In the renal encounters, quantification was a constant source of difficulty. Many of the key biomedical topics are expressed through quantitative metaphors, for example, percentage of function, and relationships between different quantities -the patient's weight in fluid as opposed to muscle, the amount of certain foods consumed and the amount and frequency of medications and blood test results, length of visits home / time without dialysis, fluid consumption and body fluid retention, high and low blood pressure, high and low blood test results. Litres and millilitres, hours and dates, grams, kilograms and percentages have little if any relevance in the experience of most Yolŋu and the Yolŋu ways of expressing quantity and spatial and temporal concepts and relationships are often completely unknown to staff.
Vocabulary and concepts are strongly influenced by different needs for expressing meaning depending on the cultural context. In Western culture, for example, concepts related to time, such as duration and frequency, are expressed using abstract numerical measures. Questions about how long and how often are common particularly in a medical context. Such questions can be difficult for people who talk about time in reference to real events rather than clocks and calendars.
Even when working with an interpreter communication can be ineffective when metaphors are used that cannot be easily translated.
The use of metaphor is a powerful and widely utilised communicative tool. There are problems, however, when people using them in biomedical discourse fail to recognise the extent to which they are culturally specific and not necessarily meaningful to patients from a different cultural background, even if they may use and understand the individual words.
In Australia, health staff make extensive use of a machine metaphor when talking about the body and its functions, comparing the body to 'some sort of machine prone to breakdown but capable of repair by injections, manipulations, incisions, and replacing and mending parts' (Pauwels, 1995, p.172).
Pauwels (1995) suggests that the solution to these potential areas of miscommunication is not to list all possible health beliefs and associated metaphors for different cultures. Due to the many variations within any culture, such an attempt risks overgeneralisation and cultural stereotyping.
Health staff do need to be aware of, and sensitive to, potential differences and to reflect on how their own use of language may be open to different cultural interpretations.
As part of a careful educational process, however, an understanding of the cultural dimensions of metaphor can also enable much more effective communication between cultural groups if metaphors from the target culture are used to help explain concepts from the other culture.
Just as this strategy can be effectively used in education approaches about biomedical concepts with Yolŋu, there is also potential in using a similar approach to assist health staff to better understand Yolŋu concepts. Such a process can only be effectively realised through a close collaboration between members of both groups, with a constant awareness of the ontological and epistemological diversity (e.g. differences in ideas about the nature of reality and of knowledge) among both health staff and Yolŋu.