Vaccination is crucial for preventing the spread of the polio, a highly contagious disease that can lead to paralysis and even death. But widespread, ongoing conflict in Somalia means that vaccination campaigns are hampered by restricted access to conflict zones, and the displacement of communities - making it difficult for healthcare workers to reach vulnerable populations. The destruction of health infrastructure, disruption of healthcare services, and compromised safety of healthcare workers further contributes to the decline in vaccination coverage.
Fears, mistrust, and the spread of misinformation in conflict-affected areas also undermine the willingness of communities to participate in vaccination programmes. Additionally, interrupted supply chains and political challenges exacerbate the difficulties in planning and executing effective vaccination programs.
But there is an often overlooked challenge for vaccination campaigns - language understanding, which plays an important role as effective communication is essential for disseminating information about vaccines, their benefits, and the vaccination process.
Clear and culturally appropriate messaging about polio vaccination in local languages helps build trust, eliminate misconceptions, and encourage vaccine acceptance within communities. Language understanding is also crucial during the administration of vaccines as it ensures that healthcare providers can communicate clearly with individuals about the procedure, potential side effects, and post-vaccination care. Misunderstandings due to language barriers can lead to hesitancy or resistance, obstructing vaccination coverage.
According to research by Minority Rights Group and CLEAR Global, in partnership with three health organizations working in Mogadishu, Somalia, there are at least 10 distinct languages or dialects spoken, although this diversity is not officially acknowledged or widely documented. Many of these languages lack a written form and are not taught in school. Despite the absence of comprehensive census data on language usage, it is known that Somalis speak Mahaatiri, predominantly spoken in North and Central Somalia, and Maay, commonly spoken in many parts of Southern Somalia.
While Maay is considered a national language, its primary use in government administration occurs mainly in the Southwest State and extensive regions of Southern Somalia, excluding the capital of Mogadishu. There might be an assumption that families migrating from Maay-speaking areas to Mogadishu can quickly adapt to Mahaatiri, as the two languages are related. This research by Minority Rights Group found that understanding and speaking Maay doesn't directly translate into understanding Mahaatiri, and vice versa.
Most people interviewed were living in internally displaced people camps, and could not read and write, and the Maay speakers were tested with Mahaatiri and Maay audio recordings and posters that were used during polio vaccination campaigns by UNICEF, the Ministry of Health (MoH) and partners. The team also tested the understanding of key terminology in Mahaatiri with Maay speakers.
Researchers found that Maay speakers do not fully understand polio vaccination campaigns. Information is typically conveyed in Mahaatiri, posing challenges for Maay speakers who often do not fully understand it. This language barrier is evident in individuals expressing frustration and the desire for information they can understand. Informal translators, often neighbours or friends, are sometimes relied upon to bridge the language gap, but their limited health knowledge may result in reduced trust in the information. The use of interpreters during immunization visits still leads to some misunderstandings, highlighting the persistent language-related challenges in effective communication during health campaigns.
The researchers also discovered that Maay speakers do not fully understand the images and visual aids. Comprehension of visual aids on polio vaccinations proved challenging. Maay speakers faced difficulty understanding the Maahatiri text accompanying the images, attributing this to illiteracy or unfamiliarity with Maahatiri reading. Furthermore, they expressed that the images did not accurately reflect their own lived experiences.
Not understanding vaccination campaigns and information adds to Maay speakers' feelings of marginalization and discrimination, the research revealed. Maay speakers have faced long-standing language discrimination in a society mostly made up of Mahaatiri speakers. This discrimination is perceived by many as a way the Mahaatiri language reinforces social inequalities between Mahaatiri speakers and those who speak other languages.
During the colonial era (1840-1960) Radio Mogadishu broadcast news in both Maay and Mahaatiri. However, around the time of independence, Radio Mogadishu stopped airing broadcasts in Maay, continuing exclusively in Mahaatiri. These historical experiences of discrimination contribute to the existing sense of marginalization among Maay speakers, influencing their reactions to current public health information. Many participants shared instances of language-based discrimination in service provision and healthcare settings.
Partial understanding may limit trust in vaccination campaigns as indicated by the research. Incomplete understanding of health information makes people skeptical and suspicious about polio vaccinations. People are afraid of vaccination campaigns that they do not fully understand.
The study revealed that recordings or audio fragments in Maay were more easily understood than text and pictures, and the recordings in Mahaatiri. "I don't understand what the vehicles say," a man from Wadajir, Banadir, said during the study - speaking about a mobile polio vaccination campaign using speakers and music boxes on a van illustrated with campaign messages. It was frustrating for him, he said.
However, not all Maay words were equally well understood, as there are different Maay dialects. People interviewed for the research spoke the following dialects - Maay-Baidoa, Maay-Hamari, Maay-Bakool, Maay-Koryoley and Maay-Awdhegle. Still, any Maay dialect was much better understood than the Maahatiri spoken by the health workers.
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Polio vaccination knowledge among the research participants was low. Many of them did not have a good understanding of the signs and symptoms of polio, its treatment, and preventive measures.
Because information is not available in their language, many people won't know where to go or won't access health services. Not understanding where to access trusted medical health services may also lead people to seek only traditional healthcare.
As one study participant expressed, in cases of paralysis, people often rely on traditional healing methods, receiving massages and staying indoors due to a lack of understanding about the transmission of the condition and limited knowledge about it.
All Maay speakers interviewed requested information about polio vaccines in their own language. They felt that making the information available in Maay would increase vaccine uptake as people also want health information to be delivered in a way that is understandable and culturally and linguistically sensitive.
"It would be good that people who know my language speak, so that I don't refuse whatever they do, and that is how I would vaccinate the children, because now, I have no idea what they are talking about," a woman was quoted saying, while another participant asked that everything that they heard be replaced with Maay. - Edited by Juanita Williams
