In 2009 based at Mseleni hospital in KwaZulu Natal I was tasked to assess patients with epilepsy and to provide basic seizure education to doctors and nursing sisters in rural clinics. Mseleni is a government run hospital 60 km from the South-African—Mozambique border providing primary health care to 90 000 people. Over 3 weeks patients were seen with an interpreter in eight rural clinics across an area of 300 km2. The real challenge was not limited resources, or varying seizure aetiologies of alcohol withdrawal, trauma and HIV infections, or the use of older anti-epileptic drugs but rather the clinical nature of obtaining a diagnosis of epilepsy, which undoubtedly cannot be achieved without master of the local language. Story-telling and history taking through a highly skilled Zulu interpreter was limited and probably reflects language evolution. The native tongue is Zulu a Bantu language originating from sub-Saharan Africa, which is tonal, with many click consonants and inflections. Words used to outline clinical details and descriptive seizure semiologies commonly used in Caucasian languages derived from Anglo- Saxon, Viking and Latin based words do not exist in tribal tongues. Therefore Zulu patient stories may not be reliably translated and so in essence the nature of what we as epilepsy clinicians do is lost. Therefore the real art and personal challenge was to interpret stories with limited language, the use of mime or even by employing the ‘pantomime of compliant’.
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