Years ago, when I worked in public health, a repairman was working in the office, and he approached me and asked, “So, antibiotics, are you for them or against them?” I explained that we advocated for them to be used responsibly. But the conversation we had is predicated on a basic, common understanding of what an antibiotic is. One problem that public health officials potentially face in educating people about the appropriate use of antibiotics is that the words used to describe antibiotics might themselves be doing harm (boldface mine):
In our own social research in rural northern Thailand (Chiang Rai; a mostly rural province with 1.3 million inhabitants), we have also come across varied expressions of ‘antibiotics’. For example, rather than ‘wonder drugs’, antibiotics are often referred to as ‘anti-inflammatory medicine’ (‘yah kae ak seb’), which links to local descriptions of illnesses as being caused by ‘inflammations’ of the body (e.g. in the case of a sore throat). Moreover, some local ethnic groups in Chiang Rai (e.g. Akha) may not have an equivalent of the Thai term in their mother tongue and rather refer to antibiotics as the ‘medicine that relieves the pain’, and yet other people would not actively distinguish between antibiotics and other kinds of medicine. These are not the only examples, and our informants also had a wide range of notions and descriptions for other medicines ranging from brand names (e.g. Tiffy) via generic descriptions (fever reliever) to descriptions of appearance (‘the white pill’). The literal translation of ‘antibiotic’ (‘yah pa ti chee wa na’) is a technical term with Pali roots (akin to Latin) that is hardly used or understood in rural Chiang Rai. Even seemingly unambiguous expressions like ‘drug resistance’ (‘due yah’)—literally translated into being ‘stubborn to [the effects of] medicine’—are being interpreted by non-native speakers or people without active conceptions of antibiotic resistance as meaning ‘being too stubborn to take medicine’. Language is therefore not merely a means to overcome ‘irrational behaviour’ but it also reflects more fundamentally how people think about medicine and illness. We first need to understand and address such deeper-rooted local conceptions and behaviours involving antimicrobial use. Antimicrobial resistance information campaigns referring for example to ‘antibiotics’, ‘bacteria’ or ‘viruses’ could otherwise be fruitless or have unforeseen behavioural repercussions.
Given that many antibiotic resistance genes of concern, such as carbapenemases, have been observed first (and possibly originated) in non-Western parts of the world (though the West is also pretty good at shipping resistance genes to other areas too!), these ‘translation’ effects could be a real impediment to encouraging the appropriate use of antibiotics. This highlights the importance of working with and developing local experts who can bridge these gaps.