Problems affecting Deaf people when they use health services designed for hearing people

There are several groups of people who, even in these fervent days of equal rights and political correctness, consider that their needs have not been addressed. One such group is the Deaf. There are around 8.7 million people in the United Kingdom who are deaf or hard of hearing.¹ The lowercase d in deaf used to describe the physical impairment of being unable to hear most or all sound. This article focuses on the specific needs of those people who describe themselves as Deaf, where the capital D dicates membership of the Deaf community and the use of British Sign Language (BSL) as the first or preferred language. An estimated 50000 people in the United Kingdom use BSL as their preferred language.

As in every other section of society, Deaf people are individuals and have various opinions about their lack of hearing. Some deeply resent their deafness and welcome anything that may improve hearing, whereas others do not consider themselves to be impaired in any way. Their lack of hearing becomes a positive thing and something to be proud of, as it grants them access into the Deaf community and gives a rich inheritance of unique history and tradition.

Special equipment

When hearing people want to visit their general practitioner they normally telephone and make an appointment. However, around 420000 people in the United Kingdom do not have sufficient hearing to use a standard telephone. Deaf people commonly use text phones (Minicoms), which consist of a small screen and a keyboard. Messages are typed in, and the reply is displayed on the screen. A study of Deaf women's health needs in Manchester found that few general practitices had Minicoms. Staff in the practices that did have a Minicom rarely knew how to use it, and in some cases the equipment had simply been left in its box and not plugged in. The Royal National Institute for Deaf
People (RNID) Typetalk service provides an alternative to obtaining a Minicom, as it allows conversations to be relayed between speech phones and text phones, using a trained operator. This service is not widely known about and hence not used effectively.

As hospital inpatients, Deaf people have further need of special equipment to allow them the same privileges as hearing patients have and to prevent them from becoming isolated on wards. Deaf women highlight the need for items such as visual fire alarms and baby alarms on maternity wards so that Deaf mothers can know when their babies are crying. They also point out that having to gain access to units by intercom--although this is a good security precaution--causes immense problems to deaf people.

Information needs

Even when using an interpreter, healthcare professionals can unconsciously simplify and reduce the information they are providing to Deaf people, assuming that a more detailed explanation would be too difficult for the person to understand. This maintains the old paternalistic doctor patient relationship and does not allow the patient to participate in the making of decisions. The lack of information can be such that it is not possible for people to make informed decisions and hence give informed consent to procedures. Instances of Deaf people having surgery and not knowing why are not uncommon. A Deaf woman describes the situation: "Sometimes nurses will give information, but we never get full information like hearing people. The doctors shout at us and all the ward hears about our problems, but we don't know what is wrong."²

Ways to address problems faced by Deaf people in health services
• Training of staff to use Minicoms or Typetalk
• Provision of environmental aids where appropriate, such as visual fire alarms, baby alarms, Minicoms, and subtitled television.
• Health information presented in signed videos or picture based leaflet, also by trained counsellors fluent in BSL
• When people are trying to lipread, facing them, speaking clearly (not shouting), and ensuring that lighting and furniture layout are suitable
• Arranging interpretation to suit the requirements of the individual person
• Training all staff in basic Deaf awareness
• Training interested staff in BSL

Many people do not realise that BSL is a language completely different from English, with different vocabulary and grammar. Many signs cannot be translated into English without complex and lengthy explanations. Consequently, many people for whom BSL is their first language struggle to understand written as well as spoken English and would benefit greatly from signed videos or leaflets based around pictures, with written information kept to a minimum. Doctors' handwriting is also infamously indecipherable and forms another barrier to understanding written information.

Communication needs

Many of the problems faced by Deaf people could be solved by simple measures, but healthcare staff do not have sufficient Deaf awareness to address these issues. It is often assumed that all Deaf people are able to lipread. This is not the case. Lipreading is at best imprecise, with often as few as one in 12 spoken words being understood by the person lipreading.³ It is difficult and tiring, requiring a huge effort of concentration, and understandably, some Deaf people are unable to lipread successfully. It is impossible to lipread when bright lights are shining in your face, or when the person talking to you is facing away from you, looking at a computer, writing notes, or examining you.

Outpatient departments are one of many areas of special difficulty. Deaf people are not aware when their name has been called, and because of the extreme time pressure on clinics, staff assume that the person has not attended and call in the next patient. Showing the name on a screen as well as calling it out would avoid this, as would a ticket system, such as that used in supermarkets to show whose turn it is next.² The short time for each consultation is usually insufficient to allow for the communication problems, and unless the Deaf person arranges his or her own interpreter, interpretation is probably not provided. In such a situation, although Deaf patients can make themselves understood, they may not necessarily understand information given.

The use of interpreters is generally the preferred option. It is useful to have some continuity, so that the same interpreter is used on each occasion and the Deaf person does not have to adjust to the different styles of each different person. It is important to ensure, however, that the interpreter is qualified. Healthcare issues can be sensitive areas, and information is confidential, so it is vital that the person interpreting is properly trained, rather than a well meaning neighbour or relative. The situation that causes most concern, however, is the use of children as interpreters for their Deaf parents. This occurs comparatively frequently and may involve the use of very young children aged under 3 years, if no one else is available. Everyone involved should realise that it is not fair to the child to be party to sensitive information about their parent's health; some consider that this verges on child abuse.² It is of the utmost importance that healthcare professionals do not accept children as interpreters, and provide an alternative.

Many people consider that there is a need for healthcare professionals who sign, both specialist counsellors to provide health information to Deaf people and other staff with basic conversational skills, who can reassure Deaf people and help to relieve the isolation. A ward sister with some BSL speaks about how she communicates with Deaf people when they are on her ward: "I don't think I do much, just what I would do for anyone else, explaining things, taking them up to theatre and so on. I'm used for translation, but not officially."

The Deaf community is a fascinating entity. Deaf people have a wonderful heritage of language and tradition that they are justifiably proud of. Despite their abilities to communicate fluently with each other, they can encounter problems when they attempt to interact with the hearing world. Raising levels of awareness, and appreciating that communication difficulties are two sided could solve many of these.