Deaf Patients, Hearing Medical Personnel: Interpreting and Other Considerations

By Tamara Moxham

When deaf people interact with the medical system, access can mean the difference between life and death. Accommodations are not always intuitive to medical personnel, and not all deaf patients know how to explain why they need what they do. Interpreters, family, and friends of deaf people and patients themselves can either help or make it much

• Language: English
• Publisher: Butte Publications
• Release date: Feb 24, 2017
• ISBN: 9781939349101

Tamara Moxham

Tamara Moxham, MEd-IP, CI, CT, NIC-Master, was raised in a multicultural family in southern New Hampshire. She began her interpreter training at the University of New Hampshire at Manchester in 1988 and later transferred to Rochester Institute of Technology at the National Technical Institute for the Deaf, where she earned an AAS in interpreting in 1993. She began her independent contractor interpreting that same year. She has worked as an interpreter in Maine, NH, NY, Michigan, Nevada, Oregon, and Washington. She began re-searching and presenting workshops to other interpreters in 2001. Ta-mara earned a certificate of completion in mentoring through Teaching Interpreter Educators and Mentors (TIEM online) at Northeastern University in Boston, where she later earned a Masters of Education specializing in Interpreter Pedagogy in 2010. She taught at Seattle Central Community College's Interpreter Train-ing Program from 2009 until its closure in 2013. She is both a pri-vate mentor and also works with the statewide mentorship program through the Center for Childhood Deafness and Hearing Loss/Washington School for the Deaf. There, she mentors K-12 educational interpreters and does skills diagnostics for staff interpreters who are preparing for performance reviews. This is her third book through Butte Publications. She studied anthroposophy and Waldorf education in England. She is a new member of the board of Jet City Improv. Tamara and her husband live in Seattle, WA, with their furry menagerie. See more at www.interpretingetc.com Chris Eisle, AAS Research Assistant, has been interpreting professionally for two years in primarily clinical medical settings. He has also assisted several interpreters with research and support in designing workshops for presentation. He wishes to thank his husband, Foster Larson, who remains in many ways the reason for it all.

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Deaf Patients,

Hearing Medical Personnel:

Interpreting and Other Considerations

Second Edition

by

Tamara Moxham, MEd-IP, CI, CT, NIC-Master

Butte Publications, Inc.

Hillsboro, OR

Deaf Patients, Hearing Medical Personnel:

Intepreting and Other Considerations

Second Edition

By

Tamara Moxham, MEd-IP, CI, CT, NIC-Master

© 2017 Butte Publications, Inc.

All rights reserved. No part of this publication may be reproduced or

transmitted in any form or by any means without permission

in writing from the publisher.

Editor: Ellen Todras

Design and Layout: Anita Jones

Butte Publications, Inc.

P.O. Box 1328

Hillsboro, OR 97123-1328

U.S.A.

eISBN 978-1-939349-10-1

Printed in U.S.A.

Preface to the Second Edition

When I first began this project in 2001, my goal was simple—to unpack the experience of deaf and hard of hearing people interacting with the medical world. I chose to do this using a three-fold approach: give the medical community information that will not only educate them but give them a practical way to successfully treat their deaf patients; provide tips that may help deaf patients navigate this system and help their hearing family support them in this effort; and discuss interpreting in the medical field, culminating in techniques that will let interpreters be the most effective.

In this, I succeeded marginally. I am very aware that as a hearing person, I will never have the perspective of a deaf person. As someone who does not have any deaf family members, I will never have the perspective of a hearing person who has witnessed family members face unnecessary barriers to health. In the first edition of this book, I tried to involve deaf people where I could. In this edition I aim to rectify this by involving as many deaf people as possible, representing many facets of their lives, to show as diverse and robust a set as possible of primary source input for the reader.

When a colleague recently presented me with a copy of the first edition and asked me to sign it (something that always surprises me), I found myself nostalgic and leafed through the book. I was struck at how outdated a lot of the information was. This is not surprising. Technology has come far in the 11 years since the book was first published. Pagers, TTYs, and telephone books have been supplanted by smart phones, tablets, video phones, and the Internet. Laws have changed, regulations have been refined, and natural changes have taken place over time.

Later, when I reread the book more fully, I realized that the much more troubling omissions were the stories from deaf and hard of hearing people themselves as well as the perspective of medical providers and administrators. This is something that this edition aims to correct. Among other updates in this edition, I include experiences shared by deaf people who were willing to be interviewed. I thank them for their trust and transparency; see Thanks and Acknowledgments. I have also included the perspectives from several stakeholder committee members in Washington State’s medical intrpreter task force. Many members of this group are deaf—which makes their participation even more valuable. I interviewed several executive directors of advocacy organizations, and I have also approached those few members of the deaf community who are also interpreters—Certified Deaf Interpreters (CDIs). They have the unique perspective of interacting with the medical profession both as deaf patients and professional interpreters. Some also are parents of minor children. I have also added a quote from these interviews at the beginning of every chapter to underline the fact that this all goes back to access and care of deaf and hard of hearing people. Further quotes have been added within some chapters to lend experience to certain points throughout. Additionally, I interviewed several interpreter managers at Seattle-area hospitals to get their perspectives on how they handle access as a whole, and deaf patients in particular.

I thank all of the people who made this project possible originally and in this current version. I apologize for beginning this project without identifying the ways in which my hearing privilege adversely affected the information and readers’ experience, and I also hope that this version is more inclusive and useful.

A Word about Pronouns

In the first edition, I was careful to be grammatically correct with pronouns, often using the option that is available when writing—s/he. I find in this edition that this is not serving the needs of everyone it aims to. Although prescriptively incorrect, they is being used in reference to hypothetical people even when the subject of the sentence is singular. I will be using it this way for this reason, and to include people who do not conform to gender binary expectations. There are a growing number of people who prefer this pronoun. This publication is for everyone, so I am adjusting my language to embrace everyone.

Identifiers

People with hearing loss identify themselves in a number of different ways. Most hearing people think the word deaf or the phrase hearing impaired is the accepted term. People with hearing loss are not a single population, but rather several different ones. For ease of reading, I will use the word deaf, unless I mean one of the specific populations unpacked below. This is so that the repetition of indicators won’t distract from the content.

•Deaf (note the capitalization): This references the group of people who use ASL as their native language. English is either their second or co-primary language. They are members of the Deaf Community and Deaf culture, which is extremely different from mainstream American or hearing culture. To this group of people, the term hearing impaired is as marginalizing as the term white-impaired would be to people of color.

•Hard of hearing: This is the most fluid of all of the terms. Hard of hearing references a range of identities. Medically, it means that the individual has some level of auditory access; however, they may not be able to function aurally depending on the environment. Hard of hearing people who can function like their hearing counterparts (some who work as interpreters) in a quiet, well-lit room with one other person may need to fully rely on interpreting services in a group of people, a strange environment, or with people who have accents they are not used to. They may use assistive technology heavily or not at all.

Cultural note: in the Deaf community the term very hard of hearing refers not to auditory ability, but rather to where on the cultural spectrum between hearing and Deaf the person exists. In this case, very hard of hearing describes a person who behaves in a very culturally hearing manner.

•Late-deafened: This refers to people who are culturally hearing (no matter the presence of any subcultures or immigrant status), and who slowly or quickly lose their hearing over time. They often do not use any form of signed communication, rely on assistive technology, and go through a grieving process for the sense that they have lost.

•Deaf-blind: This group encompasses anyone who has loss of vision and hearing that in any way interrupts daily functioning and requires accommodation for independent living. Many hearing people think that this refers only to people who have a 100 percent decibel loss in their ears and a 100 percent vision loss. This is only one type of deaf-blind person. People who identify this way may have Usher’s Syndrome, in which a deaf person’s vision degrades from the periphery in (tunnel vision); macular degeneration, where a blurry or absent spot appears in the middle of the vision and grows; or many other combinations.

•Deaf-blind people have a variety of communication and access needs that change over time.

•deaf: This term often refers to all of the above and is the term that refers to the sensory inability to hear.

One more note about hearing impaired: Some people who identify as hard of hearing, deaf, or most especially late-deafened may use this term in certain situations or when talking to hearing people with little or no knowledge of the many varieties of deafness. During the advent of politically correct changes in language, hearing people (without consulting the Deaf community) mistakenly thought that this term was less insulting than deaf (which was often paired with dumb or mute in the past). Because of this, some nonculturally Deaf deaf people may elect to refer to themselves thusly when applying for jobs, by moving attention away from their hearing loss and refocusing it on their abilities or their identity as a whole.

With these updates, my hope is that everyone involved will be well represented and comfortable with the information that follows.

Tamara Moxham

September 2016

Chapter One

Housekeeping

Lawmakers must accept the fact that access for deaf patients is its own category. This cannot fit into existing systems for other categories of disabilities.

—L.K., interpreter, executive director, deaf advocacy organization

What Is the Purpose of This Book?

At first glance it may seem that this publication is for interpreters. Those who have read the first edition will realize that in fact it covers a broad variety of issues that deaf people face in the medical world whether they are patients, family, or employees. Although interpreting is the primary consideration and will be addressed extensively, this is only one facet.

The goal of this book is to present the perspectives of everyone involved in health care for deaf people. Issues that deaf people face often don’t occur to hearing people, whether they are directly serving deaf people or in the back offices dealing with the legal end of access. Most deaf people don’t have knowledge of the inner workings of medical facilities and how the processes to make and change policies work. Family members of deaf people don’t always understand the consequences of not teaching deaf children to advocate for themselves or not interpreting for family members, and although their intentions are good, it can enable a broken system.

This publication seeks to give all stakeholders a snapshot of the others’ perspectives with the ultimate goal of effective access for all.

How to Use This Book

In order to make information easier to access as a resource, the following icons have been added as superscripts where applicable:

primarily for medical personnel

primarily for interpreters (ASL, signed system transliterators, CDIs, or spoken language)

primarily for patients

primarily for families of deaf patients

A Word on Medical Interpreting

Medical interpreting is not unlike all other kinds of interpreting in that interpreters’ primary purpose is to make communication possible between those who do not share a common language; however, the subject matter in health care can consist of life-threatening and life-changing issues. Clearly, these are not subjects that can risk misinterpretation. Ironically, there are situational issues that can hinder the interpreting process. Negotiating these obstacles is difficult when there are limits to the system, patients don’t know the channels to get accommodations, and medical facilities honestly think they are doing all they can. It often falls to the interpreters to spend a great deal of time in the educational aspect of their role.

Who Is This Book For?

•Interpreters who wish to specialize in medical settings

•Interpreters who work in medical situations as part of their wider contracting business

•Deaf and hard of hearing individuals who want more information on how to cooperate with professionals to get their medical needs met with more success

•Medical staff and personnel who will be working in direct contact with deaf patients, their families, and interpreters

•Administrators who want to know more about accommodating deaf patients and staff

•Anyone with deaf or hard of hearing loved ones who wants more information on this subject

How Is Medical Interpreting Different from Other Types of Interpreting?

Anyone working in the medical field must receive special training. This education includes vocabulary, scientific information, techniques, equipment usage and maintenance, interpersonal issues such as bedside manner, insurance and legal issues, patients’ rights, administration, billing, medical personnel safety, cultural issues surrounding procedures, interacting with patients’ families, and keeping up-to-date with the latest advancements. Since there is not currently a specific medical interpreting certificate or test, many interpreters achieve this same level of competency by pursuing independent studies, workshops on medical interpreting, and mentorships.

Even hearing patients who have complicated medical concepts explained to them in their