By Willy Chowoo
In Uganda, access to healthcare services for the deaf community is being severely hindered by the government’s failure to recruit sign language interpreters at healthcare facilities. “Access to health services by deaf persons is a big challenge, this is due to communication barrier, many medical workers are too busy to learn sign Language and it becomes very difficult to help”, Mr. Bonny Okoda, a member of the Board of Directors of Uganda National Deaf Association notes.
This gap in service provision, under the purview of the Ministry of Health, has left many deaf individuals struggling to communicate their medical needs effectively, leading to inadequate treatment and care.
According to the 2014 Uganda National Housing and Population statistics, there were over 1,083,649 Deaf people in Uganda (UBOS 2014). This has since increased to 1,290,000 as of Uganda’s population of 2022. This number can even be more as per 2024 Population Census whose partial result released puts Uganda’s population at 45.9 million from 34.6m in 2014. The deaf individuals are supposed to be getting healthcare services from the government health units. Uganda has 2 National Referral Hospitals, 17 Regional Referral Hospitals (RRHs) and 62 are General Hospitals (GHs), and a number of health centre IVs, IIIs, and IIs, but due to a lack of sign Language interpreters attached to these units, the deaf individuals are not adequately getting this service.
In the Acholi sub-region, Northern Uganda, with a population of 2 million people (Census 2024), the deaf community often faces significant barriers in accessing healthcare services too due to communication barriers with the health workers at different health units. The sub-region has four big government hospitals such as Gulu Regional Referral Hospital with 225 lower health units within the 8 districts and a city across the subregion and all of them are without government-recruited Sign Language interpreters to help with translation.
Gulu Regional Referral Hospital is the leading healthcare facility in the North with a capacity of 370 beds for inpatients; the hospital offers a wide range of medical services, including surgical, medical, pediatric, obstetrics, and gynecology services. Patients are always referred from different health units across the 8 districts and the city to get further treatment from the hospital. However, medics here are not able to effectively talk to the deaf patients seeking treatment. “The hospital is badly in need of interpreters, there are a number of deaf patients who usually come here seeking for treatment, but we don’t have people to talk with them”, Mr. Walter Wryekwen, the Hospital Principal Assistant Secretary.
Some of the deaf patients have expressed their frustrations and dismays over the unfair treatment they usually experience while seeking healthcare services at different health units in the subregion, especially Gulu RRH.
Ajalo Piona, 25, is a resident of Pece Cell in Gulu City and a resilient deaf woman who faced a disheartening experience at Gulu Regional Referral Hospital in 2016. Seeking medical attention, Fiona arrived at the hospital with the hope of receiving treatment for a persistent health issue-the tooth decay. However, her hope quickly faded as she realized there were no sign language interpreters available.
“ I was badly off, nobody could attend to me, I took long in the queue, then some nurse came and gave some tablet as pain killer without diagnosing, after two days of persistent pain, I came back to the hospital and spent the whole day without getting any assistance”, Ajalo narrates her painful story. She adds that the tooth decay afterward disappeared naturally without any treatment from the hospital.
Fiona’s inability to communicate her symptoms and understand the medical staffs instructions left her feeling isolated and frustrated. Despite her efforts to convey her needs through gestures and written notes, the lack of understanding from the hospital staff resulted in her leaving without receiving any treatment. Fiona’s experience is a stark reminder of the systemic barriers that prevent deaf individuals from accessing essential healthcare services.
Misdiagnosis and Treatment Barriers.
Deaf individuals say they are always diagnosed wrongly in most of the health units they go to seek for health assistance. They attribute this to the language barrier. Mr. Ocen Dominic, chairman of the Gulu District Deaf Association says, “Healthcare workers cannot understand sign language, and it is worse with those who cannot write and read (Deaf). “But for those who can write, they can exchange notes with health workers, but this is also not effective”.
Opiro Richard, a 27-year-old resident of Bungatira in Gulu district, recounts how he was wrongly diagnosed due to this communication gap. Feeling cold, he visited Gulu Regional Referral Hospital but ended up being tested for HIV/AIDS instead. He notes that there are many deaf individuals who are unaware of their HIV status, and those who are positive struggle to access ARVs because of the language barrier.
“We have our members dying silently,” Opiro reveals. “There are very few counselors who know sign language to communicate with them; so many deaf people die at home rather than in hospitals.” He adds that deaf patients often spend the entire day in queues without food, only to miss out on treatment, which discourages more from coming to the health units.
Mr. Ocen notes that this situation discourages many patients from seeking medical care and even affects their willingness to pursue education. He highlights the plight of women, particularly those needing antenatal services, who face these communication challenges. Mr. Ocen recounts a troubling incident involving a young girl who sought help for a private health issue at the hospital but was unable to communicate her needs and left without receiving any treatment.
Mr. Bony Okoda (deaf), a board member of UNAD says their hope is only for the government to recruit sign language interpreters at all hospitals and train health workers in basic sign language to ensure proper healthcare access for the deaf, “lack of sign Language interpretation has also been leading to wrong medical prescription leading to death. There are cases where midwives are beating deaf expectant mothers on delivery beds when instructions are not followed by them because they don’t hear”, Okoda notes that the nurses think the deaf are stubborn and end up slapping them.
Okoda discloses that UNAD has been lobbying for the employment of sign Language Interpreters in all general hospitals and the Ministry of Public Services to put sign language Interpreters into government structures. “They can better assist deaf patients accessing medical services, some services need lot of confidentiality, and hence it may not be fair for the Deaf without sign Language interpreters”.
Stepping In For the Silent Voices
Northern Uganda has the highest number of deaf people according to the 2014 census. This is attributed to the 20-year Lord’s Resistance Army (LRA) insurgency that has left many families displaced and others killed. War-related incidents can cause deafness due to loud bombs and gunshots. The problem of communication barrier is not only in health units, is everywhere even at home.
There are also cases where the deaf patients themselves do not have a language due to lack of exposure to the deaf community, isolation, discrimination by the parents, and community. “Parents oppressed their children, keep them home isolated, and deaf grew up without any language, and it becomes very difficult to help them even if there is a sign language interpreter at the health units”, Okoda adds.
However, amidst these challenges, two dedicated sign language interpreters, Abalo Sandra, and Eric Otober, are making a profound difference. With over a decade of experience, they have been tirelessly working to bridge the communication gap between deaf patients and healthcare providers. Their efforts have been life-changing for many in the deaf community.
At 37, Abalo Sandra has spent the past ten years as a beacon of hope for the deaf community. Her journey into sign language interpretation began out of a deep-seated desire to make a difference in the lives of those who are often marginalized. Abalo’s commitment to her work is evident in her daily interactions at various healthcare facilities, where she translates the concerns and needs of deaf patients into a language that healthcare workers can understand.
Her role goes beyond mere translation. She provides emotional support and advocacy for deaf individuals, ensuring they receive the care and attention they deserve. Her presence in hospitals is a testament to the impact one person can have in transforming healthcare experiences for an entire community.
At this point of interaction, it is the deaf or their caretakers who usually hire sign Language Interpreters whenever they need assistance at the health units. “ I have helped so many people over the past ten years, but what I remembered most was during our field visit, I helped a young girl at Awach Health Centre IV to give birth as there was nobody who could understand her, we are always called whenever there is an emergency where the patients feel they need our assistance,” Abalo recalls.
Similarly, Eric Otober-36 has dedicated six years of his life to sign language interpretation. His journey was inspired by personal experiences and a strong desire to bridge the gap in healthcare accessibility for the deaf. Eric’s work in the Acholi sub-region involves not only translating medical consultations but also educating healthcare providers about the unique needs of deaf patients.
Eric’s efforts have been instrumental in fostering a more inclusive environment within healthcare facilities. His advocacy has led to increased awareness among medical staff, encouraging them to be more patient and understanding when treating deaf individuals. Eric’s contributions highlight the importance of education and empathy in creating a healthcare system that serves everyone.
These two experienced sign language interpreters in the sub-region have been at the forefront of this mission for over a decade. Their work involves interpreting for deaf patients during medical consultations, ensuring that they understand their diagnoses, treatment plans, and any other critical information conveyed by healthcare professionals.
“Many deaf people come to the hospital with various ailments, but without an interpreter, they struggle to communicate their symptoms to the doctors,” Sandra explains. “We step in to ensure that their voices are heard and that they receive the proper medical care.”
Mr. Freddy Odong, a psychologist at Gulu Regional Referral Hospital at Mental Health Unit, says he is still upset when he failed to help a deaf person who came to the unit seeking for help, “there was no way I could help him, we struggled, and failed to get anybody to help us translate what he was saying, he could not write nor neither read, the patient left the hospital without any help and he has never returned to the unit again.”
Odong adds that at the unit, there are a number of patients with hearing disability but they struggle to get treatment, “there was a time when two deaf individuals came seeking for treatment, but what saved us was, one could write well in English, so we exchanged a bulk of notes explaining the symptoms and signs of what they were suffering from, but all of them were diagnosed and got treatment, however, “we request the government to urgently deploy sign Language Interpreters at the unit”. He adds
The work of Sandra and Eric goes beyond mere interpretation; it involves advocacy and education. They frequently conduct workshops for healthcare staff, teaching them basic sign language and raising awareness about the unique needs of deaf patients. This dual approach not only improves immediate communication but also fosters a more inclusive and understanding healthcare environment.
Despite their efforts, the absence of government support remains a critical issue. There are still many hospitals and clinics across Uganda without access to sign language interpreters, leaving a significant portion of the deaf community underserved. This gap highlights the urgent need for a national policy mandating the recruitment and training of sign language interpreters in all healthcare facilities.
“The government must recognize the importance of this service and allocate resources accordingly,” Eric emphasizes. “Interpreters should be a standard part of every healthcare team to ensure that deaf individuals are not left behind.”
The work of sign language interpreters like Sandra and Eric exemplifies the profound difference that dedicated individuals can make in their communities. Their efforts not only provide essential medical support but also champion the rights of the deaf community, pushing for greater inclusion and accessibility in Uganda’s healthcare system.
The Call for Inclusive Healthcare
The Ministry of Health’s failure to address this issue not only violates the rights of the deaf community to access healthcare but also highlights a broader systemic neglect. There is an urgent need for the recruitment and deployment of sign language interpreters across all healthcare facilities in Uganda to ensure that deaf individuals receive the care and support they deserve.
Without these essential services, the deaf community will continue to face significant barriers, leading to poorer health outcomes and increased marginalization. It is imperative for the Ugandan government to recognize the importance of sign language interpretation in healthcare and take immediate steps to rectify this oversight.
Mr. Ocen Dominic, chairman of the Gulu District Deaf Association says the challenge of a significant communication barrier can be solved through the intervention of the government. “We appeal to the government to recruit sign language interpreters at all hospitals and train health workers in basic sign language to help bridge this gap.”
The Ministry of Health Spokesperson Mr.Ainebyona Emmanuel-says the ministry is aware of the urgent need to have sign Language Interpreters for all the health units in the country to address this challenge. “The sign language interpreters have been factored into the newly approved human resource structures at the lower health facilities”, he notes
In a circular dated 7th May 2024 by the Ministry of Public Service to all the Chief Administrative officers in Uganda about the new staff establishment at health Centre IVs and Health Centre IIIs, it is indicated that the government is in the process of recruiting one sign Language interpreter to be attached to one health Centre IV and III in all 146 districts in Uganda. This means the first batch of recruitment will have 292 Sign Language Interpreters far much below the total number of health facilities in the country which is at 3,194 as of the 2020 Ministry of Health report.
The Permanent Secretary Ministry of Public Service Mrs. Catherine Bitarak Musingwiire in her letter requested the Chief Administrative Officers to follow the new adjustment to accommodate the officers whose positions were not provided for in the approved structure based on the wage bill. As the letter reads in pieces, “You are advised to implement the approved structures within the available wage provision for the financial year 2023/2024”.
In Acholi sub-region, it would mean there would be 17 sign Language Interpreters in the new recruitment policy by the Ministry of Service at the lower health center IVs and IIIs. As each district shall have two Signers plus the city. This will leave a gap of 66 signers in 83 lower health units in the sub-region.
The staffing gap for sign Language Interpreters still very huge despite the current intervention
Mr. Okoda says the new policy shall help in bridging the gap, but urges the government to provide inclusion in all the sectors in the country. “It will have a great impact on the deaf community and the country at large. We are still pushing to make sure this is extended to cover other sectors, too, like education and judiciary, among others”
Mr. Openy Samuel, an advocate of the High Court and a leading expert in disability rights, urges Uganda government to implement a comprehensive policy on the inclusion of deaf individuals in the healthcare system. His call to action highlights the ongoing challenges faced by the deaf community in accessing essential medical services due to a lack of sign-language interpreters in healthcare facilities.
Mr. Openy emphasizes the critical need for a clear and enforceable policy that ensures all healthcare facilities in Uganda are equipped with trained sign language interpreters. “The absence of interpreters is not just a matter of inconvenience; it is a violation of the rights of deaf individuals to access healthcare services,” he stated. “This systemic oversight must be addressed urgently to prevent further marginalization of the deaf community.”
Audio file one: Mr Openy Samuel- a lawyer talking about the needs to implement inclusion policy to benefit the deaf individuals in Uganda.
Despite the efforts of interpreters like Abalo Sandra and Eric Otober, who have been aiding the deaf community for over a decade, the absence of government support and policy remains a significant hurdle. “While individuals like Sandra and Otober play a vital role, their work should be supported and expanded through government initiatives,” Mr. Openy notes.
The government of Uganda in 2020 through parliament enacted the Persons with Disabilities Act (2020) -An Act to provide for the respect and promotion of the fundamental and other human rights and freedoms of persons with disabilities. Section 7 of the Act maintains that there shall be non-discrimination in provision of the health services for persons with disabilities, but does not specify the issues of accessibility by deaf individuals
Mr. Openy’s advocacy aligns with broader calls for disability rights and inclusion in Uganda. He insists that a national policy should include mandatory recruitment of sign language interpreters at all healthcare facilities, continuous training for healthcare providers on communicating with deaf patients, and public awareness campaigns to highlight the importance of inclusive healthcare services.
He adds that the government must take responsibility for ensuring that every Ugandan, regardless of their hearing ability, has access to quality healthcare. This requires a dedicated policy, adequate funding, and a commitment to training and recruitment.
Mr. Openy thinks that a local initiative to fundraise to support the sign Language interpreters shall be an option as the government delays to deploy the Sign Language Interpreters at different health Units in the country
Audio file two : Mr Openy Samuel- a lawyer advocating for local initiative to fundriase to keep sign Language Interpreters at government health units.
As the debate continues, it is clear that the implementation of such a policy would not only benefit the deaf community but also advance Uganda’s commitment to human rights and equality. Mr. Openy’s call to action serves as a crucial reminder of the need for systemic change to ensure that all citizens can access the healthcare they deserve.
