Author: Sandra Lombe, October 3 2017 - The challenges the deaf and the blind are facing in accessing health services are not new to Zambia, however, it seems the government has heard their cry and one can only hope the solution is now coming.

As the government finds a solution

‘Accessing comprehensive, quality health care services is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability and premature death, and achieving health equity for all.'

Article 25 of the United Nations' Universal Declaration of Human Rights 1948 clearly states that "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services."

Every person is entitled to Human Rights without discrimination.

What are Human rights? -these are rights inherent to all human beings, whatever their nationality, place of residence, sex, national or ethnic origin, colour, religion, language, or any other status. These rights are all interrelated, interdependent and indivisible.

Some of the human rights include:

a.      Social Security - Everyone has a right to affordable housing, medicine, education, and childcare, enough money to live on and medicals.

b.      The Right to Life - Everyone has the right to life, and to live in freedom and safety.

c.       The Right to Privacy - Everyone has the right to privacy this is not just about their homes, family but even their health.

Under the right to health every person has the right to the highest attainable standard of physical and mental health including access to all medical services, sanitation, adequate food, decent housing, healthy working conditions and a clean environment. Ideally people are supposed to be certain of a system of health that protects them. This also means that health centres, medicines, and health personnel’s’ services must be accessible, available, acceptable, and of good quality for everyone, on an equitable basis always. Meaning even the physically challenged should enjoy these facilities and services without being disadvantaged. Even their right to privacy and confidentiality should be respected. There should be no barrier to accessing health services at all costs. Health information must be easily accessible for everyone, enabling people to protect their health and claim quality health services.

Everyone must have access to equal high-quality and comprehensive healthcare but just how possible is this for the deaf? They need third parties to interpret for them, simply meaning there is no privacy or confidentiality.

In 2005, I wrote a story on a deaf woman, Susan Mshoka and she highlighted challenges she faced whenever she accessed health services. She had to receive the news of being HIV positive through an interpreter.  I understand she relocated to Eastern Province a few years ago and I have not been able to locate her… I hope she is well. Her story is not so different from that of many people with disabilities specifically the deaf and the blind. People with disabilities especially the deaf, dumb and blind normally face challenges accessing health services in the country.

 In the case of one being found to be HIV positive, the problem also comes in when they have to disclose their status to their family members and worse still collecting drugs. If one does not know how to write and read, they have to move with a bottle (or a snapshot of a bottle of the drugs prescribed to them) and show it to the health care providers so that they are given the correct drugs.

 Despite the world making progress in fighting some of the diseases, most of the physically challenged and specifically the deaf still have serious challenges in accessing the health services.

When it comes of issues of HIV Counselling and Testing, this is close to zero for them. They have for years been crying out saying there is no privacy and confidentiality in accessing health services as they always need a third person to explain what the medical personnel could be saying. There is no confidentiality and so they opt to shun accessing the health services.  The limitation in sign language counselling makes it more difficult for them to seek among others Voluntary Testing Counselling (VCT) services even antenatal visits for deaf women. The blind who can hear are abit advantaged- they can simply walk into the doctors or nurses room and explain what is wrong with them, but face the problem knowing what kind of drugs they are given.

With the government of Zambia recently announcing compulsory testing and treatment, it is hoped that the ministry puts in place all the measures soon, so that the deaf will not get their HIV results through the nodding of the doctor’s heads (indicating one is HIV positive) or shaking from left to right to indicate that one is HIV negative.

Sign Language is a language used by the Deaf community in Zambia. However, it is not clear how many Zambians use Zambian Sign Language, although it is taught in some special schools and interpreters appear on some television programmes.

A few deaf persons that are educated can communicate with the medical personnel by writing down their complaints, and the doctors respond through writing. However, this too is not so ideal.

The solution could lie in training the health personnel in sign language, but again how many of the physically challenged or deaf know sign language. The gap is still wide, they are suffering in silence. One can only hope that the country sets up VCT/ health centres for the deaf, this will go a long way in helping solve the issues surrounding their lack of accessing health services.

Pastor Lewis Nkhoma says the deaf community in Zambia are still facing a lot of challenges including accessing health services.

“The truth is that the Deaf community are facing a big challenge in accessing health services. There are no sign language interpreters in both government and private clinics. A good example is even the University Teaching Hospital (UTH) there is no sign language interpreters let alone medical staff trained in sign language. Most of the deaf are also poor and cannot afford hiring a sign language interpreter and pay for their transport whenever they seek medical attention as such they shun going to the hospitals,” he explains. 

“In other cases, the interpreter will even ask for lunch allowance in addition to the transport and charge fees for him or her to offer interpretation service at clinics. Most interpreters do not have the deaf at heart but money, their charge is a bit expensive too. It would be better if there was one or two places were the deaf could access the medical services which has interpreters for free.”

Pastor Nkhoma, who is Deaf Ministries International senior pastor, said that some deaf who cannot read and write (illiterate) are allegedly sometimes given wrong medicines at health centres because they cannot communicate effectively. “You know well doctors do not know sign language, they only use pen and piece of papers to communicate to a deaf person but those who do not know how to read and write still have challenges. The other problem is that the Ministry of Health are not thinking of the plight of the deaf people.”

He called on the government to find solutions to the plight of the deaf and ensure that every citizen has access to health services. 

Bessy Phiri of Lusaka’s Mtendere area says the only time she has accessed health services was when she was delivering her first child who is now 10 years old. The other two children, all who talk and hear, have been delivered from home.

“It is difficult even when I am not feeling well to go to the hospital. All I do is buy over the counter drugs. I send my children to buy. I am lucky that two of my children are in school even if I struggle to pay for them. Just recently I was dragged to the clinic by my neighbour when she found me lying in the house and had a high temperature. I don’t even know what tests were conducted on me. All I remember is that blood was taken and I was given drugs and a few days later I was back on my feet,” she narrates.

But the Ministry of Health (MoH) in Zambia says it is developing policy guidelines that will ensure that people with disabilities are not left out in accessing the medical services in the country. This is good news especially for the blind and deaf who have serious challenges accessing medical services. 

Ministry of Health spokesperson Dr Maxwell Bweupe in an interview assured that the government was developing policy guidelines to ensure that every citizen did not have challenges accessing health services.

He admitted that there were no medical personnel specifically trained in sign language, but some were trained in special care for children.

“You are quite right (Lack of sign-language-trained medical personnel) but as a government following the declaration of the testing and treatment we are developing guidelines so everyone will not be left behind. That is something we must have developed long ago so that we encompass all people regardless of their disability,” he said.

“However, we have people with special skills especially to deal with children (paediatric HIV care). Not really sign language interpreters but we have a cadre of special medical personnel.”

He said the government was working to ensure that everyone had access to health services and enjoyed their privacy and confidentiality whenever they seek medical services. “That is an area we need to put more effort and strength,” he said. 

Governments should, as a matter of urgency, consider having medical personnel in sign language interpretation. Maybe this should be part of the curriculum. This will go a long way in helping the people that cannot speak, the ‘deaf’. This will also make accessing health care easy and hustle free.  Every person wants to have adequate service, attention and privacy when they seek medical care. This normally is not the case with the people that cannot speak or hear. They have for a long time been disadvantaged; their privacy has been infringed upon simply because they have to voice out through a third person.

When you visit some health institutions, it is clearly stated and placed that ‘patients are entitled to their privacy’. How then do they have their privacy respected if they always have to go with a third person to interpret for them?

One can only hope that there will also be braille at health institutions so that the blind are also not left out.

With so many strides being made in the health sector, I am left wondering how the blind will utilise the HIV self-test... of course they will not. But this can work for the deaf, if or when they go to the hospitals and find no interpreter they can test themselves, but still how do they interpret the results????

The self-test could be a solution to the discrimination and stigma but the current pronouncement by government for ‘mandatory’ testing and treatment is the right way to go.

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