By  Josephine EJEH

Imagine that you have a medical emergency, but you can’t communicate with the doctor because he doesn’t understand what you are saying. Imagine the doctor asking you questions to diagnose your ailment, but you don’t understand what he is saying or what the medication he has prescribed for you is for. JOSEPHINE EJEH looks at this and many other challenges faced by people with hearing loss when accessing healthcare services in public hospitals in Abuja, Nigeria’s Federal Capital Territory (FCT) due to the absence of sign language interpreter

Parents of Children with Speech and Hearing Loss to the Rescue   

Normally, children of the age of Nuhu Yakubu, the son of the village chief of Tunga-Ashere, Sani Yakubu are able to communicate directly with the doctors about their symptoms. But for the 8-year-old born with speech and hearing loss, that is almost impossible. Hence, Yakubu acts as an interpreter for his son in the absence of a sign language interpreter.

His worry, however, is the difficulty other children with speech and hearing loss in his community would encounter when they are fully grown and become independent if the hospitals continue to operate without addressing their needs.

“For now, since he is still young, his mother and I used to take him to the hospital when we noticed he is sick because he cannot communicate directly with the doctor. We used to help the doctor to identify what is wrong with him because there is nobody in the hospital that can understand him. These children will find things very difficult when they become adults if there is nobody to interpret for them. We beg the government to employ interpreters in our health centres to make life better for our deaf children,” the village chief told The ICIR.

Hadiza Musa, who also serves as an interpreter for her 10-year-old daughter, Labira Musa, also born with speech and hearing loss, shares the same concern as Yakubu.

“For the sake of the future of our children, we want to have sign language interpreters in our hospital because one day, Labira will become a grown-up girl and will become independent,” said the mother of four whose last-child, Jabiru also suffers a similar fate.

The ICIR visited the Primary Health Care Centre in Tunga-Nasara community under AMAC, where the health officer in charge of the health centre, Abubakar Tanko confirmed that since 2017 when he resumed at the office, no sign language interpreter has been deployed to the centre.

He expressed the need to have one on the ground in case of an emergency.

At Karu Primary Healthcare Centre, investigation also shows there is no professional sign language interpreter in the health centre. The health officer in Charge, Akila Udoji confirmed to The ICIR that since three years ago that he was deployed to the centre, the health facility had not engaged the services of a sign language interpreter.

While some health workers acknowledged the need to have a professional sign language interpreter on ground in their health facilities, Udoji thinks otherwise.

“We don’t have any interpreter here. The issue is, what will they be doing here. If we were to employ one, the person will have to sit all day doing nothing,” the officer who did not see the need for an interpreter to be stationed at the centre said.

According to him, since he was deployed to the centre, it is only one patient with hearing loss that has visited the hospital and “she came with somebody who was interpreting for her.”

When asked during a visit to the health facility to confirm if the hospital had a sign language interpreter on ground at the hospital, Dr Lasisi Akinola Muideen, the Medical Director of Kubwa General Hospital, said he does not talk to the press when there is no issue.

The doctor who declined further comments on the issue said: “We don’t have any issue with that. We have rapport and we are working with the deaf people association so there is no problem. We are civil servants so we are not allowed to talk to the press.”

In Bwari General Hospital, a top management staff who doesn’t want his name mentioned claimed that the hospital has a nurse who has a basic knowledge of sign language. She helps out with the interpretation whenever the need arises.

“We also have somebody we usually call when a deaf person visits the hospital,” the source said.

Deaf Persons resort to Self-Medication

Due to the communication difficulty, many people with hearing loss and speech impairment stay away from the hospital and indulge in self-medication at greater risk to their health.

Mahapatra Tanmay, Department of Epidemiology, School of Public Health, University of California, Los Angeles, California, USA in a Commentary on Self-care and self-medication published online by Annals of Tropical Medicine and Public Health.org cited Maria Esperanza Ruiz and the World Health Organisation(WHO)as saying, the self-medication might lead to “ incorrect self-diagnosis, inappropriate choice of therapy, bacterial resistance, drug interactions, failure to seek appropriate care, prolonged treatment period, serious adverse effects (often irreversible), treatment failure, drug dependency, abuse and delay in treatment for malignant cases.”

But due to the existing communication barriers, people with speech and hearing loss like Bose who goes to health care in Kuje General Hospital resort to self-medication especially when her daughter who sometimes accompanies her to the hospital to interpret for the health workers is not available.

She expressed frustration she faces during some the visits to the public hospitals

“Because they don’t have a sign language interpreter. It is very discouraging. Most of the time we are not comfortable. The doctor does not give me the needed attention because we have to write and write so sometimes, I go to the pharmacy to get my drugs instead. I want the government to employ interpreters in the health facilities and health workers should learn sign language also. It will go a long way to address the communication problem we face,” she said.

A top management source in the hospital who spoke on the condition of anonymity, however, claimed the hospital has a desk officer who is knowledgeable in this sign language. “She is always on standby. We contact her when there is a special need,” the source told our reporter.

At an early age, 7-year-old Manir Umar is already getting used to self-medication. His mother, Zuliar Umar hardly takes him to the hospital when he is sick. She rather buys him drugs from a medicine store. On very rare occasions when she takes him to the hospital because there is nobody at the Tunga-Ashere health centre, she translates for her son.

Non-Governmental Organizations to the rescue

Though non-governmental organizations have done much to improve the welfare of people with speech and hearing loss especially in the area of healthcare delivery, there is still a huge gap because the Nigerian government which has the constitutional obligation to ensure healthcare services for all without discrimination has done little for people living with disabilities, according to a recent report by The ICIR.

Previous interventions by non-government organizations in this respect were hardly complimented by the government.

One of such commendable efforts that come to mind is the free sign language interpretation services for women with speech and hearing loss, sponsored by an international nongovernmental organization, Ipas Nigeria in partnership with the Australian High Commission between 2016 and 2017 in about public hospitals in the Federal Capital Territory (FCT).

The six months pilot project aimed at increasing access to reproductive health services for women with speech and hearing loss.

After relentless advocacy, the Deaf Women Aloud Initiative and Deaf Women Association, secured a project to partner with the organisation and commission to train twelve professional sign language interpreters who were deployed in six public hospitals in the FCT to offer free services for people with speech and hearing loss. The project made accessing healthcare services very easy for people with speech and hearing loss.

Several men, women with speech and hearing loss and their children who had not visited the hospital before, came from the communities to access healthcare services free of charge in the hospitals at the expense of Ipas and the embassy because there were sign language interpreters in the hospital all the time.

But six months after the pilot project ended, the Nigerian government failed to sustain the effort despite calls from Ipas to ensure that at least one professional sign language interpreter is stationed in public hospitals.

The government turned deaf ears to the call and three years on, it is still yet to implement the recommendation in a policy brief issued during the end of the project dissemination meeting in respect of the deployment of at least one sign language interpreter in all public health facilities in the country.

Speaking during the end of project dissemination meeting of its “increasing access to reproductive health services for deaf women” project, Country Director of Ipas Nigeria, Mrs Hauwa Shekarau had said the pilot project was aimed at the overall goal of reducing maternal morbidity and mortality among deaf women in the FCT.

She said for many years before the project, many women with speech and hearing loss could not go to hospitals because of the communication barrier with health personnel, saying that many pregnant women suffering from the same issue could not go for ante-natal and delivered their babies at home. This reportedly resulted in increased maternal and child mortality rate among deaf women.

The Deaf Women Association of Nigeria (DWAN) for the FCT has been advocating for the deployment of sign language interpreters to public hospitals for many years without any tangible response from the government side.

With support from some organisations like Maries Stopes, DWAI is championing the development of health-specific sign language glossaries to help health workers such as doctors and nurses to understand the health challenges of persons with hearing loss and be able to communicate with them in the absence of sign language interpreters.

The Chairperson of the association in Abuja, Janet Fasakin told The ICIR that she is overwhelmed with complaints from her members on a daily basis, Janet, a hearing-impaired person, is overwhelmed with complaints from her members who encounter communication challenges in accessing health care service on a daily basis.

“The absence of sign language interpreters in hospitals is affecting our members very much. When they go to the hospital to check their health and there is no interpreter in the hospital, the doctor or other health workers will always want to communicate by writing but what about the Deaf person that cannot read or write because he or she is illiterate?

“How can this be possible? They may want to discuss or explain their challenge to the doctor, but how can they go about this,” she queried.

As a leader who desires to proffer solutions to the myriads of challenges confronting her members, it is either she accompanies them to the hospitals or gets an interpreter that can escort them to the hospital.

“Better still, some of their family members follow them to the hospital but this is wrong because it is their privacy that is being invaded. They want to explain what is wrong with them privately to the doctor but when you are bringing in a third party, the conversation is no longer private. If there is an interpreter, it will reduce the challenge of bringing in the third person because, with that independent interpreter, the patient will confidentially see the doctor,” she told The ICIR.

Janet, who is hearing impaired said the government should stop ignoring the needs of people with speech and hearing loss, consider their health and total wellbeing as a priority by employing sign language interpreters in all the hospitals.

On efforts made by the FCT Health Management Board, the Acting General Manager, Dr. Francis Alu told The ICIR that the board had taken steps to ensure persons with speech and hearing loss have easy access to healthcare services.

The health management board ensured that phone numbers of trained sign language interpreters were given to public hospitals in the FCT and also displayed at strategic places in the hospital to enable health workers reach out to them when the need arises.

“We also encouraged the Association of People with speech/hearing impairment to always ensure their members come with or reach out to those trained sign language personnel whenever they are coming to the hospitals to make it easier for them to be attended to,” he told The ICIR through an SMS.

Asked who picks up the bill for the services rendered by the trained sign language interpreters, Dr Alu said organizations that cater for and support the people with disabilities pick the bills while the staff of the hospitals who are trained on sign language do it on a volunteer basis.

FCT Primary Health Care Centre Lack Adequate Manpower

In an interview, the Director Primary Health Care, FCT Primary Healthcare Board (PHCB), Dr. Ruqqaya Wamakko told The ICIR that the agency considers people living with disabilities as an integral part of the society.

She said the over 250 primary health care centres in the FCT were generally bedevilled with the challenges of manpower, let alone sign language interpreters.

Dr. Ruqqaya said the board lacked the resources to employ and deploy sign language interpreters to all its health centres.

“On the issue of having stationed people to interpret, we don’t have sign language interpreters to interpret between health workers and deaf people because we don’t have enough facility to do that. But we partner with the Deaf Women Aloud Initiative because we still know the importance of taking care of people with disabilities especially in terms of maternal, sexual reproductive health and neonatal and child nutrition. This is key because we want to prevent maternal and child mortality,” she said.

She, however, said that the agency has been supporting Deaf Women Aloud Initiative with the formation of sign language glossaries over the years.

The Director of Primary Health Care, assured that when the glossary is out, health workers would be trained and the glossaries made available on their desk so that when people with hearing loss visited the hospitals and health centres, they could go through it and be able to communicate with them and manage them well.

“Since the board does not do the employment of staff personnel, it is easy to train our health care workers on basic sign language so we call on partners that can support us with the training,” she said.

The ICIR contacted the Spokesman of the Federal Ministry of Health, Jimi Oyetomi to inquire about the intervention the ministry is carrying out to ensure persons with speech and hearing loss and other people living with disability have unhindered access to healthcare but he became furious and declined to comment on the issue.

“Did the deaf people complain to you that they are not able to access healthcare? Most of the time you journalists come up with hypothetical situations. I cannot respond to this kind of thing,” he told this reporter.

Pressed further, Jimi said: “Write what you are asking for, type it and come and submit it to the Honourable Minister of Health at the registry.”

The Public Relations Officer of the National Primary Healthcare Development Agency, Ohitito said it is not the responsibility of the agency to provide sign language interpreters at the PHCs because the Federal Government does not have direct dealings with them.

Way forward

A health worker in charge of the Abuja @ 30 clinic in Kuje, Mary Innocent believes that attending to patients with speech and hearing challenges will be easier if health workers are trained on sign language rather than depending on the writing.

While stressing the urgent need to bridge the communication gap between healthcare providers and people with hearing impairment to make it easier for them to access healthcare facility, the Executive Director of Women Aloud Initiative called on all stakeholders to unite in the endorsement of the need to secure and promote the human rights of deaf people as well as reaffirming their support for full participation with sign language.

President Muhammadu Buhari had recently, approved the appointment of an Executive Secretary(a hearing-impaired person and sign language user) for the National Commission for Persons with Disability and other members.

Helen believes that despite the giant step a lot still needs to be done to sensitize the society, media, NGOs, CSOs, institutions and government and non-government organizations etc about the importance of sign language and ensure that the content of Discrimination Against Persons with Disabilities Prohibition Act 2018 yielded the best outcomes.

Now in her sixties, the National President, Deaf Women Association of Nigeria (DWAN), Deaconess Adedoyin Beyioku-Alase popularly known as Mama Deaf, whose hearing loss occurred at the age of 18 said: “The Society is our problem because they make us afraid of everything. Deafness or disability is not our problem.”

The member, Board of Trustees of Deaf Women Aloud Initiative said deafness and disabilities can happen to anyone so the society should be structured to accommodate the needs of Deaf persons and other persons living with disabilities in all spheres.

With the approval of the composition of the governing council of the National Commission for Persons with Disabilities (NCPWD) on August 24, 2020 by the Nigerian President Muhammadu Buhari, expectations are high that when the commission hits the ground running, it will address the plights of people living with disabilities who suffer discrimination in different spheres of the society.

It is, however, uncertain whether the budget of the NCPWD will feature in the 2021 appropriation to avoid financial hiccups in the take-off of the commission.

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