Do you understand what I'm saying?

In Ghana, English is the official language. But, its far from the only one. There are close to 80 tribal dialects spoken. Twi, Ga, Nzema, Ewe, Hausa and Fanti...those are the few I've heard of. As far as I can tell they have no relation to each other...

I learned some Twi in Kintampo. Enough to say good morning and introduce myself. People responded either by looking confused, or by laughing at me. I like to think the laughter was from the joy of hearing an obruoni (white person) speak the language...but it might have also been how I pronounced things like Eti Sen? (How are you?)

Even though most Ghanaians speak English, communication can be difficult in our shared language. The English they speak is more British than American. And I can't tell if its the speed at which I talk or my accent, but many things in my conversations will get lost in translation. Consider this encounter with a pregnant Fanti woman I took to ultrasound:

Me: Do you speak English?
Her: Small, small.
Me: First baby?
Her: ::no answer::confused look::
Me: First baby? ::waving hands over stomach::
Her: You know if its a boy or a girl?
Me: No...
Her: Its a boy?
Me: I don't know...Do you want a boy?
Her: Where are you from?
Me: United States. You?
Her: Central Region ::incomprehensible town name::
Me: Ok.
Her: ::silence::
Me: So...first baby?

While I did get her to ultrasound...and while I was able to communicate the baby looked "ok"...I felt lost by not speaking her language. I didn't know if she had any questions or complaints. I couldn't tell if she wanted advice about having a baby. We spent most of the time regarding each other in silence so we didn't have to force a conversation in broken speech.

To know your patients...you really have to speak their language. As many Ghanaians will ask when they finish chatting with me - "do you understand what I'm saying??"