Sage Journals: Discover world-class research

Abstract

The role of language is one of the most critical elements in communicating COVID-19 public health mandates globally. This study aims to explore how Tibetans in the multilingual Kham region came to understand COVID-19 and develop health choices. To accomplish this goal, we used a culture-centered approach to examine how the words/phrases of COVID-19 influence Kham Tibetans’ agency [the ability to develop actions (or lack thereof)] to work on the infectious disease and the pandemic management policy in China. This analysis explores the interactions among social structure, culture, and agency in the creation of transformative practices for negotiating the digital biomedical environment. Based on 30 in-depth interviews with Tibetans in the Kham region, we illustrate that the dialogical praxis to co-construct languages significantly impacts Tibetans’ deliberate agency, the capacity to act that is conscious or intended, to work on COVID-19 and the pandemic-control policy.

Plain Language Summary

Language is one of the most important elements in communicating COVID-19 public health mandates globally. The purpose of this study is to understand how Tibetans in Southwest China understand COVID-19 and develop health choices. Therefore, we use the framework of a culture-centered approach to examine how words/phrases of COVID-19 influence Kham Tibetans’ ability to develop actions to cope with pandemic management policies in China. This study analyzes how the interaction between social structure and traditional Tibetan cultural values enable and/or limited Tibetans’ health actions. Based on 30 in-depth interviews with Tibetans in the Kham region, we present the hybrid indigenous languages that are culturally appropriate and can effectively communicate COVID-19 mitigation. This study provides insights for practical implications in constructing the form and content of health messages in a public-health crisis in indigenous regions.

Keywords

Tibetan languages critical intercultural communication culture-centered approach health choice COVID-19 in China

Introduction

ལུང་པ་རེ་རེ་སྐད་ལུགས་རེ། བླ་མ་རེ་རེ་ཆོས་ལུགས་རེ།

Every district has its own dialect, every lama¹has his own doctrine.–Tibetan Proverb

Since the outbreak of the coronavirus, COVID-19, global public-health communication about it has been characterized by an exclusion of linguistic minorities (Chen, 2020; Chew, 2021; Piller et al., 2020). Communicating in the appropriate language(s) regarding this new disease and its meaning has been crucial to allowing various groups to understand the illness and develop health strategies. According to Word Health Organization (WHO, 2020a), the name of the disease (COVID-19) and the virus (severe acute respiratory syndrome-coronavirus 2, SARS-CoV-2) did not even exist before February 2020. The first popular names used in the media were “Wuhan Virus” and “China Virus,” in different languages, even though WHO (2020b) guidelines warned that place-specific names could lead to stigmatization (ostracization), and xenophobia. WHO (n. d.) has made critical health information available in six official languages: English, Arabic, Chinese, French, Russian, and Spanish. Recommended mitigation strategies included wearing masks, sheltering-in-place, social distancing and so forth; however, the majority of these terms did not exist or were alien to linguistic minorities in indigenous communities. Many minority language speakers struggled to develop medical terminologies regarding the disease and, therefore, the relevant strategies for working on it (Bai, 2020; Chen, 2020; Chew, 2021).

The nuanced meanings of any given language are vital, in this case, to communicating the meaning of COVID-19 and its public-health strategies in multilingual communities like the Tibetan regions in China. A Tibetan proverb says, “Every district has its own dialect, every lama has his own doctrine.” A “standard” Tibetan language has not been developed yet, and Tibetan languages are pronounced differently in every region. However, developing a culturally situated language for COVID-19 can provide critical agency for minority groups like Tibetans, especially in surviving a social-economic breakdown during the pandemic. Agency is broadly defined by critical intercultural communication and health communication scholars as the ability to act on and make changes in the world (Dutta, 2016; Halualani & Nakayama, 2010; Ocloo et al., 2020). Drawing from subaltern studies, agency thereby involves “the enactment of everyday choices and decisions by community members, amid structural constraints, that reflect the daily negotiations of [various objectives within these] structures” (Dutta et al., 2016, p. 4).

This study aims to highlight Tibetan agency in this global health crisis. To achieve this, we use Dutta’s (2008, 2016) theoretical framework, the culture-centered approach (CCA, explained later), to explore how Tibetans in the multilingual Kham region understand COVID-19 and develop health choices. Doing so, we examine how words/phrases of COVID-19 influence the Kham Tibetans’ agency in working on the pandemic and China’s pandemic-control policy.

Background of the Study

Although some studies have explored issues of communication within Tibetan culture, many of them generally regard “the” Tibetan language as a singular entity and have neglected the multicultural and multilingual nature of Tibet (Hartnett, 2013; Li & Cao, 2022; Ono & Jiao, 2008; Wang et al., 2022). To understand how Kham Tibetans understand COVID-19, the diversity of Tibetan languages and their status requires explanation. Generally, Tibetan or Tibetic languages refer to various tongues classified into three major ethnolinguistic communities – Kham, Amdo, and U-Tsang. Despite using the same written characters, they have little mutual intelligibility when spoken (Tournadre, 2014). As Kang and Li (2021) noted, it takes time for people from different regions and areas (even within the same linguistic group) to communicate across regional tongues.

The Kham region of Tibet in Southwest China’s Sichuan province is one of the most multilingual regions in the eastern Himalayan area. In Kham, Tibetans speak roughly 26 non-Tibetic tongues, in addition to the regional Tibetic variety, whether language, dialect, or another form (Roche & Suzuki, 2018). Many non-Tibetic languages have not been recognized by the state (Roche & Tsomu, 2018). Overall, Tibetans in Kham speak the Kham Tibetan languages (such as Ganze, Dege, or Baiyu variety, etc.), a Sichuan dialect (a Southwest Chinese variety), and a number of non-Tibetic tongues. It can be challenging to construct healthcare messages and mitigate COVID-19 in the multilingual communities in the Kham region.

In China, most health messages formulated by the authorities for COVID-19 were in standard Chinese, Mandarin. For many Tibetans, the term, new corona virus, or “COVID-19,” in the standard Chinese may not communicate meaningful concepts that work for the pandemic. Language is a worldview that signifies meaning for different people and groups (Kang & Rawlins, 2017). The neglect and exclusion of minority languages continue to disadvantage indigenous communities like those in Kham Tibetan region.

Literature Review

Although scholars have pointed out that culturally appropriate health messages have been crucial to developing meaningful responses to COVID-19 among indigenous communities (Bai, 2020; Chew, 2021), minority languages have rarely been recognized as an important resource. Generally, research in the interdisciplinary fields of culture, language, and health communication has explored how indigenous people understand health and develop health choices to manage infectious diseases focused on three types of relationships between health authorities and local communities (Araujo et al., 2021; Ahmed et al., 2020; Bai, 2020; Basu & Dutta, 2009; Chew, 2021; Dutta & Jamil, 2013; Elers et al., 2021). The research primarily uncovered structural inequalities that suppressed indigenous communities and limited their ability to develop strategies to cope with infectious diseases; it also explored ways in which health experts and authorities used a participatory approach to engage local communities. Some research that covered COVID-19 recognized the effectiveness of indigenous communication (Araujo et al., 2021; Bai, 2020; Chew, 2021; Elers et al., 2021) in the Global South. However, previous research has not prioritized such language as an important agency regarding the pandemic.

First, research has uncovered communicative and material inequalities―a dominant neoliberal political economy, racial/ethnic discrimination, and social-economic disparities―significantly influenced marginalized groups’ health and well-being (Ahmed et al., 2020; Elers et al., 2021). These structural inequities often emphasized top-down enforcement of COVID-19 precautions, such as mandatory “social distancing” or “sheltering-in-place” for marginalized populations, which affected socio-economic well-being and resulted in more fear, silence, and resistance. Elers et al. (2021) analyzed institutional racism and found the dominance of whiteness in New Zealand excluded the Māori from pandemic decision-making, and top-down lockdown measures forced low-income people to abandon everyday patterns of living, including work, social lives, and a manageable routine remaining in place (p. 111). The narratives pointed out that health communication interventions furthered marginalization of vulnerable communities, and these voices were largely eliminated from the interventions.

Second, growing numbers of scholars stated that health experts and authorities should use a participatory approach and dialogically engage insiders’ (local population and cultural authorities) health practices to better serve the indigenous community (Basu & Dutta, 2009; Bates et al., 2019; Dutta & Jamil, 2013; Lumpkins et al., 2021). For instance, Bates et al. (2019) used a wall art project in Chaquizhca, Ecuador, to explore a rural community’s definitions of physical, social, and mental healthcare, expressed via storytelling in terms of ethnic health and the physical functioning and rights of the child. These local articulations can provide an important grounding upon which health authorities can engage and serve the community. Lumpkins et al. (2021) identified that American Indian tribal leaders served as important cultural gatekeepers and formed a trusted health network with which to address historical trauma and healthcare-related issues.

In practice, the experts’ control over the local communities and their implementation of the global health communication model have emphasized government or civil-society programs. However, some adapted their programs to accommodate the needs of indigenous peoples (Araujo et al., 2021; WHO, n. d.). It is vital to link up with such communities and peoples to learn from their responses in mitigating the pandemic. As some have been quite visible and important researchers have called for government to better support locally emergent efforts. For instance, Araujo et al. (2021) found that indigenous communities in Brazil, Columbia, and Peru organized food banks, blockades and checkpoints of quarantine for visitors and migrants, and established online platforms for translating and disseminating COVID-related information. These overlooked efforts need to be taken seriously when working on COVID-19 issues.

Furthermore, some research highlighted co-constructed communication strategies for working on COVID-19 in indigenous communities, such as performing songs, stories, and developing minority-language media (Bai, 2020; Bober & Willis, 2021). Bai (2020) analyzed verbal and visual signs of Mongolian artists’ participation in global and national discourses, as they performed a characteristically Mongolian culture using traditional narratives, such as the khuuriin ülger (fiddle story), to communicate health messages. These studies help our understanding of culturally situated strategies as they evolved in response to the pandemic. The content, source, channel, and genre of locally emergent health messages have significantly affected COVID-19 prevention in indigenous regions.

Health authorities have often labeled minority languages as “barriers” to effective health communication (Elers et al., 2021; Martin & Nakayama, 2018). Comprehension of the dominant language has become a norm with which to evaluate indigenous people’s health literacy. A broadly adopted definition internationally, health literacy refers to “the degree to which individuals have [the] capacity to obtain, process, and understand basic health information and service needed to make appropriate decisions” (Institute of Medicine, 2004, p. 32; Mei et al., 2020; Xinhua, 2021, June 15). To challenge this way of naming diseases and developing health choices, this study will provide an in-depth examination of how Tibetan languages have served as agency for mitigating COVID-19.

Use of Minority Languages as Agency: A Culture-Centered Approach

According to Dutta (2008, 2016), CCA explores the construction of health meanings and the development of health solutions among marginalized groups through an interplay of structure, culture, and agency. Primarily, culture reflects the shared values, practices, and everyday meanings and contexts through which health, illness and treatment are negotiated (Dutta, 2008; Dutta et al., 2022). In the broader understanding of Tibetan culture, the Buddhist philosophy of “emptiness” and “dependent arising” are regarded as core principles for understanding and negotiating everyday life. The wisdom of emptiness means the “ultimate nature of things [as] a lack of … independent, definable, and discrete entities with [an] intrinsic nature” (Thupten Jinba, 2019, p. 11). Struggles negotiating the meaning of health and illness could be understood as intrinsically “empty,” meaning they are impermanent, like the reflection of the moon on the water, fabricated by our minds as we cling to the concept of “self” (Shantideva, 2008). We should be mindful that the concept of “emptiness” does not mean non-existence but “dependent arising.” It means any chain of causes and effects expressed through cosmic energy and the rhythm of nature (Chuang & Chen, 2003). The two principles are often manifest in Tibetans’ practice of compassion in daily life: the understanding that everything is devoid of a discrete nature, with the affirmation that we are all connected and are obligated to “relieve every suffering of all [other] sentient beings” (Shantideva, 2008, p. 34).

In addition, culture does not instill in communication any “neutral” or “equalizing” quality (Nakayama & Halualani, 2010, p. 7), but is “a site of struggle where various … meanings are constructed” (Martin & Nakayama, 2000, p. 8). The concept of “culture” assumes these meanings are situated in a group of people, such as a Tibetan ethnicity, based on similar cultural origins, traits, or meanings. The boundaries of a culture are basically assumed to be coterminous with the boundaries of an ethnic group (Kolas & Thowsen, 2004). Thus, the culture we refer to is both a commonly held system of meaning and the site of a power struggle in the political process of language.

Second, structure refers to organizing political and economic systems of rules, policies, and procedures, enabling or constraining cultural groups from access to resources and, here, proactive health strategies (Palmer-Wackerly et al., 2020). In the Kham Tibetan region, a variety of structural barriers prevented minority language speakers from having access to COVID-19 information and resources, even though the Chinese government implemented a very thorough Zero-COVID policy in 2020. It later evolved into Dynamic-Zero COVID during the Omicron crisis in July 2022. In both policies, each Chinese province launched its own health code apps to record each resident’s movements and COVID-19 test results. Even though 95% of the population is equipped with mobile phones in Southwest China’s ethnic Tibetan regions (Kang & Krone, 2021), it remains unclear how Tibetans use these apps with interfaces predominantly in standard Chinese. Some even had to use the Xizang province’s (also called Tibetan Autonomous Region) health app (Figure 1). Although the app was bi-lingual, the biomedical language made it difficult for Kham Tibetans to understand how the COVID-19 management policy corresponded with each terminology.

Figure 1.

Xizang province (Tibetan Autonomous Region) health management APP interface in standard Chinese and Tibetan.

As an important exemplar of structure, the Xizang province health app provides information such as travel history, residence, and medical records. It would then generate a QR code that identifies the individual’s risk level as red, yellow, or green. Often, an individual had to test negative and receive a green code on their health management app every 48 or 72 hr to work and travel. Based on different regional interpretations of the national COVID-19 policy, a person defined as close contact by their county health authorities might receive a red or yellow code, which would limit everyday mobility. Health QR code checkpoints are installed in almost every residential building, in public places such as shopping centers, on the highways, and even in remote villages. The app interface uses much bio-medical vocabulary in both standard Tibetan and Chinese languages. It has been a struggle for many minority language speakers to understand the information in the app, as well as to cope with the top-down digital control structure.

Last, agency is broadly understood as more than one’s ability to act but, as above, daily collaborative decision making in view of structural constraints (Dutta et al., 2016). Dutta (2008, 2016) also noted that in using dialogue to build infrastructures for participation and creating cultural meanings in health are important illustrations of what we want to call agency. In addition, when social and political structures marginalize specific communities, everyday health actions can be both deliberative and non-deliberative. Scholarship has highlighted indigenous agency and pointed out that agency, as such, does not necessarily produce one clear and definitive action (Broadfoot et al., 2018; Cruz & Sodeke, 2021; Kang & Krone, 2021). For instance, Broadfoot et al. (2018) reconceptualized postcolonial agency as “a force or capacity, translated as an act or non-act, capable of bringing about a change in another’s situation, perception, or action” (p. 124). In this sense, practicing situational silence or conformity without directly challenging the authority can also be a community-anchored praxis.

The CCA approach explores interactions among structure, culture, and agency in the co-creation of transformative practices challenging dominant communication practices in healthcare in the global South. To examine how Tibetans understand COVID-19 and develop critical health choices, we address the following:

Research question: How do different words/phrases of COVID-19 influence Kham Tibetans’ agency to work with COVID-19 and China’s pandemic-control policies?

Methodology

To accomplish this study, we engaged the “core methodological tool” or guideline, of CCA dialogue (Dutta et al., 2016, p. 5). Guided by a dialogical principle of interviewing, Puba conducted 30 in-depth interviews with native speakers of Kham languages from May 2021 to September 2022. The first 14 occurred in-person. Due to the gradual lockdown of cities and townships from July 2022, the rest of the interviews were conducted online via WeChat (Similar to WhatsApp) audio-calls. In the following, we detail data collection, responsibility, and reflexivity protecting participant privacy, identity, and the integrity of data analysis.

Data Collection

We designed the semi-structured interview protocol in English, Tibetan, and Chinese (See Appendix). Puba spoke a variety of Kham regional languages. He used a snowball sampling strategy for recruiting participants and conducted 30 interviews from May to November 2021. The interviews ranged from about 30 to 90 min. Sixteen men and 14 women participated (Table 1). All 30 participants were native speakers of Kham regional languages, as they were born and raised in the Ganzi Tibetan Autonomous Prefecture of Sichuan Province. The interviews were conducted based on the language preference of the participants. Eighteen interviews were conducted in the regional languages of Kham. Twelve interviews were conducted in Chinese. Among the 12 interviews in Chinese, seven were in Sichuan dialect, and five in Mandarin (Table 1 noted the language used to conduct each interview).

Table 1.

Demographics of Participants.

No.	Pseudonym (given by participants)	Age	Sex	Occupation	Region	Languages and proficiency (1. mother tongue; 2. fluent; 3. somewhat fluent; 4. beginner )
1	Gama	28	Male	Farmer	Ganze	*1. Ganze variety of Kham Tibetan
2.	Tsola	28	Male	Farmer/Nomad	Dege	*1. Dege variety of Kham Tibetan
3.	Norbu	29	Male	Famer/Nomad	Dawu	1. Daohua (rTa’u, a non-Tibetic language) *2. Sichuan dialect
4.	Tsomo	24	Female	Teacher	Shiqu	*1. Ganze variety of Kham Tibetan 2. Mandarin (standard Chinese) 3. Sichuan dialect
5.	Gyanuo	43	Male	Monk	Dege	*1. Dege variety of Kham Tibetan 2. Mandarin (standard Chinese) 3. Sichuan dialect
6.	Lhamo	23	Female	College student	Batang	1. Batang variety of Kham Tibetan 2. Mandarin (standard Chinese) *3. Sichuan dialect 4. English
7.	Tenzin	25	Female	College student	Litang	1. Litang variety of Kham Tibetan *2. Mandarin (standard Chinese) 3. Sichuan dialect 4. English
8.	Lhamo 2	28	Female	Farmer	Daocheng	1. Daocheng variety of Kham Tibetan *2. Sichuan dialect
9.	Baqing	25	Female	College student	Derong	1. Derong variety of Kham Tibetan *2. Mandarin (standard Chinese) 3. Sichuan dialect 4. English
10.	Yongzhong	24	Female	Teacher	Daocheng	1. Daocheng variety of Kham Tibetan 2. Mandarin (standard Chinese) *3. Sichuan dialect
11.	Pema	27	Female	College student	Dege	*1. Dege variety of Kham Tibetan 2. Mandarin (standard Chinese) 3. Sichuan dialect
12.	Busong	57	Male	Famer	Shiqu	1. Shiqu variety of Kham Tibetan *2. Sichuan dialect
13.	Tseji	30	Female	Teacher	Litang	1. Litang variety of Kham Tibetan *2. Mandarin (standard Chinese) 3. Sichuan dialect
14.	Dorje	29	Male	Farmer/Nomad	Dege	*Dege variety of Kham Tibetan
15.	Yixi Ladrup	26	Female	College student	Yajiang	1.Minyak (non-Tibetic language) 2. Mandarin (standard Chinese) *3. Sichuan dialect
16.	Tangbo	26	Male	College student	Seda	*1. Seda variety of Kham Tibetan 2. Mandarin (standard Chinese) 3.Sichuan dialect
17.	Tsomo	28	Female	Government employee	Luhuo	1. Luhuo variety of Kham Tibetan *2. Mandarin (standard Chinese) 3. Sichuan dialect
18.	Lhamo 3	Not disclosed	Female	Middle school teacher	Baiyu	*1. Baiyu variety of Kham Tibetan 2. Mandarin (standard Chinese) 3. Sichuan dialect
19.	Rengqing	Not disclosed	Male	Farmer	Baiyu	*Baiyu variety of Kham Tibetan
20.	Samdrop	24	Female	Teacher	Ganzi	*1. Ganzi variety of Kham Tibetan 2. Mandarin (standard Chinese)
21.	Tashi	25	Male	Student	Litang	1. Litang variety of Kham Tibetan 2. Mandarin (standard Chinese) *3. Sichuan dialect 4. English
22.	Tsewen	25	Male	Farmer/College student	Derong	1. Derong variety of Kham Tibetan *2. Mandarin (standard Chinese) 3. Sichuan dialect
23.	Zemay	27	Male	Government employee	Litang	*1. Litang variety of Kham Tibetan 2. Mandarin (standard Chinese) 3. Sichuan dialect
24.	Jime	Not disclosed	Female	Teacher	Baiyu	*1. Litang variety of Kham Tibetan 2. Mandarin (standard Chinese)
25.	Asso	27	Male	Doctor	Baiyu	*1. Baiyu variety of Kham Tibetan 2. Mandarin (standard Chinese) 3. Sichuan dialect
26.	Luozin	27	Male	Teacher	Baiyu	*1. Baiyu variety of Kham Tibetan 2. Mandarin (standard Chinese) 3.Sichuan dialect
28.	Silang	26	Male	Student	Dege	*1. Dege variety of Kham Tibetan 2. Mandarin (standard Chinese) 3. Sichuan dialect 4. English
29.	Tashi	28	Male	Monk	Dege	*1. Dege variety of Kham Tibetan 2. Sichuan dialect
30.	Sonam	Not disclosed	Female	Graduate student	Baiyu	*1. Baiyu variety of Kham Tibetan 2. Mandarin (standard Chinese) 3. Sichuan dialect 4. English

indicates the language used to conduct the interview.

Responsibility and Reflexivity

Several steps were taken to protect the identity and safety of participants, including transcribing interviews immediately and erasing the audio files. The names of the villages of the interviewees were also concealed. The names used in this study were preferred pseudonyms given by the participants. In 20 instances where participants felt uncomfortable or concerned about privacy-related issues, interviews were not recorded. Puba kept detailed notes on each interview.

We also reflected on how our subjectivity might influence their research and report. First, Puba’s Kham speaker identity and multi-lingual capacity made him accountable in relating to diverse Kham speakers. Second, because of our decade-long involvement in indigenous languages revitalization, we actively reached out to endangered language speakers. We both were particularly empathic with non-Tibetic speakers’ experiences in the research report.

After the we completed the first draft of the essay, Puba contacted all participants online for member checking from August and September 2022 to enhance confidence in the data (Creswell & Poth, 2018). He first sent a short member-checking request via the WeChat app, asking if all the participants were willing to read over or have a conversation on the research results. Twenty-one participants responded to the member checking. Second, Puba shared three pages of research results in the Tibetan and Chinese languages and used a voice call to communicate the results with the 21 participants. They agreed that the results truthfully represented their experience. In particular, two participants added more recent emergent phrases about COVID-19 and the impact of COVID-19 management policies in the Omicron crisis on their lives during the calls. Therefore, we included the participants’ evaluations of initial experiences with COVID-19 in 2020 and their concerns with the later pandemic-control policy in 2022.

Data Analysis

We used thematic analysis to examine the data (Lindlof & Taylor, 2013). Puba transcribed and translated the data into Chinese, spanning 79 pages. The notes from unrecorded interviews filled 36 pages. The transcript of the interviews in Tibetan was combined with the translation into Chinese for data analysis. This allowed us to code languages Tibetans used to describe COVID-19.

We worked together, as we first performed an inductive analysis to locate 13 key codes related to naming, meaning, and health choices. Following the open coding, we observed the core CCA principles expressed as the Tibetans in Kham developed COVID-19 vocabularies and their agency. Last, based on the core concepts of CCA contextualized by the authors: culture, structure, and agency, we re-organized the 13 codes into the eight key codes, three themes emerged (Table 2).

Table 2.

Codebook.

Themes	Key codes (frequently used words/phrases of COVID-19)	English translation	Significant quotes on agency (action and non-action)
(1) The language insufficiency: Agency as inaction with fear and confidence	Chinese: xin guan新冠	new corona	Norbu, a 29-year-old famer: “I don’t know what to do because I was so scared after hearing the news in standard Chinese language [xin guan]. I just stayed at home.”
	Chinese: xin guan新冠	new corona	Three bilingual Tibetan and Chinese speakers: The Chinese central government could develop a good system to take care of the infectious disease. Therefore, they[the villagers] do not necessarily need to do anything.
	Tibetan: lo tseགློ་ཚད།	a lung disease (very general)	A 23-year-old college student Lhamo: “Villagers at home don’t think we would be infected and there was not any sense of crisis.”
	Tibetan: gya nak lo tseརྒྱ་ནག་གློ་ཚད།	the lung disease from the Han region	43-year-old Lama Gyanuo: “Tibetans are immune to COVID-19, as it resulted from the karma of the Han people’s lack of compassion regarding consumption of wild animals.”
(2) The language inconvenience: Agency as active and passive conformity	Tibetan: dozhi naduk ཏོག་དབྱིབས་ནད་དུག	new corona virus	28-year-old government employee Tsomo adopts active health measures, such as wearing masks and social distancing, although her family members thought she did it as a government worker “formality.”
	Tibetan: rim ne རིམས་ནད།	infectious illness	27-year-old Doctor Asso: health mandates such as staying home, wearing masks, and washing hands
	Minyak: enre sarba	a new disease	26-year-old college student Yixi Lhadrup: “I could not leave the house at all during the Wuhan lockdown… I didn’t care about [whether I] got infected. My life simply doesn’t matter.”
(3) The language impermanence: Agency as dialogical praxis.	Tibetan: lo tse zha yul ma གློ་ཚད་འཇའ་ཡལ་མ།	the lung disease as an evanescent rainbow	28-year-old Tibetan lama Tashi: “I used official scientific preventive measures to prevent viruses [such as wearing masks, and social distancing]. On the other, as a Tibetan, I use traditional methods, such as wearing traditional Tibetan medicine bags, chanting mantras, and praying to the Three Jewels.”
(3) The language impermanence: Agency as dialogical praxis.	Chinese: xin guan 新冠 Tibetan: gue ne འགོས་ནད། Tibetan: lo tse zha yul ma གློ་ཚད་འཇའ་ཡལ་མ།	new corona; infectious disease; the lung disease as an evanescent rainbow	Villagers self-organize to make the cloth-masks, wear the mask, and maintain social distance to work with COVID-19.

Guided by CCA, the three themes answered research questions about how indigenous words/phrases of COVID-19 influenced Kham Tibetans’ agency for working on COVID-19 and China’s pandemic-control policy. They are: (a) the language insufficiency: agency as inaction with fear and confidence, (b) the language inconvenience: agency as active and passive conformity, and (c) the language impermanence: agency as dialogical praxis.

Results

The Language Insufficiency: Agency as Inaction with Fear and Confidence

One of the significant themes showed that the majority of Kham speakers understood COVID-19 using the abbreviated Chinese word xin guan (新冠,new corona) or reduced it to the Tibetan term lo tse (གློ་ཚད།, lung disease) in the early stages of the pandemic in 2020. Yet, both xin guan and lo tse are insufficient for developing a full understanding of COVID-19. The Chinese term xin guan is often spoken with a high level of fear. On the contrary, lo tse was used with confidence about being invulnerable to it. In the interaction of the health structure and local culture, both terms allowed the Kham Tibetan agency to avoid a deliberative action to work on mitigating COVID-19.

In the early stages of the pandemic, sentiments of fear emerged when the Tibetic speakers used xin guan (new corona), but it fails to explain the virus or the illness in the Tibetan context. Often, the authoritarian healthcare communication structure facilitated precautionary measures, but the bio-medical lingua-franca of the Chinese and Tibetan languages did not warrant meaningful action even in the earlier days of the pandemic. For instance, the Daohua speaker Norbu (pseudonym), a 29-year-old famer, said,

When the pandemic situation in our county was severe, the local government used mobile speakers, WeChat chatting groups, and specialized translators [cadres] to translate [the COVID-19 strategies]. When the Daofu county reported a lot of cases, I [didn’t] know what to do because I was so scared after hearing the news in standard Chinese language [xin guan]. It doesn’t make sense. I just stayed at home.

In the framework of modern development, the Tibetan culture and its lifestyle may be seen as primitive, backward, and superstitious, especially as Tibetans’ religious practices have been a large part of Tibetan life (Kolas & Thowsen, 2004). From the perspective of the bio-medical paradigm that has populated China since the 1950s, Tibetans have experienced a lack of modern medical knowledge and a need to be saved from this backwardness. The Kham speakers with little Chinese language competence demonstrated their inaction (Broadfoot et al., 2018), and were further marginalized due to a high level of fear. The health messages in standard Chinese often symbolized rules that address highly educated bilingual Chinese and Tibetan speakers, but did not communicate much meaning to speakers with a lower socio-economic status.

In contrast, three participants who received undergraduate degrees in Chinese universities or government training in the bi-lingual system also indicated that they often used the term new corona in Chinese, which is convenient but insufficient. However, they proudly asserted that China’s health system could “fight this illness” and pointed to the capacity to build large-scale quarantine centers in about 10 days, such as the Fire God Mountain Hospital of Wuhan (Xinhua News Agency, 2020, February 6). They indicated that the Chinese central government could develop a good system to take care of the disease; therefore, they did not fundamentally need to do anything.

Five speakers of the Kham regional language indicated that lo tse has been used in family and public communication about COVID-19. The spread and effects of this generalized “lung disease” were called “confusing,” but it did not seem “infectious” among Tibetans. A 23-year-old college student, Lhamo (pseudonym), who speaks the Batang variation of Mandarin, and English, shared her confusion over the naming of COVID-19:

At the beginning of the pandemic, we didn’t really know what it’s [COVID-19] called because we don’t hear it in our regional language. Villagers at home don’t think we would be infected and there was not any sense of crisis. Our family called it lo tse; it refers to just general lung disease. And it is from the outside [of our village].

As in many other communities, public discourse associated with COVID-19 has fostered xenophobia. COVID-19 was regarded as an infectious disease stemming from “outsiders,” and with a very low infection rate in Tibetan regions in China, villagers regarded it as the Han Chinese people’s disease. Gyanuo (pseudonym), a 43-year-old monk said, “In rural villages, my family called it gya nak lo tse (རྒྱ་ནག་གློ་ཚད།), the lung disease from the Han region.”

Like Lama Gyanuo, three other participants also believed that Tibetans are immune to COVID-19, as it resulted from the karma of the Han people’s spiritually insensitive consumption of wild animals. In this case, the perceived Tibetan culture, assumed coterminous with the boundaries of this ethnic group (Kolas & Thowsen, 2004), combined with a passive linguistic structure (Dutta, 2008), encouraged a general non-deliberative agency (inaction) when working on COVID-19.

The Language Inconvenience: Agency as Active and Passive Conformity

The second theme showed that either using a Tibetan phrase (often a direct translation from Chinese) to describe COVID-19 or making a new phrase from a Tibetan minority language (the Minyak language) created an inconvenience for local Tibetans in understanding COVID-19 and its health issues. Primarily, eight participants used the literal translation, new corona virus, from the Chinese government’s: dozhi naduk (ཏོག་དབྱིབས་ནད་དུག). They indicated that the term is inconvenient for “exhibition” purpose because it was merely a translation of the bio-medical terminologies without communicating any cultural meaning. Even though using the Chinese language can be a struggle, using the translation of the biomedical term is more convenient. For instance, a 28-year-old government employee, Tsomo (pseudonym), from Luhuo County, said:

The quality of the translated Tibetan news in my region is not good. I’d rather read the COVID-19 news stories with one glance than struggle so hard to read the translations [of Chinese] to Tibetan in my region. It is a waste of time to read the inadequate or low-quality translation in Tibetan. I think the Chinese language is an accurate tool [to use to understand] COVID-19.

She pointed out a common problem in the Kham region: many Tibetan news media in the townships treated the Tibetan translation as “facework,” an act that superficially respected and dignified some “stubborn Tibetans” because “most of the Tibetans don’t read it, anyway.” She also said she took seriously active health measures, such as wearing masks and social distancing, although her family thought she did it as a formality as a government worker.

A Tibetan doctor, Asso (pseudonym), from Baiyu County, also said this official translation in Tibetan had little effect on people’s health choices because it has no resonance with the cultural authority, the Four Tibetan Medical Tantra. He said:

I do not use the term dozhi naduk (ཏོག་དབྱིབས་ནད་དུག), as it is merely a direct translation; it only signifies the illness [with which] one’s lung is being infected. I prefer to use rim ne (རིམས་ནད།) to explain [it] to my community because rim (རིམས་ནད།) is a better way to tell people the illness is “infectious” among people with close contact… Using a brand-new medical vocabulary that does not exist in the Tibetan Medical Tantra will be difficult [to communicate to Tibetan people].

Dr. Asso said he would avoid crowded areas, wear surgical masks to treat patients, and wipe all surfaces with alcohol, even if the count of positive cases did not signify an outbreak in his county. Note that he uses the term rim ne from the Four Tibetan Medical Tantra, called Sowa Rigpa in Tibetan. Sowa Rigpa means the sacred texts encompassing the traditions of Tibetan medical systems and healing, with roots more than 2,000 years old (Garrett, 2008). This Tibetan word, rim ne, refers to a “poisonous and pernicious parasite,” like a demonic element in the human body that spreads from the eyes, ears, nose, mouth, and so on (Rinwang Tsering, 2003, p. 153) . The “parasite” is a metaphor for infectious disease in the present. In Tibetan culture, an infectious illness, like plague or smallpox, is a karmic consequence of “demonic” elements attributed to the angry female goddess, Mamo Khandro, who spreads them by exhaling (Lobsang Yongdan, 2016, p. 578).

Key cultural stories were missing in the translation of the COVID-19 health narratives and information in the early stages of the pandemic. Dr. Asso’s use of these terms was not known in other counties. The confirmational agency Tibetans developed came from using the bio-medical lingua franca for the Tibetan phrase: COVID-19. It often decreased their willingness to follow COVID rules, such as wearing masks or social distancing. But many secretly violated the health mandates, such as joining evening circle dances or praying in the monastery.

In addition, non-Tibetic tongues, such as the Minyak language, are considered inconvenient (or problematic) for many Tibetan health authorities in the Kham region. The insensitivity to minority languages reinforced health inequities but created opportunities for people speaking them to develop their own COVID vocabulary. A 26-year-old Minyak speaker, Yixi Lhadrup (pseudonym), struggled with lockdown at home during the Wuhan crisis. He said:

Unlike other Tibetan languages, our Minyak language does not have a written script. We felt this disease is like cancer and something that could easily terminate your life… We called it enre sarba [enre means “illness,”sarba“new”], meaning, simply, a new disease. I don’t remember anything from the Tibetan language news about COVID precautions and policies, even though I heard them a lot on TV or social media. Some local officials visited our house and tried to educate us in Tibetan. I could not leave the house at all during the Wuhan lockdown. I [was] afraid I would be troubling the country if I walk[ed] out. I didn’t care … if I got infected. My life simply doesn’t matter.

Minyak speakers like Yixi Lhadrup did not find the hybrid term enre sarba meaningful. Without a fully developed healthcare terminology in the Minyak language, his choice of self-quarantine, his feeling of not “troubling the country” and the statement that “my life simply doesn’t matter” indicated a passive conformity to COVID restrictions during the Wuhan scare. From Tibetan cultural values, this existential resignation of self, this detachment of self and aim to reduce the suffering of others (Shantideva, 2008), can be seen as both passive and active, a paradoxical agency regarding the COVID mandates. As noted in CCA, the cultural value of reducing the suffering of others enabled the agency.

More than half the participants indicated that the local health authorities’ insensitive implementation of COVID-19 precautions, linguistically and culturally, reinforced health inequities between Tibetic and non-Tibetic speakers. When Puba conducted member checking during the 2022 Omicron crisis, the challenges for non-Tibetic speakers were not just understanding the new variants but the Dynamic-Zero COVID Control Policies. Two participants said they were very confused about how “close contact” with a positive case was defined. One shared that his family lives in Sichuan, bordering Xizang province. They used the telecommunication service from Xizang because it had better reception. When the authorities announced a province-wide lockdown, the family’s health code turned red (high-risk exposure). Although the county had no COVID cases, the family was named as “close contacts” by the county health authorities and moved to quarantine. They called the county leaders to complain but were asked to talk to the app developer. They called the developers but could not communicate the problem to customer service, because the representative did not speak their language. The local authorities could not change their situation because this language inconvenience could not communicate the issue. On the structural level, the health code determined that they had to remain in quarantine for a week and take daily COVID tests. Complaining without success, they had to conform to the technologically determined COVID-control policy. A lack of resources in non-Tibetic languages and the technological infrastructure further constrained the minority speakers’ agency.

The Language Impermanence: Agency as Dialogical Praxis

Participants said the naming of COVID-19 and the illness itself were, together, an impermanent phenomenon, which is a central belief in Tibetan Buddhist culture. Such an understanding is consistent with the Buddhist notion of emptiness, indicating the nature of things is often illusory and impermanent (Thupten Jinba, 2019). Developing a fluid understanding of the pandemic seemed to give rise to Tibetan agency in coping with it and the general control policy. In the early stage of COVID-19, there was no consensus about what to name the illness in the Tibetan languages, and local monastic leaders became important sources of leadership in understanding the disease in cultural terms. Tashi (pseudonym), a 28-year-old Tibetan lama from Dege, said:

We call the new infectious disease “the lung disease as an evanescent rainbow (གློ་ཚད་འཇའ་ཡལ་མ།).” It was first named by the Khenpo Tsultrim Lodro at the world-renowned Larung Gar Buddhist Academy in Sertar. From my understanding, it refers to … our body attaining the complete knowledge [with which it] could transform itself into the five radiative lights that compose a rainbow. I discussed with monks and villagers the chaos we experienced in 2020, [but] the disease comes to us for a reason. It would disappear [if] we learn with it… On one hand, I used official scientific … measures to prevent viruses [wearing masks and social distancing]. On the other, as a Tibetan, I use traditional methods, such as wearing … Tibetan medicine bags, chanting mantras, and praying to the Three Jewels [the Buddha (the exemplar), the Dharma (the teachings), and the Sangha (the community)].

Lama Tashi’s understanding of infectious illness as a Tibetan Buddhist cultural value is a natural (including human nature) phenomenon. The agency he embodied with which to work on COVID can be seen as a dialogical praxis combining scientific measures from the Chinese government and the Buddhist practice of healing. According to Freire (2000), dialogical praxis means, upon reflecting on reality, people act together to transform it through action and reflection. In this view, Tibetan agency stipulating health choices (or those lacking) is not an individual act but one of a community in dialogue trying to make sense of the illness and act on it.

In addition, Baqing (pseudonym), a 25-year-old female student from Derong said that the naming of COVID-19 has been changing and her community used different terms in different situations. She said:

People in my village used the Chinese term xin guan (new corona) during Wuhan COVID-19 crisis. Later my neighborhood called it gue ne (འགོས་ནད།), referring to “the infectious illness,” [as] promoted by the regional government media, and “the lung disease as an evanescent rainbow” from the Larung Gar Buddhist Academy Online Chat Group. Which term to use depends on who we speak to.

As Baqing said, villagers self-organized via the WeChat app and discussed ways to prevent COVID-19 in the villages and townships. In these groups, many Tibetans (including non-Tibetic speakers) found talking about COVID-related information an effective way to understand the illness, especially discussing COVID as presented in videos and podcasts.

On social media, Tibetan-language teacher-influencers can become a trusted network with which Tibetans can understand COVID and related health information. Nine participants from our interview indicated the “Yutso Teaching Tibetan” WeChat podcast (Figure 2) was one of the most important sources of information. Viewers can leave questions for the podcaster Yutso and talk to her on the webpage or via online chat groups.

Figure 2.

A screenshot of “Yutso Teaching Tibetan” podcast.

A 57-year-old farmer and nomad, Busong (pseudonym) from Shiqu County said:

Teacher Yutso not only teaches the Tibetan language, but most importantly, she talked about how to avoid scammers²… From migrant workers to nomads and monks … everyone understood what she was saying. She did not just read news [translating bio-medical information from Chinese to Tibetan], she analyzed the news with us.”

Busong’s business was not negatively affected during the early stages of COVID because there was a very small number of COVID cases in his village. He added that, after listening to Yutso’s podcasts, he was still observing precautionary measures, such as washing his hands more often and wearing a mask in public spaces. Busong thought these actions protected his family and community.

The podcaster, the Tibetan teacher Yutso, not only accommodated speakers in Kham regional languages but used non-biomedical vocabulary to explain preventive strategies. For instance, in a podcast, Yutso would receive questions on masks and explain why a mask is necessary (2020, January 30):

All provinces have people infected regardless of ethnicity. This illness is transmitted by air from our mouths. … the invisible water [droplets] from our mouth … could transmit the illness. A mask does not mean a “face cover.” It is covering our mouth and nose to prevent the tiny water from our mouth moving to another person.

A few participants indicated their villages were voluntarily making cloth masks after discussing Yutso’s podcasts during a family gathering. In the early stages of COVID, they agreed that strict quarantines were necessary. During the lockdown, the co-constructed social media spaces dialogically enabled deliberative agency with which Tibetans could organize and make community-based health choices such as making a mask, wearing it, and maintaining social distance.

Last, the evolving new usages of COVID-19 in the region illustrated the language impermanence. During member checking in the 2022 Omicron crisis, we found that our participants used other terms to describe the disease. One of the most frequent was corona illness (ཏོག་ནད།), closest to the Chinese term xin guan (new corona). Many popular Tibetan singers, like Nima Tsering (2022), along with social media influencers in the Kham region, have used corona illness, and it evolved into stable use during the Omicron crisis. It shows that the many Tibetan and Chinese languages surrounding COVID-19 have been in dialogue with each other and become similar.

Limitation

The research is limited in two ways. First, as with the changes in COVID-19 and its management, the regional languages in Kham Tibet have been changing at a fast pace. It was hard to capture these changes during the crisis. Many new terms evolved in different stages of the pandemic. Due to the constraints of online communication, we were unable to maintain many strong connections and track the changes in the words/phrases of COVID-19 and their influences on Kham Tibetans’ agency. Although 70% of our participants responded to the online member checking, our assessment of changes in their understanding of COVID-19 was incomplete. Second, due to the lockdown, we were unable to observe the behaviors of 16 interview participants. It affected how we make sense of the participants’ understanding of COVID-19, and their health choices (i.e., social distancing and/or mask-wearing during interviews, etc.). Last, we noticed that the local understanding of the new variant has been interwoven with the local government’s application of the nation’s COVID policy during the member checking. It was difficult to separate them from the top-down and bottom-up management of COVID-19. Future study can further explore how Tibetans respond to these aspects of the COVID control policy.

Conclusion and Implication

In this study, we addressed how the words or phrases of COVID-19 influenced Kham Tibetans’ agency in working on the disease and China’s pandemic-control policies. Guided by CCA (Dutta, 2008; 2016), we concluded that the locally emergent indigenous languages of COVID-19 (not just a simple translation from the official language) significantly impacted the forms of agency as they interacted with various cultures and structures during the pandemic. First, in the use of the insufficiently translated phrases from Chinese, the agency of Kham Tibetans often manifested itself in inaction due to fear. The words that were considered insufficient, lo tse (generally lung disease) and gya nak lo tse (the lung disease from the Han region) created an illusory “undefeatable ethnic group” in the health crisis. Neither seemed to allow for the necessary community agency to develop effective healthcare choices. Meanwhile, it is notable that agency could also be understood as a force or capacity that translates as both action and nonaction (Broadfoot et al., 2018). The “doing nothing” health choice could result from the interaction of the authoritarian top-down structure of health communication and the ethnocentric perception that “Tibetans are immune” in the early stages of COVID.

Second, the direct translations of COVID-19 from Chinese and Tibetan are seen as problematic and ineffective for Kham Tibetans to understand the infectious disease and to develop agency. The standard Chinese-centered linguistic healthcare structure has constrained the agency of minority speakers. Major state media in the Tibetan autonomous regions predominately broadcasted COVID-19 messages in the lingua franca of the Tibetan languages of their region, often a translation of the standard Chinese bio-medical language. The local cadres also used loudspeakers or mobile trumpets to deliver these messages in rural regions. Such messaging did not enable active health choices within the COVID restrictions. The bio-medical phrases translated into local languages did not seem to support meaningful action. Therefore, Kham Tibetans had to both actively and passively conform to strict biomedical measures, without an adequate understanding of the illness. Tibetan medical studies scholars Choeden Yeshi et al. (2009) emphasized that effective government-operated health and hygiene programs in rural Tibet across languages require long-term face-to-face, focus group training and dialogue with locals and their leaders. However, such programs have not been very effective in the pandemic due to the need for social distancing.

Lastly, if appropriate dialogue is practiced, the language and meaning of COVID-19 evolves, as the understanding of the illness changes from Tibetan Buddhism to that of today’s bio-medical policy structures. This transformation could be a constraint but also a source of innovation and inspiration (Dutta, 2012). Our participants have noted it is significant that the Buddhist monastic leaders and the teacher-influencer Yutso engaged credible bio-medical sources of Chinese language in dialogue with traditional Tibetan cultural values. Tibetans’ deliberative agency is manifest as a dialogical praxis, for example, from practicing compassion in social distancing and self-organizing to making masks in the early stages of COVID, along with helping each other during the nucleic acid tests in the lockdown phase of the Omicron crisis. Like the tribal leaders’ roles as gatekeepers in American Indian communities (Lumpkins et al., 2021), Buddhist monastic leaders and Tibetan-language teacher-influencers are a trusted network of health information; they can facilitate “translating” the language of COVID and address health-related issues.

Overall, this study provided insights for two practical implications in constructing the form and content of health messages in a public health crisis. First, it calls for local authorities to develop health messages in regional languages that are culturally appropriate. Despite the normalized top-down public communication context in China, it is essential for health authorities to listen to voices of marginality, of socio-economic disparity, and of linguistic alienation (the structural exclusion of non-Tibetan speakers), in order to develop a more humane and just public health communication system. Second, regional health management personnel can work closely with monastic leaders and credible social media influencers like Yutso to co-construct health messages with locals.

Footnotes

Appendix: Semi-Structured Interview Protocol

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Ethics Statement

The authors followed their institutional guidelines to protect of the privacy and the welfare of the human research subjects in this study.

ORCID iD

Dongjing Kang

Data Availability Statement

To protect the research participants’ privacy and identity, the data set will not be shared.

Notes

References

Ahmed

Pissarides

Stiglitz

(2020). Why inequality could spread COVID-19. Lancet Public Health, 5, e240. https://doi.org/10.1016/S2468-2667(20)30085-2

Araujo

Cannon

Schmidt-Sane

Shankland

Snijder

Y.-C.

(2021). Key considerations: Indigenous Peoples in COVID-19 response and recover. Social Science in Humanitarian Action Platform. https://www.socialscienceinaction.org/resources/key-considerations-indigenous-peoples-in-covid-19-response-and-recovery/

Bai

(2020). Fighting COVID-19 with Mongolian fiddle stories. Multilingua, 39(5), 577–586. https://doi.org/10.1515/multi-2020-0087

Basu

Dutta

M. J.

(2009). Sex workers and HIV/AIDS: Analyzing participatory culture-centered health communication strategies. Human Communication Research, 35(1), 86–114. https://doi.org/10.1111/j.1468-2958.2008.01339.x

Bates

B. R.

Marvel

D. L.

Nieto-Sanchez

Grijalva

M. J.

(2019). Painting a community-based definition of health: A culture-centered approach to listening to rural voice in Chaquizhca, Ecuador. Frontiers in Communication, 4(37), 1–13. https://doi.org/10.3389/fcomm.2019.00037

Bober

Willis

(2021). The Covid-19 pandemic and minority language media in Europe: the effects of spring 2020 lockdowns. Journal of Multilingual and Multicultural Development, 1–17. https://doi.org/10.1080/01434632.2021.2005074

Broadfoot

K. J.

Munshi

Cruz

(2018). Releasing/Translating agency: A postcolonial disruption of the master’s voice among Liberian market women. In The agency of prganizing, edited by Brummans

B. H. J. M.

(ed.), pp.123–141. Taylor & Francis.

Chen

(2020). Public health messages about COVID-19 prevention in multilingual Taiwan. Multilingua, 39(5), 597–606. https://doi.org/10.1515/multi-2020-0092

Chew

K. A.

(2021). KeepOurLanguagesStrong: Indigenous language revitalization on social media during the early COVID-19 pandemic. Language Documentation & Conservation, 15, 239–266. http://hdl.handle.net/10125/24976

10.

Choeden

Yeshi

Wangdui

Puchung

Holcombe

(2009). Health and hygiene behaviour change: Bottom–up meets top–down in Tibet. Development in Practice, 19(3), 396–402. https://doi.org/10.1080/09614520902808266

11.

Chuang

Chen

G.-M.

(2003). Buddhist perspectives and human communication. Intercultural Communication Studies, 12 (4), 65–80.

12.

Creswell

J. W.

Poth

C.N.

(2018). Qualitative inquiry and research design: Choosing among five approaches. Sage.

13.

Cruz

Sodeke

(2021). Debunking eurocentrism in organizational communication theory: Marginality and liquidities in postcolonial contexts. Communication Theory, 31(3), 528–548. https://doi.org/10.1093/ct/qtz038

14.

Dutta

M. J.

(2008). Communicating health: A culture-centered approach. Polity.

15.

Dutta

M. J.

(2016). Neoliberal health organizing: Communication, meaning, and politics. Routledge.

16.

Dutta

M. J.

Jamil

(2013). Health at the margins of migration: Culture-centered co-constructions among Bangladeshi immigrants. Health Communication, 28(2), 170–182. https://doi.org/10.1080/10410236.2012.666956

17.

Dutta

M. J.

Mohan

Dutta Mandal

Kaur

Pitaloka

Pandi

Tan

Bashir

Prasad

Sun

Thaker

Comer

Zapata

Tan

Luk

Rahman

Etchart

Falnikar

Ganchoudhuri

Kumar

Sastry

(2016). Culture-centered method: The nuts and bolts of co-creating communication infrastructures of listening in communities. CARE center for culture-centered approach to research and evaluation. Singapore, National University of Singapore.

18.

Dutta

M. J.

Jayan

Elers

Rahman

Pokaia

(2022). Receiving healthcare amidst poverty during the COVID-19 lockdowns: A culture-centered interrogation. Health Communication, 37(12),1503–1509 https://doi.org/10.1080/10410236.2022.2111634

19.

Elers

Jayan

Elers

Dutta

M. J.

(2021). Negotiating health amidst COVID-19 lockdown in low-income communities in Aotearoa New Zealand. Health Communication, 36(1), 109–115. https://doi.org/10.1080/10410236.2020.1848082

20.

Freire

(2000). Pedagogy of the oppressed (30th anniversary ed.). Continuum.

21.

Garrett

(2008). Religion, medicine and the human embryo in Tibet. Routledge.

22.

Halualani

R. T.

Nakayama

T. K.

(2010). Critical intercultural studies at a crossroads. In Nayama

T. K

Halualani

R. T.

eds., The Handbook of Critical Intercultural Communication (pp. 1–16). Wiley & Sons.

23.

Hartnett

(2013). “Tibet is Burning”: Competing rhetorics of liberation, occupation, resistance, and paralysis on the roof of the world. The Quarterly Journal of Speech, 99(3), 283. https://doi.org/10.1080/00335630.2013.806819

24.

Institute of Medicine. (2004). Health literacy: A prescription to end confusion. Board on Neuroscience and Behavioral Health, Nielson-Bohlman

Panzer

A.M.

Kindig

D.A.

, (Eds). The National Academies Press: Washington, D.C.

25.

Kang

Krone

K. J.

(2021). Organizing dissonance on the Tibetan plateau: Insights from the wisdom of nonduality. Culture & Organization, 28(1), 25–45. https://doi.org/10.1080/14759551.2021.1963963

26.

Kang

(2021). Home-in-language: examining Tibetan migrants’ narratives of homeplace amid China’s urbanization. Language and Intercultural Communication, 21(2), 174–189. https://doi.org/10.1080/14708477.2021.1876719

27.

Kang

Rawlins

W. K.

(2017). Exploring languages preservation in Kham Tibet, learning from “Discourse in the Novel,” and writing a Dialogical/Bakhtinian ethnography. Qualitative Inquiry, 23(8), 618–630. https://doi.org/10.1177/1077800416684873

28.

Kolas

Thowsen

(2004). On the margins of Tibet: Cultural survival on the Sino-Tibetan frontier. University of Washington Press.

29.

Cao

(2022). Rules we live by: How religious beliefs relate to compliance with precautionary measures against COVID-19 in Tibetan Buddhists. Journal of Religion & Health, 61, 1671–1683. https://doi.org/10.1007/s10943-022-01512-w

30.

Lindlof

T. R.

Taylor

B. C.

(2013). Qualitative communication research methods. Sage.

31.

Yongdan

Lobsang

. (2016). The introduction of Edward Jenner’s smallpox vaccination to Tibet in the early 19th century. Archiv Orientální, 84(3), 577–593. https://doi.org/10.47979/aror.j.84.3.577-593

32.

Lumpkins

Goeckner

Hale

Lewis

Gunville

Daley

C.M.

Daley

S.M.

(2022). In our sacred voice—An exploration of tribal and community leader perceptions as health communicators of disease prevention among American Indians in the plains. Health Communication, 37(9), 1180–1191. https://doi.org/10.1080/10410236.2021.2008108

33.

Martin

J. N.

Nakayama

T. K.

(2018). Experiencing intercultural communication: An introduction (6th eds). McGraw Hill Education.

34.

Martin

J. N.

Nakayama

T.K.

(2000). Intercultural communication in contexts, 2nd eds. McGraw Hill Education.

35.

Mei

Zhong

Chen

Huang

(2020). Exploring health literacy in Wuhan, China: A cross-sectional analysis. BMC Public Health, 20, 1417. https://doi.org/10.1186/s12889-020-09520-9

36.

Nakayama

T. K.

Halualani

R. T.

(2010). The handbook of critical intercultural communication. Wiley-Blackwell.

37.

Nima Tsering. (2022). ཏོག་དབྱིབས་ནད་དུག Corona virus. WeChat video channel. Lhamo Bomu Sound and Images.

38.

Ocloo

Goodrich

Tanaka

, et al. (2020). The importance of power, context and agency in improving patient experience through a patient and family centred care approach. Health Research Policy and Systems,18, 10. https://doi.org/10.1186/s12961-019-0487-1

39.

Ono

K. A.

Jiao

(2008). China in the US imaginary: Tibet, the Olympics, and the 2008 earthquake. Communication & Critical/Cultural Studies, 5(4), 406–410. https://doi.org/10.1080/14791420802416168

40.

Palmer-Wackerly

A. L.

Chaidez

Wayment

Baker

Adams

Wheeler

L. A.

(2020). Listening to the voices of community health workers: A multilevel, culture-centered approach to overcoming structural barriers in U.S. Latinx communities. Qualitative Health Research, 30(3), 423–436. https://doi.org/10.1177/1049732319855963

41.

Piller

Zhang

(2020). Linguistic diversity in a time of crisis: Language challenges of the COVID-19 pandemic. Multilingua, 39(5), 503–515. https://doi.org/10.1515/multi-2020-0136

42.

Rinwang Tsering.(2003). The collections of Tibetan medicine [藏医药研究文集]. Beijing: The Tibetan Studies of China Publication.

43.

Roche

Suzuki

(2018). Tibet’s minority languages: Diversity and endangerment. Modern Asian Studies, 52(4), 1227–1278. https://doi.org/10.1017/S0026749X1600072X

44.

Roche

Tsomu

(2018). Tibet’s invisible languages and China’s language endangerment crisis: Lessons from the Gochang language of Western Sichuan. The China Quarterly, 233, 186–210. https://doi.org/10.1017/S0305741018000012

45.

Shantideva. (2008). The way of the Bodhisattva. Trans. Padmakara Translation Group. Shambhala Publications.

46.

Thupten Jinba. (2019). Tsongkhapa: A Buddha in the land of snows. Shambhala Publications.

47.

Tournadre

(2014). The Tibetic languages and their classification. In Owen-Smith

Nathan

W. H.

(Eds.), Trans-Himalayan linguistics: Historical and descriptive linguistics of the Himalayan area (pp. 105–129). De Gruyter Mouton.

48.

Wang

Xiao

Lin

, et al. (2022). Geographic social inequalities in information-seeking response to the COVID-19 pandemic in China: Longitudinal analysis of Baidu Index. Scientific Reports, 12, 12243. https://doi.org/10.1038/s41598-022-16133-2

49.

WHO. (2020a). Naming the Coronavirus disease (COVID-19) and the virus that causes it. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it

50.

WHO. (2020b). WHO Director-general’s remarks at the media briefing on 2019-nCoV. https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020

51.

WHO. (n. d.). Select language. https://www.who.int/

52.

Xinhua News Agency. (2020, February 6th). French media: China built Fire God Mountain Hospital in 10 day—what a magnificent feat! [法媒：中国用10天建成火神山医院这是了不起的壮举!]. Xinhua. https://baijiahao.baidu.com/s?id=1657778065661763747&wfr=spider&for=pc

53.

Xinhua. (2021, June 15). China’s health literacy rate surges in 2020. The State Council of the People’s Republic of China. http://english.www.gov.cn/statecouncil/ministries/202106/15/content_WS60c83f82c6d0df57f98db376.html#:∼:text=BEIJING%20%E2%80%94%20China’s%20health%20literacy%20rate,official%20said%20on%20June%2015

“The Lung Disease as an Evanescent Rainbow”: Indigenous Languages as Agency in Communicating COVID-19 in Multilingual Kham Tibetan Region in China

Abstract

Plain Language Summary

Keywords

Introduction

Background of the Study

Literature Review

Use of Minority Languages as Agency: A Culture-Centered Approach

Methodology

Data Collection

Responsibility and Reflexivity

Data Analysis

Results

The Language Insufficiency: Agency as Inaction with Fear and Confidence

The Language Inconvenience: Agency as Active and Passive Conformity

The Language Impermanence: Agency as Dialogical Praxis

Limitation

Conclusion and Implication

Footnotes

Appendix: Semi-Structured Interview Protocol

Declaration of Conflicting Interests

Funding

Ethics Statement

ORCID iD

Data Availability Statement

Notes

References