A study on assessing communication challenges between clerks and deaf patients at Nelson Mandela Academic Hospital was conducted in 2010. The aim was to assess the existence of communication challenges, possible reasons and solutions to these. The literature reviewed identified a gap in the knowledge of communication between staff and deaf patients. A health systems’ study was conducted using a descriptive, cross sectional survey. The study population was made up of 33 clerks who worked at the registration and records area and deaf patients who stayed at Efata and received health services from the hospital. All clerks were interviewed and a random sample of 106 deaf patients was estimated using Epidat statistical software. Self administered questionnaires were used for data collection. Results confirmed the existence of communication challenges between the two groups. A majority of clerks were not trained in Sign Language. They used a combination of methods to communicate with deaf patients, and few clerks could use Sign Language. The patients also used a combination of methods due to the frustration of not having a common method of communication with clerks. The findings clearly showed that there are communication challenges between the two groups and Sign Language needed to be introduced to clerks in order to accommodate deaf patients. Further research may be done on all healthcare providers and to all deaf patients in the region served by Nelson Mandela Academic Hospital, and this could have a positive impact on the quality of service offered by the hospital to the deaf community.

Executive Summary During 2010-2012, a Leonardo da Vinci-funded EU project focused on enhancing the language skills of Deaf people, interpreters and Health Care Professionals. Project partners from Cyprus, Ireland, Poland, Scotland and Sweden reviewed current knowledge of policy and practice, and embedded the resulting analysis into a programme of materials to support reflection, knowledge and skills development internationally. This report presents the project's initial 'state-of-the-art' review, with particular reference to the partner countries. Sign languages are now widely recognised, for theoretical and practical purposes, as full, natural languages, and sign language interpreting has consequently been established as a respected profession. Sign language interpreters mediate between hearing and deaf people: this entails a complex transfer of meaning between languages, cultural domains and linguistic modalities, and between members of highly literate communities and those whose languages have no written form. Decades of development in understanding of the most effective part to be played by interpreters in small-group dialogue have concluded that communication is best facilitated with recognition of the interpreter as a linguistic partner, and an active participant in the joint creation of meaning. Good practice in interpreting rarely entails a passive role whereby the interpreter acts as a mere conduit for others' words.   In respect of healthcare interpreting, the situation in the partner countries (and beyond) varies widely, from minimal recognition of the need for dedicated provision for deaf patients, to relatively explicit and well-resourced entitlement to services. In none of the partner countries do services address all identified requirements, despite recognition that inadequate provision can lead to damaging and indeed life-threatening consequences. Training and associated resources for all three key groups – interpreters, healthcare staff and deaf people – are insufficient or non-existent across the board. No-one has a stable, clear set of expectations about how communication can most effectively proceed in these situations. In this context, it is predictable that regulation of quality can be highly problematic. Comparison with North America and Australia highlights a range of adoptable best practices, requiring investment over time in order to generate and implement more effective approaches. It must be recognised that the mere provision of sign language interpreters is only the beginning of true access to healthcare for deaf people. In order to maximise positive outcomes, members of all three key groups must become familiar with a common set of assumptions and practices to reinforce the need to operate as a collaborating triad in the co-constructing of effective interaction. Consistent, high-quality outcomes need to be assured through empowered regulatory mechanisms, for which models exist internationally. / MEDISIGNS

Introdução: O atendimento interlinguístico e intercultural de pacientes surdos nos contextos de saúde é tema pouco explorado pela literatura. A inserção de TILS-GI é um importante meio de viabilizá-lo, conforme previsto em lei. Objetivos: Identificar a atuação de TILS-GI em serviços de saúde, na mediação entre equipes falantes de português e pacientes surdos usuários de libras. Conhecer a percepção de TILS-GI sobre aspectos éticos relacionados à comunicação, autonomia e privacidade de pacientes surdos, tomados aqui como princípios éticos em saúde, conceitos teóricos e eixos de análise. Metodologia: Trata-se de pesquisa qualitativa, empírica, descritiva e de caráter exploratório baseada na análise dos eixos comunicação, autonomia e privacidade. Foram entrevistados 30 TILS-GI atuantes nas regiões metropolitanas de São Paulo e Rio de Janeiro. A análise dos resultados utilizou-se de depoimentos individuais a partir de situações vivenciadas ou hipotéticas. Resultados: Os TILS-GI entrevistados eram ad hoc. Não foram localizados profissionais empregados na saúde. A atuação deles na área foi pontual, esporádica, voluntária, informal e em situações de gravidade de saúde, temas sigilosos ou na falta de familiares acompanhantes. Ao que concerne ao eixo comunicação, os desafios da interpretação relacionam-se à falta de formação específica na área (jargão, desafios intermodais e interculturais), a não saberem lidar com questões de escopo da saúde e pela proximidade pessoal de muitos profissionais com os surdos. No eixo autonomia, foram identificados graus de participação do paciente dependente, em muito, da postura dos TILS-GI e das equipes de saúde. No eixo privacidade, a privacidade de informações teve respostas homogêneas do grupo, que defendeu que o legítimo informante quando outros desejam saber informações junto aos TILS-GI sobre o paciente surdo é o próprio, algo referenciado no código deontológico da categoria. Em contrapartida, a variedade de respostas sobre privacidade física revelou menores amadurecimento e consenso entre eles. Conclusão: Os TILS-GIs nomeiam problemas éticos na sua prática em saúde e com os surdos passam por tarefas múltiplas que extrapolam a mediação linguística e por sofrimentos diversos, alguns evitáveis. São figuras essenciais por viabilizarem os direitos desta população. Sua potencial parceria com os envolvidos, contudo, exigiria um processo mais ativo de reflexão e troca entre eles. / Introduction: The intercultural and interlinguistic service to deaf patients in the health contexts is an overlooked topic by specialized literature. The insertion of the TILS-GI (Portuguese abbreviation for Translator Interpreter of Brazilian Sign Language and Interpreter-Guide) is an important means to enable such service as provided by law. Objectives: Identifying the performance of TILS-GI in health services in the mediation of Portuguese-speaking teams and deaf patients, users of Brazilian sign language. Bringing to light the perception of TILS-GI about ethical aspects related to the communication, autonomy and privacy of deaf patients, understood herein as heath ethical principles, theoretical concepts and guiding analytical themes. Methodology: This is a qualitative, empirical descriptive research, of exploratory character based on the themes of communication, autonomy and privacy. Thirty TILS-GI who work in the Greater São Paulo and Rio de Janeiro areas were interviewed. The instrument of sampling consisted of three parts. The result analyses used the individual testimonials based on hypothetical or lived experiences. Results: the TILS-GIs interviewed were ad hoc. No professional employed by the health department was located. Their performances in the area were eventual, sparse, volunteer, informal and sometimes in high risk situations, dealing with confidential topics and when in lack of family members. In the terms of the communication axis, the challenges of interpretation are related to the lack of specific training and formal education in the area (jargon, intermodal and intercultural challenges), to the inability to cope with health-related issues and to the personal close relation of the professionals with the deaf patients. In the autonomy axis, we identified several degrees of participation of the patient, which heavily depends on the stance of the TILS-GI and the health teams. In the privacy axis, the information privacy was referred to homogenously by the group, which defended that the legitimate informant about the deaf patients processes was the TILS-GI themselves, according to the ethical code of the category. On the other hand, the variety of responses about the physical privacy was revealing of the lesser maturity and consensus among them. Conclusion: The TILS-GI have named ethical problems in their practice in the health area and how deaf people undergo multiple situations that extrapolate the linguistic mediation and unnecessary suffering. They are essential characters in the sense of enabling the rights of this populations. Their potential partnership with 9 all the participants of the interaction, however, would demand a more active process of reflection and exchange.

Introdução: O atendimento interlinguístico e intercultural de pacientes surdos nos contextos de saúde é tema pouco explorado pela literatura. A inserção de TILS-GI é um importante meio de viabilizá-lo, conforme previsto em lei. Objetivos: Identificar a atuação de TILS-GI em serviços de saúde, na mediação entre equipes falantes de português e pacientes surdos usuários de libras. Conhecer a percepção de TILS-GI sobre aspectos éticos relacionados à comunicação, autonomia e privacidade de pacientes surdos, tomados aqui como princípios éticos em saúde, conceitos teóricos e eixos de análise. Metodologia: Trata-se de pesquisa qualitativa, empírica, descritiva e de caráter exploratório baseada na análise dos eixos comunicação, autonomia e privacidade. Foram entrevistados 30 TILS-GI atuantes nas regiões metropolitanas de São Paulo e Rio de Janeiro. A análise dos resultados utilizou-se de depoimentos individuais a partir de situações vivenciadas ou hipotéticas. Resultados: Os TILS-GI entrevistados eram ad hoc. Não foram localizados profissionais empregados na saúde. A atuação deles na área foi pontual, esporádica, voluntária, informal e em situações de gravidade de saúde, temas sigilosos ou na falta de familiares acompanhantes. Ao que concerne ao eixo comunicação, os desafios da interpretação relacionam-se à falta de formação específica na área (jargão, desafios intermodais e interculturais), a não saberem lidar com questões de escopo da saúde e pela proximidade pessoal de muitos profissionais com os surdos. No eixo autonomia, foram identificados graus de participação do paciente dependente, em muito, da postura dos TILS-GI e das equipes de saúde. No eixo privacidade, a privacidade de informações teve respostas homogêneas do grupo, que defendeu que o legítimo informante quando outros desejam saber informações junto aos TILS-GI sobre o paciente surdo é o próprio, algo referenciado no código deontológico da categoria. Em contrapartida, a variedade de respostas sobre privacidade física revelou menores amadurecimento e consenso entre eles. Conclusão: Os TILS-GIs nomeiam problemas éticos na sua prática em saúde e com os surdos passam por tarefas múltiplas que extrapolam a mediação linguística e por sofrimentos diversos, alguns evitáveis. São figuras essenciais por viabilizarem os direitos desta população. Sua potencial parceria com os envolvidos, contudo, exigiria um processo mais ativo de reflexão e troca entre eles. / Introduction: The intercultural and interlinguistic service to deaf patients in the health contexts is an overlooked topic by specialized literature. The insertion of the TILS-GI (Portuguese abbreviation for Translator Interpreter of Brazilian Sign Language and Interpreter-Guide) is an important means to enable such service as provided by law. Objectives: Identifying the performance of TILS-GI in health services in the mediation of Portuguese-speaking teams and deaf patients, users of Brazilian sign language. Bringing to light the perception of TILS-GI about ethical aspects related to the communication, autonomy and privacy of deaf patients, understood herein as heath ethical principles, theoretical concepts and guiding analytical themes. Methodology: This is a qualitative, empirical descriptive research, of exploratory character based on the themes of communication, autonomy and privacy. Thirty TILS-GI who work in the Greater São Paulo and Rio de Janeiro areas were interviewed. The instrument of sampling consisted of three parts. The result analyses used the individual testimonials based on hypothetical or lived experiences. Results: the TILS-GIs interviewed were ad hoc. No professional employed by the health department was located. Their performances in the area were eventual, sparse, volunteer, informal and sometimes in high risk situations, dealing with confidential topics and when in lack of family members. In the terms of the communication axis, the challenges of interpretation are related to the lack of specific training and formal education in the area (jargon, intermodal and intercultural challenges), to the inability to cope with health-related issues and to the personal close relation of the professionals with the deaf patients. In the autonomy axis, we identified several degrees of participation of the patient, which heavily depends on the stance of the TILS-GI and the health teams. In the privacy axis, the information privacy was referred to homogenously by the group, which defended that the legitimate informant about the deaf patients processes was the TILS-GI themselves, according to the ethical code of the category. On the other hand, the variety of responses about the physical privacy was revealing of the lesser maturity and consensus among them. Conclusion: The TILS-GI have named ethical problems in their practice in the health area and how deaf people undergo multiple situations that extrapolate the linguistic mediation and unnecessary suffering. They are essential characters in the sense of enabling the rights of this populations. Their potential partnership with 9 all the participants of the interaction, however, would demand a more active process of reflection and exchange.

Among human needs, communication is the most important. In health, it becomes even more relevant due to need of interaction between professional and patient, and due to the fact that inadequate communication, besides affecting treatement, can lead to unnecessary suffering for the patient and complicate the disease. Considering that the communication barrier hinders or prevents the interaction between deaf patients and health professionals, it can be overcome when they find strategies to communicate. The present study has aimed to investigate the perception of the hearing health care professional and deaf subjects in relation to the strategies used and to the aspects of communication established in health services. This quantitative, qualitative, descriptive and exploratory research was composed of 43 health professionals, who work in in a university hospital of a city in Rio Grande do Sul (RS), and 23 deaf people, who are students and teachers in a special school for deaf people and from federal institutions of higher education from two cities of RS. The instruments used were two questionnaires, both in written Portuguese language (PL), one to hearing health professionals, and another to deaf people. These had helped from the researcher, who is fluent in Sign Language (SL), from two SL interpreters who translated to LIBRAS (Brazilian Sign Language) each written question, in order to ensure those would understand the questions and to facilitate participants answers. Data collection was performed by the analysis of the 72 responses of the participants. The results have shown that the main strategy used by the deaf subject is writte PL, considered as a language that facilitates understanding. Mimics/gestures were evaluated by hearing professionals as a facilitator for understanding information during communication. The hearing companion is the strategy most used by both groups in health care. The deaf subject considers that speech (spoken language) used by professional hinders an understanding, while the health professional considers LIBRAS as the language that hinders the understanding of information in communication. Moreover, the deaf subjects believe the SL interpreter written PL are the strategies that contribute most to promote their autonomy and respect their privacy, respectively, while hearing professionals consider the use of hearing prosthesis. Therefore, we can see that there were differences of opinions among the deaf subjects and hearing professionals in relation to communication strategies. We can be concluded that this is one of the reasons that contribute to the maintenance of communication difficulties between hearing professionals and deaf subject in access to and health care. / Dentre as necessidades humanas, a da comunicação é a mais importante; na saúde, ela se torna mais relevante, devido à necessidade de interação entre profissional-paciente, e também ao fato de que uma comunicação inadequada pode, além de influenciar no tratamento, ocasionar sofrimento desnecessário para o paciente e risco de agravamento da doença. Considerando que a barreira de comunicação que dificulta ou até impede a interação entre paciente surdo e profissional de saúde pode ser superada quando estes encontram estratégias para se comunicarem, o presente estudo teve como objetivo investigar a percepção de profissionais ouvintes da área de saúde e dos sujeitos surdos em relação às estratégias utilizadas e aos aspectos de comunicação estabelecidos durante o atendimento em saúde. A pesquisa de cunho quanti-qualitativo, descritiva, de caráter exploratório, teve sua amostra composta por 43 profissionais de saúde, que atuam em um hospital universitário de uma cidade do interior do estado do Rio Grande do Sul (RS), e por 23 sujeitos surdos, que são alunos e professores de uma escola especial para surdos e de instituições federais de ensino superior de duas cidades do estado do Rio Grande do Sul. Os procedimentos de coleta constaram da aplicação de dois questionários, ambos em Língua Portuguesa (LP) escrita, um destinado aos profissionais de saúde ouvintes e outro aos surdos, sendo que estes contaram com o auxílio da pesquisadora, que é fluente em Língua de Sinais (LS) e de duas intérpretes de LS, que traduziram para LIBRAS (Língua Brasileira de Sinais) cada pergunta escrita, a fim de certificarem-se do entendimento do teor da pergunta e favorecerem as respostas por parte do participante. A análise dos dados foi realizada por meio das respostas obtidas pelos 72 participantes da pesquisa. Os resultados demonstraram que a estratégia mais utilizada pelo surdo é a LP escrita, considerada por ele a que também facilita o entendimento. A mímica/gesto foi avaliada, pelos profissionais ouvintes, como facilitadora da compreensão das informações durante a comunicação. O acompanhante ouvinte é a estratégia mais utilizada por ambos durante o atendimento em saúde. O surdo considera que a fala (língua oral) usada pelo profissional ouvinte dificulta o entendimento, enquanto que o profissional de saúde considera a LIBRAS, utilizada pelo surdo, como a que dificulta a compreensão das informações durante a comunicação. Além disso, o surdo acredita que o intérprete de LS e a LP escrita são as estratégias que mais contribuem para promover sua autonomia e respeitar sua privacidade, respectivamente, enquanto que os profissionais ouvintes consideram o uso de próteses auditivas. Portanto, pode-se perceber que houve divergências de opiniões, entre profissionais ouvintes e sujeitos surdos, em relação às estratégias de comunicação. Pode-se concluir que este é um dos motivos que contribuem para a manutenção das dificuldades de comunicação existentes entre profissional ouvinte e sujeito surdo no acesso e no atendimento em saúde.