By Koffi Barry
The incorporation of sign language interpreters in the healthcare system is gaining traction in the lakeside City of Kisumu. This comes after the County government of Kisumu employed two sign language interpreters in July, 2021 to assist patients with hearing impairments access services at two main hospitals within the county.
Kenya has about 150,000 people who are deaf, according to the 2019 Kenya Population and Housing Census report. Kisumu shares a proportional population of the deaf community with at least 0.3% of its population being part of this group.
In the past, deaf patients faced many challenges to accessing healthcare services in the country including communication barriers. As such most of the deaf patients resort to other means of getting health services such as self-prescription of medicines whenever they fall sick.
While sign language interpreters have been co-opted into the other areas of society including the media, the healthcare systems still lag behind despite health being a very crucial part of a person’s development and well-being.
The sign language interpreters abased at the Kisumu County Referral Hospital (KCRH) and the county’s referral hospital Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) have helped to create safe and friendlier spaces where the deaf community in Kisumu feel is more inclusive than before.
While the Constitution of Kenya, 2010, has provisions that promote the inclusion of people with disability in all spheres of life, the country has done little to ensure they are accorded what is due to them. The inclusion of sign language interpreters in the healthcare system is in line with the constitutional provisions in articles 2, 34 & 54 that are progressive towards this end.
Before the inclusion of sign language interpreters as part of service providers at the hospital, Leon Otieno, a person with hearing impairment, was not happy of the service delivery at the only referral hospital in the county.
“Initially when I visited the hospital, I was forced to write down my sickness on a piece of paper in order to communicate to the health staff,” he said, adding that this is a very tiresome task which discourages most of the other patients form seeking health services with some only turning up at the hospital when their ailments have become worse.
After sometime, he got tired of writing down his ailments on a piece of paper or his phone to share with the doctors and nurses. After abandoning the practice of writing to communicate at the hospital, he was forced to work with the schedules of some of his friends who were proficient in sign language to access healthcare.
Otieno found this to be very frustrating and is happy that the county government has decided to employ resident sign language experts to assist patients like him whenever they seek treatments at the hospitals.
“On my next visit to the doctor I will meet the sign language interpreter and chat with him without needing to interrupt the schedules of my colleagues and friends to accompany me to hospital,” he added.
For him, the question of confidentiality also used to trouble him as he would be forced to share his ailments with other people such as his friends as opposed to sharing directly with the health staff.
At both hospitals, when a patient visits the hospital and it is discovered that they have hearing impairments, the sign language interpreter is alerted to offer the services that are required in the diagnosis, treatment and care of such patients.
In Kisumu County Hospital it helps that the sign language interpreter is stationed at the out-patient department. At JOOTRH the sign language interpreter is stationed at the speech therapy department. Despite their locations at the two facilities, they are free to move to every department of the hospital where their services are required.
According to Judith Omino, a sign language interpreter at JOOTRH she is constantly on the move at the hospital and takes initiative to get to the deaf patients. “I am usually on call and visit every section of the hospital to offer interpretation services depending on the need. I visit the labs, theatre, mortuary and out-patient departments when there is a patient,” she said.
Apart from her interpretation services, she is tasked with assisting during the disability assessments at the Ear, Nose and Throat (ENT) clinic for patients with hearing impairments. The disability assessments are carried out every Monday. The assessments are vital as they contribute data that is essential for estimating the prevalence of disability, identifying the needs of people with disability and monitoring the inclusion of people with disability.
“When there are meetings at the facility, I am usually in-charge of the interpretation so I sign through the room for the deaf patients to come forward. They are then placed at advantageous positions where they are able to follow through,” Omino said.
When Domtilla Anyango visited the JOOTRH hospital in the past, she found the spaces less friendly and would leave more frustrated than she came after failing to get services she required. She had to seek the services of either family or individuals outside the hospital who could interpret sign language to the health staff.
“Before, when I visited the hospital, I used to feel bad about the services offered. Whenever I was sick I was forced to look for persons outside the hospital to help explain my sickness,” she said.
However, unlike Otieno, hospital visits would set her back financially and with every visit she had to get money to pay for the services. “I used to pay sign language interpreters from outside the hospital to access health services,” Anyango says.
She is quick to add that her attempts at writing in Kenyan Sign Language (KSL) did not bear much fruit as the type of English used in the system was not well comprehended by the healthcare workers.
“English for deaf people is a challenge and most health workers who are not trained in KSL do not grasp it further compounding the problems which at times lead to wrong prescriptions,” Anyango noted.
With the Inclusion of sign language interpreters like Omino at the hospital, she is more confident of the services offered. When I visited she was having a meeting with the interpreter who usually accompanies her to the occupational therapy unit for her sessions with the doctor. Even though the hospital has just one sign language interpreter at the moment she is glad and says that the single interpreter is better than not having one at all.
In the past health staff used to rely on crude methods and sometimes a patient would resort to writing down their health problems for easier communication between them and the health workers. This however proved to be a challenge especially when a patient is unable to write or express their health challenges in writing.
Moreover, some patients lack basic communications skills further complicating an already complex problem. Additionally, English in KSL is different and hence hard to decode for some health workers.
Juliana Adhiambo Warindu is a nurse at JOOTRH’s ENT clinic. She is not trained in sign language and has had to rely on the services of the interpreters to communicate to her deaf patients.
“In the years before, I would meet my deaf patients and out of the need to understand them I used to try to sign but I stopped after I learnt that my signs would even turn out to be abusive of sorts in the process of communicating to them,” she said.
The employment of sign language interpreter has come as a great relief to her and she believes she will deliver her duties adequately. She admits that the interpreter has narrowed the communication gaps that existed before as they used to receive patients with conditions that required a bit if history to treat and without an interpreter, they could only do so much.
The presence of sign language interpreters at the facility has also reduced the waiting times for this category of patients. Some patients would arrive at the facility in the times past and out of the frustrations would resort to sitting at the benches and leave without getting the health services after getting nowhere to turn to. This has since changed thanks to the interventions meant to arrest the situation.
“Through my rounds within the various departments of the hospital, I identify the deaf patients whom we give preferential treatment and they are happy they don’t have to wait long in the queues,” said Omino.
The availability of a sign language interpreter at JOOTRH has increased deaf patient numbers to 20 in a month. At the hospital, the busiest days in the department are on Mondays when disability assessments are conducted.
As every morning the KCH hospital holds health talks with patients and staff in attendance, Nancy Festus Charo signs to assist deaf patients to understand the proceedings. Even though she is attached to the out-patient department at the hospital, like Omino, she is called to any department based on the need for her services.
“When the doctors, nurses and health staff encounter a deaf patient they usually alert me to assist in communicating either to the patient or information from the health workers,” she said.
“I also assist in guidance and counselling of the deaf patients who prefer marrying from within their circles.”
For Charo, her desire to learn sign language was born out of necessity. She is slightly impaired herself and uses braille to write due to her poor vision. From a young age, she has schooled in special needs schools where she learnt the skills.
Records at the hospital show that the health seeking behavior among patients with hearing impairments have improved to an average of 40 patients in a month as opposed to the past where they used to shun such facilities and records about them remained scanty.
Nerea Aoko is a nurse at KCRH and has undergone life before and after the inclusion of sign language interpreters into the health system at the facility. On her part, the absence of the sign language interpreters at the facility was a setback to how they managed diseases for this cadre of patients.
“Initially we had problems with understanding what the patients were saying and we relied on family members who would sometimes accompany them to hospital to solve the deadlocks in communication,” she said.
She admits that this delayed access to the right services that could save the lives of a patient especially in a case of an emergency that required urgent management and care. Sometimes, the patients visited the facility alone without being accompanied by family members who could be busy running other errands at the time. For her, the availability of a sign language expert is a relief to the barriers to communication that existed before.
In the past, the patients who are often quick to anger would leave the facility dejected and they would miss an opportunity to arrest medical conditions that could worsen with time. At times we use to treat the patients without having the right history of their ailments due to the breakdowns that existed.
“In my opinion, even though we did the best we could do in the prevailing circumstances, I feel diagnosis and treatment was not well made to begin with,” she added.
Despite acknowledging the roles played by the sign language interpreters, she is quick to add that there is need for training of more health staff in Kenyan Sign Language to boost patient confidence in the processes involved.
“Direct communication between a patient and the primary caregiver is important and boosts their confidence levels in the healthcare system,” she said.
Adhiambo has also decried the number of people trained in sign language who are attached to the hospital. They only have one sign language interpreter to fulfill their communication problems. At times she is held in different departments thereby increasing the waiting times for deaf patients at the facility.
The problem of gender is another one that presents itself. At the two facilities, there are only female interpreters. This discourages male patients from sharing some of the medical conditions because they might not be comfortable with interpreters of a different gender, she discloses.
According to Charo and Omino at times they are forced to use the normal gesturing to communicate to deaf patients who are not proficient in sign language.
“We need protective clothing to protect us in the course of our duties as we visit every section of the hospital at times without protective equipment,” said Omino, adding that some deaf patients also come seeking interpretation services for the social functions as opposed to health related issues.
Patient confidentiality is a challenge which can best be cured if more health staff are trained in KSL. This is because health workers take an oath to keep patient information in confidence as opposed to the sign language interpreters who may not themselves be health workers.
Health workers willing to learn KSL depend upon the goodwill of the County and National governments to learn these vital skills to enable communication with deaf patients. Sign language for health workers is only available at select medical training campuses across the country in Molo and Murang’a and costs shs. 60,000 (about USD 600) for a six months course.