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Beyond dispensing: A day at a Malaysian medical sign language workshop

Rachel Soon
Medical Writer
07 Aug 2019
Participants at "Beyond Dispensing: Malaysian Medical Sign Language", a workshop by the Malaysian Community Pharmacy Business Forum (MyCPBF). (Photo credit: MyCPBF)

Individuals with hearing disabilities often have issues with healthcare access due to communication gaps between them and medical staff. At the recent Beyond Dispensing: Malaysian Medical Sign Language 2019 workshop jointly organized by the Malaysian Community Pharmacy Business Forum (MyCPBF), the Malaysian Sign Language and Deaf Studies Association (MyBIM), The Light and the Malaysian Federation for the Deaf (MFD), a group of healthcare professionals took some time off to learn how to bridge the gaps.

On a cloudy Saturday morning in Puchong, MyBIM instructor Annie Ong moved to the front of a lecture hall, ready to begin her presentation. Instead of the usual wave of clapping, what greeted her was the sight of two hundred hands lifted over the audience’s heads, silently waving back and forth at the wrists.

Ong smiled broadly. To her and to the other members of the Deaf community seated in the room, the gesture was the same as loud applause.

“Good morning to everyone,” she said with her hands. Beside her, interpreter Anita Wong translated her quick gestures into spoken words. “Tell me: why do you want to learn Sign Language?”

A young woman stood up to shyly introduce herself. She was a former part-time assistant pharmacist at a community pharmacy. There was a deaf couple who came once, wanting to purchase milk powder, she said. It was a simple product, and they wanted to know the benefits of taking it, but the pharmacist she was assisting couldn’t understand them.

MyBIM sign language instructor Annie Ong describes aspects of the Deaf community. (Photo credit: MyCPBF)

MyBIM sign language instructor Annie Ong describes aspects of the Deaf community. (Photo credit: MyCPBF)

“It was tough, but … I managed to capture what they wanted to know in the end. They were so happy when they could understand me,” she said. “So I thought something like this is important to know.”

Another audience member, a former pharmacist in a public hospital, remembered a deaf patient who had been prescribed a certain medication. The doctor had written instructions on the prescription to ask the patient if they could buy an alternative medication at a lower dosage, which was more suitable to their condition. But the pharmacist didn’t know how to ask.

“They seemed like they couldn’t understand what I was trying to say. In the end, all I could do was give them the original medication. It was frustrating,” she said.

Later in the day, many of the audience members shared similar stories. Whether from pharmacies, consultation rooms or wards, the participants of the workshop were there to learn how to bridge a challenging communication gap between them and future deaf patients.

Hurdles in communication

In 2013, the MFD reported that there were only 50 to 60 qualified sign language interpreters in the country to serve a community of more than 55,000 individuals registered as deaf with government social services. [The Star Online. MFD: Massive shortage of sign language interpreters. Available at: https://www.thestar.com.my/news/nation/2013/09/20/more-interpreters-needed Accessed on 23 July 2019]

Often, this means that deaf patients are forced to rely on either relatives or acquaintances to translate on their behalf, or to try conveying their needs to healthcare professionals who may neither fully understand the patient nor make themselves fully understood to the patient.

Sharing her experiences during the workshop was Dr Dorothy D’Anne, representative of The Light, a small non-profit organization of professionals offering medical and legal services to underserved deaf persons, such as those living in poverty or remote areas.

“Working in the internal medicine department of a hospital, most patients I’ve met who are deaf are shy in expressing themselves or even avoid clinics or hospitals altogether, even when they’re very sick,” said D’Anne. “They’re afraid of miscommunication which can happen at every level; wrong medication, wrong channels and difficulty in guidance. [In a busy hospital setting] it’s sad to say that they [healthcare professionals] sometimes even ignore deaf patients.”

The Light representative Dr Dorothy D’Anne (left) describes the non-profit’s work with underserved deaf communities, with interpreter Anita Wong (right). (Photo credit: MyCPBF)

The Light representative Dr Dorothy D’Anne (left) describes the non-profit’s work with underserved deaf communities, with interpreter Anita Wong (right). (Photo credit: MyCPBF)

When D’Anne learned sign language, she found her deaf patients were far more open and trusting with her, pouring out their issues and concerns. Both doctor and patients found the consultation process more comfortable and thorough speaking face-to-face, rather than going through an interpreting relative or friend.

“As healthcare professionals, equipping ourselves with a language our patients can understand helps build trust between them and us, and more complete treatment can be delivered,” said D’Anne.

Patient stories: Hafiz Siraj

“Many of us cannot afford to have a personal interpreter when seeking treatment. They’re expensive and difficult to obtain, especially on short notice, like during an emergency. So, we use hearing family members as interpreters instead … but because they’re not professionals, they may not be able to interpret the doctor’s or the patient’s words properly. They might be emotional or unable to give a full explanation to the doctor.

“Furthermore, sometimes the patient might not want their family members to know the details of their health problems. But they don’t have the privilege of doctor-patient confidentiality like the hearing do.

“When I was admitted in the hospital for a hernia surgery last September, my mother was my interpreter. I was comfortable because she was my mother, she knew all my health history, she could interpret quite well, and the surgeon was a relative. Then I realized, what if I didn’t have an interpreter all the time with me? I would be confused by the many pre- and post-surgery procedures. I would also be very afraid because I would not have understood what was happening.

“Being in a hospital is already a scary experience for most people. Imagine not being able to understand what is going on and what the doctor is saying.”

Patient stories: Edward Wong

“Once, I was at the hospital for a pre-JPJ exam medical check-up. When I entered the consultation room and sat with the doctor, he started talking non-stop. I tried to tell him: “Wait, wait, I’m deaf—I can’t hear anything you’re saying.” And what happened instead was that he just kept talking but moving his mouth slower. I think he assumed I could read his lips, but I can’t do that.

“Please wait. Let’s write what we’re trying to say instead,” I told him. Writing went much better. But he had this facial expression like he was in a hurry … every few minutes, he would start to talk again, and I would have to remind him to write instead.

When he dismissed me, I couldn’t help thinking to myself about that impatient look on his face. Didn’t he understand that deaf people need more time to communicate? You can’t just hurry us and ask us to get out. We’re different from hearing people who can do it so much faster.

Understanding the deaf

Ong highlighted the distinction between the term ‘Deaf’—which is used to refer to a cultural identity of common values, norms, traditions, language, and behaviours shared by a community of deaf persons—and the term ‘deaf’, which refers to a person’s audiological status.

“The Deaf don’t generally perceive themselves as handicapped, impaired or disabled,” said Ong. “On the other hand, ‘deaf’ describes anyone with congenital or acquired deafness due to illness, trauma or age. They may not necessarily identify with Deaf Culture or know how to sign the languages used.”

The Deaf community also includes the hard of hearing (HoH) and hearing persons related to Deaf individuals, such as Children of Deaf Adults (CODAs), hearing parents of deaf children, interpreters, teachers, and Friends of the Deaf (FOD).

Workshop participants practice the basic alphabet signs under Ong’s instruction. (Photo credit: MyCPBF)

Workshop participants practice the basic alphabet signs under Ong’s instruction. (Photo credit: MyCPBF)

While BIM (Bahasa Isyarat Malaysia) is widely used in the Malaysian Deaf community, Ong noted that it is far from the only formalized sign language in use; others include American Sign Language (ASL) and British Sign Language (BSL). Signs can vary widely across the languages, and many deaf individuals develop their own informal signs within their own social circles.

“BIM is our national sign language and more multicultural than ASL, because it makes use of signs that draw from various Malaysian cultural communities,” said Ong. “It was developed by the first generation of deaf students at the Penang Federation School for the Deaf, who hailed from all across the country.”

While Ong led the audience through a series of lessons on BIM signs for the alphabet, numbers, common greetings and phrases, as well as medical terms, she clarified that there was still much that the participants could learn to improve their abilities. However, even basic signs could be immensely encouraging to patients, she said.

“Simple gestures like that help show your interest in trying to listen to the problems of the deaf,” said Ong. “I hope that more healthcare professionals can pick up sign language to improve accessibility for the community.”

Ong’s tips for communicating with the deaf:

  1. To get their attention, stand in their field of view and wave a hand before their face. Some accept a gentle tap on their shoulder.
  2. Flicking the lights off and on helps get their attention at a distance or in a crowded room.
  3. Make signs against a dark or plain background; bright colours and patterns are visually distracting.
  4. Move aside objects that sit between both of you (eg, cups, bottles), so that their visual field can fully focus on your face and hands.
  5. Even if you don’t know the exact signs for things, physical expressiveness helps to convey your tone. When gesturing, make use of your facial expressions and body language.
  6. Miming the shapes and actions of things can also be helpful if you don’t know their signs.
  7. Remember that different deaf persons are comfortable with different forms of communication; literacy, lipreading and fluency in a standardized sign language are not universal.

For more information on sign language education resources, you can refer to the following organizations:

  • Malaysian Sign Language and Deaf Studies Association (MyBIM): mybimorg.blogspot.com/p/introduction.html
  • Malaysia Federation of Deaf (MFD): www.mymfdeaf.org
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Most Read Articles
Stephen Padilla, 25 Jul 2019
Nonvitamin K antagonist oral anticoagulants (NOACs) appear to confer more clinical benefits to elderly patients with atrial fibrillation (AF) than vitamin K antagonist anticoagulants (VKAs), suggests a study, adding that this is primarily driven by the lower rates of major bleeding.
22 Aug 2018
In patients with atrial fibrillation (AF) naïve to oral anticoagulants (OACs), standard-dose nonvitamin K antagonist OACs (NOACs) provides better survival benefits than warfarin, a recent meta-analysis has shown.
Stephen Padilla, 31 Aug 2018
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Stephen Padilla, 11 Sep 2018
Use of diclofenac, a traditional nonsteroidal anti-inflammatory drug (NSAID) with cyclo-oxygenase-2 (COX-2) selectivity similar to COX-2 inhibitors, is associated with higher cardiovascular health risk compared with nonuse, paracetamol use and use of other traditional NSAIDs, a recent study has shown.