Congress Party MCH Mzuzu Central Hospital v MSCE Malawi School Certificate of Education NAC Nyasaland African Congress NEPAD New Partnership for Africa’s Development NGO Non-Governmental Organisation NIB National Intelligence Bureau OAU Organisation of African Unity OPD Out Patient Department OSCE Organisation for Security and Co-operation in Europe PSI Population Services International PSLC Primary School Leaving Certificate QECH Queen Elizabeth Central Hospital ROC Republic of China (Taiwan) SADC Southern African Development Community SPSS Statistical Package for Social Sciences TB Tuberculosis TBA Traditional Birth Attendant TMP Tumbuka for Medical Purposes TUM Teachers’ Union of Malawi UDF United Democratic Front UMCA Universities Mission to Central Africa UN United Nations UNDP United Nations Development Programme UNESCO United Nations Educational, Scientific and Cultural Organisation UNFPA United Nations Population Fund US/USA United States/United States of America VD Venereal Disease WHO World Health Organisation ZCH Zomba Central Hospital vi ABSTRACT Gregory Hankoni Kamwendo: Language Policy in Health Services: A Sociolinguistic Study of a Malawian Referral Hospital During the first three decades of independence, Malawi, like many other African countries, had an official policy that eschewed the country’s linguistic and cultural diversity in the name of nation building. Whilst examining how Malawi’s transition to liberal democracy has affected its language policy,