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More sign language interpreters at Japan hospitals needed for hearing impaired patients

Interpreter Ryoko Hamano, right, uses sign language to convey a doctor's message to a patient. (Photo courtesy of Sapporo City General Hospital)

TOKYO -- People with hearing disabilities in Japan are struggling to communicate their physical and mental conditions to doctors due to a lack of sign language interpreters regularly stationed at medical institutions.

As there is only a small number of medical workers who can communicate in sign language, individuals with hearing disabilities find it difficult to tell doctors about their conditions properly or receive detailed explanations from them, even by writing or asking their family members to act as an interpreter.

As a reluctance to see a doctor could lead to a patient's condition to deteriorate, medical professionals are asking for the permanent staffing of sign language interpreters at medical institutions. However, the government has done little to provide assistance to that end.

Professor Yutaka Osugi of Tsukuba University of Technology in Tsukuba, Ibaraki Prefecture, northeast of Tokyo, where students with visual and hearing disabilities study, is deaf himself. A sign linguistics specialist, Osugi recalls that when he underwent surgery at a hospital in Tokyo in 2016, he found it hard to move his fingers when he woke up from anesthesia as an IV needle was stuck in his right hand, his dominant one.

"I can't communicate in sign language," he complained to a nurse by showing a piece of paper on which he wrote the message with his left hand. But the nurse shrugged off his plea, giving a gesture that he was fine and could move his fingers all right.

When he was hospitalized again in 2018, he was forced to receive a detailed explanation about anesthesia without a sign language interpreter by his side as he had not asked the local government for their dispatch. At another time, he had to ask a sign language interpreter to leave without providing help as the doctor cancelled his appointment.

"If only they had a sign language interpreter at the hospital..." he thought time and again.

For people with hearing disabilities, it is reassuring to see sign language interpreters regularly staffed at hospitals so they can help them communicate even in emergencies. However, only around 20 hospitals across Japan have sign language interpreters, according to one survey.

At Sapporo City General Hospital in the northernmost prefecture of Hokkaido, sign language interpreters have been working as part-time staffers since 1996 following a request by a local association of people with hearing disabilities. The hospital has seen growing demand among patients for sign language interpretation, and tourists sometimes come to see doctors during their trips in the region. As of now, two sign language interpreters at the Sapporo facility deal with a total of 300 to 400 patients per month.

Ryoko Hamano, one of the two interpreters, tends to the needs of both inpatients and outpatients at the hospital. By checking on patients' conditions frequently and gathering their information, she tries to serve as a liaison between patients and medical staff. Having sign language interpretation can also help promote efficient medical examinations and prevent potential medical blunders.

"We are sort of like hotel concierges," Hamano said.

At Kagoshima City Hospital in the southwestern prefecture of Kagoshima, Ryuko Yamaguchi has been regularly stationed as a sign language interpreter since 2004. Compared to written communication, she says sign language allows for patients to express themselves more freely and for her to "grasp a better understanding of patients' living environments, which facilitates the provision of effective medical care."

When a deaf breast cancer patient moved to another hospital, the person regretted the transfer, telling Yamaguchi, "I wish I could have stayed at a hospital with a sign interpreter till the end." Yamaguchi then thought, "Sign interpreters are in greater need at medical wards for long-term care and palliative care than anywhere else."

In spite of the urgent need to make the presence of sign interpreters at hospitals more common, however, there are many challenges that need to be addressed.

First and foremost, there is a shortage of financial resources to boost the number of sign interpreters at medical facilities. While the central government has been promoting the assignment of medical interpreters for foreign patients ahead of the 2020 Tokyo Olympic and Paralympic Games by subsidizing hospitals that have staffed their facilities with such interpreters or arranged a system to have those specialists dispatched. The government has also been pushing forward with the development of core hospitals that can respond to patients in multiple languages. Meanwhile, however, there is no governmental subsidy program for the placement of sign language interpreters at hospitals, leaving hospital operators with no choice but to foot their personnel bills.

At Sapporo City General Hospital, patients with hearing disabilities are not charged extra fees for their first medical consultation if they don't have a medical referral letter, so as to secure their access to medical care. In some cases, the hospital continues to provide care to hearing disabled patients even after their conditions become stabilized. This is in spite of the fact that the more generous support a hospital provides to patients with hearing disabilities, the more it costs those facilities financially.

The second challenge is how to ensure the quality of sign interpreters. According to a survey conducted by Tsukuba University of Technology in fiscal 2018 targeting 10 hospitals staffed with sign interpreters across the nation, only two of 18 interpreters at those facilities had acquired medical care-related licenses.

This comes in contrast with the government policy for developing medical interpreters for non-Japanese-speaking patients. There is a state program to train medical interpreters, and core hospitals are staffed with not only such interpreters but also with medical coordinators, who act as a mediator between patients and medical staff. Yasuyo Osanai, a medical coordinator at the National Center for Global Health and Medicine in Tokyo's Shinjuku Ward, who holds a nursing license, commented, "The job carries a heavy responsibility as it deals with people's lives. It would be difficult to interpret without medical knowledge."

Starting fiscal 2019, Tsukuba University of Technology has been developing a training program for sign language interpreters in medical fields at the commission of the government. The school also eyes the introduction of e-learning for the program. "It is necessary to create a new license that requires medical knowledge," says professor Osugi, who is in charge of the program.

Yoshihiro Ito, head of the Yokohama-based nonprofit organization Information Gap Buster, which has been promoting barrier-free access to information by deaf people, calls for greater government support for sign language interpretation at hospitals.

"The lack of sign language interpreters at medical institutions has discouraged people with hearing disabilities from visiting hospitals and led to a gap between people with and without such disabilities in their opportunities to receive medical care to stay healthy. I hope that many people will recognize the importance of sign language interpretation and that equal access to medical care is ensured," he said.

(Japanese original by Hitomi Tanimoto, Lifestyle and Medical News Department, and Kotomi Sakuma, Educational Project Office)

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