19 May 2017

Zimbabwe Hospitals Introduce Sign Language to Bridge Gap Between the Deaf and Care

Photo: WycliffeSA/Flickr
(File photo).

Some hospitals are introducing sign language to help deaf patients.

It is just after dawn when Lincoln and Sekai Matongo arrive at the Parirenyatwa Hospital in Harare. The young couple are nervous but excited: they are expecting their first baby and this is their first antenatal visit to the hospital complex.

Lincoln, a technology consultant, has taken the day off work to be with Sekai. She is 12 weeks pregnant.

But as the queues move and the other patients are seen one by one, the Matongos are kept waiting. Neither knows how to ask for help. Lincoln and Sekai are both deaf.

At dusk, they head back to their house in Hatfield, a suburb two bus journeys and about 15km away in the south of Harare.

"We sat on the hospital benches until everyone else had been served, except us," Lincoln explains, communicating by furiously typing away on a cellphone. "I could see nurses and other hospital staff attending to the other patients but none [of them] tried to check with us."

In a country where even basic healthcare services are strained by hopelessly inadequate budgets, there is not enough help for patients with hearing difficulties. This means that many deaf patients are wrongly diagnosed and treated, admits Phillomina Chitando, the head of nursing services in Harare.

"Due to information being communicated in formats they don't understand, deaf people have remained unknowledgeable on health matters," she says. "Providing deaf patients with health education, counselling or health instructions has been impossible."

One in 13 Zimbabweans, or 7% of the total population of just over 13 million in 2012, had some form of disability, according to the national Living Conditions among Persons with Disability Survey 2013, which was a joint report by several government ministries and Unicef. Of the population with disabilities, about 110 000 people (12%) were deaf, according to the study.

But disability advocacy groups, such as the Deaf Zimbabwe Trust, estimate the number could be nearly 300 000 if unreported cases are included, says the trust's director, Barbara Nyangarai. And the country's population has also grown to more than 15 million, according to World Bank data for 2015.

Zimbabwe's deaf community has been "invisible", a 2015 baseline study by the Deaf Zimbabwe Trust found. This is because "much focus has been on other forms of disability that are more visible to the eye".

The study, which was meant to provide information for advocacy purposes, highlights the lack of access to health information by the deaf community. When asked about their understanding of a medical male circumcision drive aimed at protecting men from HIV infection, some participants answered: "I thought that my penis would be cut [off]."

"I thought they [people] would be killed by the cut."

"I saw male circumcision adverts ... [on] TV and thought it was family planning."

Most respondents said they don't visit health centres because they find it too hard to communicate with health workers. When they do go, personnel are often impatient.

One woman, asking for an explanation of what was happening during the delivery of her child, was told: "Why did you get pregnant when you are deaf?"

Another woman said nurses beat her while she was in labour. "They told me to pack my baby's clothes and I did not hear, and then she came back and beat me."

Although the sample in the trust's baseline study was small - only 70 people were part of the focus groups so the findings cannot be generalised to be representative of all deaf people in Zimbabwe - it confirms research published in 2007 by Progressio, the working name of the Catholic Institute for International Relations.

Referring to the disabled as a "forgotten tribe" in Zimbabwe, more than three-quarters of respondents in Progressio's study said healthcare professionals did not understand the health needs of people with disabilities.

Staff members at the Wilkins Infectious Disease Hospital have learned sign language so that they can help deaf patients who need medical attention. (Sally Nyakanyanga)

Sign language services are rarely available in health facilities in Zimbabwe, the Progressio survey found. Ironically, it was the first country in Africa to come up with disability-specific legislation in 1992 and, in 2013, sign language became one of Zimbabwe's 16 official languages.

But sign language is not taught in school as other languages are, says Nyangairi.

"Many deaf people haven't been to school and the majority of deaf people cannot read or write," she says.

Besides the fact that many in the deaf community may therefore not fully understand health-related information in the mainstream mass media, a lack of sign language interpreters in hospitals also means HIV prevention and other messages have not been conveyed in a way that is accessible to the deaf or hard of hearing, Nyangairi says.

But at the Wilkins Infectious Disease Hospital in Harare, the scenario is very different. Hard-of-hearing patients praise its services. When Ephraim Baliya, who is deaf, couldn't swallow or eat for days because of a sore throat, he was helped by a sign language interpreter.

"I am so grateful to have been served despite my impairment," he says.

The hospital collaborates with the Deaf Zimbabwe Trust to ensure the deaf can get proper medical treatment. The organisations have drives to provide cervical cancer screening to deaf women as well as a sign language club for health professionals at the hospital.

Sign language has been taught to 21 staff members, including nurses, nurse aides, clerks, counsellors, mortuary attendants, doctors and interns.

"This is to ensure our staff are well equipped. All the departments at the facility are now able to deal with deaf patients," Chitando says.

But the club is about more than just interpretation skills: they also go on social trips to deaf theatre productions and film screenings. It is also possible to volunteer to help deaf students or the local deaf community.

This project has been so successful that the city has expanded it.

Sixty medical professionals from clinics have been given training in basic sign language skills, Chitando says. "We want to ensure every clinic has a nurse or health staff who can use sign language."

In the 10-day training course, they are taught the first 100 words in the sign language dictionary and are shown how to give general health and HIV explanations.

The nurses on the course have started a WhatsApp group to discuss and learn from their experiences with deaf patients.

These are but the first steps, admits Prosper Chonzi, the director of health in Harare. "We hope to sell the idea to other provinces with availability of resources," he says.

The project only started last year and the first three groups of nurses completed their courses in February so it is too early to evaluate the success of the training, but Chonzi says the indications are that more deaf people are being helped.

Chitando is working on the next round of training and wants to see two nurses with sign language skills at each facility.

"We need to design a tool that can assess the efficacy of the training to enable us to identify the gaps and other options to ensure full access to health for the deaf," she says.

When Lincoln and Sekai Matongo return to the Parirenyatwa Hospital the following morning, they shuffle on to the same bench. As the hours tick by, their shoulders sag.

Then a counsellor spots them. Realising they are deaf, he takes out a pen and paper, making sure they know where to go. He does not know sign language but he is understanding.

"That counsellor was our saviour," Lincoln types on his phone. "What would make a real difference to deaf patients though is if hospitals and health centres employ medical professionals with hearing disabilities, people who understand our disabilities because they live with it themselves."

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