The time is 11:37 on a cool Thursday morning in a rural town in South Africa. It is winter and a couple walk through the wooden doors of a dental clinic that attends to a little over a thousand patients a month from different parts of a vast community. The couple quitely takes a seat next to the last person in the queue and they quietly wait for their turn to register.
As they wait, much to the surprise of their fellow comrades in pain, their move around their hands in what seem to be odd gestures, at least to extremely ignorant onlookers, but to those of us in the know, the couple is deaf and all they are doing is participating in normal conversation, much like their seemingly “abled” counterparts. The surprise dies out and everyone else goes on about their chatter as the two love birds carry on with their own conversation.
However, the atmosphere is tense around the healthcare providers, as questions begin to be asked and thrown in the air. Who will attend to these patients, who has a pen so they can write down their enquiry and service request and which doctor will consult and treat? These questions are questions that go by largely unanswered. A few moments later, the wife emerges with a green file and the husband remains behind; he was only accompanying her.
One down, but no one in this clinic knows sign language. As the wife sits quietly waiting to be seen, I emerge much to the relief of my colleagues.
Now let’s rewind just a bit.
Ever since my first encounter with deaf patients in my earlier years training as a student, I had always vowed that I needed to learn sign language. The difficulty of communicating in the absence of translaters or anyone able to sign was unbelievable. As a student activist for access to healthcare at the time, I realised that it was incredibly important that I commit to my cause to ensure that no one is left behind, deaf people included. The sad truth is that this desire largely remained lip service well into my professional career, as I had a desire, but no EASY access to an instructor or tutor. So often it would be sparked again when I interfaced with deaf patients, and would soon disappear as fast as it arrived.
My experience with Jody, a deaf fellow in a global programme I am currently enrolled with, reignited this desire to bring into reality my long standing dream to learn how to sign. A meeting with fate and the love of my life would further lead me to the door steps of a local school for the deaf, where two days ago, I met my sign language instructor for the first time.
Now back to my excited colleagues. My colleagues were simply excited to see me because they knew that they didn’t have to deal with what seemed to be a burden at the time. They knew, that I was going to offer myself up to render services to another client in need. My colleagues didn’t particularly care that I too, could not sign to save my life. All they knew is that the struggle was no longer their’s but mine. After all I had been a loud mouth about my desire to learn sign language. After a battle with paper, pen, uncoordinated and seemingly strange gestures (at least from the perspective of my client), I managed to serve and assist a happy and satisfied client.
What took extreme patience, love and understanding helped me maintain the dignity of my patient. Even in the difficulty of communication, I tried my best to put them on the driving seat of articulating their needs and communicating them with me. Perhaps this was a simple case, due to the nature of the presented case, but this encounter got me thinking.
Interacting with the health system, whether private or public, but more so the public health system is often a very intimidating, difficult and frustrating experience for patients. In their time of need, they have to deal with long queues, increased waiting times, frustrated and often overworked staff . For person’s with disabilites, the experience is far worse as they have to further deal with access issues and language barriers.
The need to be heard and understood is a fundamental human need. It is directly linked to lived values of common respect, shared dignity and inclusion. Being able to communicate our wishes and desires without barriers releases to all of us a freedom that we so often take for granted. Yet, everyday deaf patients have to struggle to communicate their desires about a chosen intevention for their care, or even about a simple desire to have the air conditioning switched on just a bit higher, for their warmth and comfort during a procedure.
It is this disconnect in communication that disarms most if not all deaf patients, who have to walk into a health facility and not meet a hearing and non-signing person with the patience to scribble drawings and writing on pieces of paper just to maintain their power of choice. So often when we cannot communicate effectively, when a disconnect exists, the tendency of the one who seems to hold power, in this case the practitioner, is to think and decide for the other person in the interest of their own time and convenience, completely ignoring the other’s needs.
What would I have done in a different scenario where the patient wanted more complex services than they wanted today? What would have happened if they wanted to share more about their aesthetic needs, about the importance of their oral health in their relationship with a significant other? How would I “hear and understand”? These are all questions as health practitioners in training we were never taught to ask.
But as an advocate for access to oral health services for ALL, I cannot sit and keep quiet when the legitimate voices and needs of segments of our population are largely ignored or left unheard. Deaf clients and any other differently abled clients need to be allowed to interface with their “care” providers in a manner and way that is free of intimidation, stress and or frustration. Honestly, the last thing we need in our time of need is to feel unheard, misunderstood and SILENCED.
I have taken a step towards inclusive care, by investing in learning a new language, sign language, all to insure that I am accessible to all, that I am able to serve all in a manner that liberates from anxiety and encourages confident engagement with the healthcare system. I am one person, but I take heart in the fact that change in a family often spills over to the rest of the village. I have chosen to be the change I want to see.
In the same spirit, I call out to the policy makers, to fellow colleagues to take bold leaps to improve access to oral healthcare, to health care services in general by investing in access improvement initiatives in their work, by influencing and lobbying policy makers to recognise the need to ensure that language, including sign language is a critical part of training for would be health professionals. If we want to take access to health services seriously, we need to take the dignity of all peoples seriously as well.
After all, healthcare is not only about life or death; it is about restoration, it is about quality of life, fairness, justice and inclusivity.