People who are deaf or hard of hearing use a variety of ways to communicate with the hearing . They might rely on sign language interpreters, assistive listening devices, speech- reading, and/or written messages. Many can speak even though they cannot hear. Under the Americans with Disabilities Act (ADA), the method of communication and the ser- vices or aids the hospital must provide will vary depending upon the abilities of the person who is deaf or hard of hearing, and on the complexity and nature of the communications that are required. Before deciding how to communicate most successfully to the family, healthcare providers should first ask the family how best to communicate with them.


It should be noted that many in the deaf community champion their unique situation and take pride in being a deaf person who only communicates through signing, using American Sign Language (ASL). This cadre of ASL signers share a feeling of belonging in the same milieu. They pride themselves as being the true deaf “culture.” They also differentiate themselves from those who are deaf but try to participate in the hearing world by speaking or communicating in other ways.


Service delivery issues. The United States enacted the ADA in 1990. Under the ADA, hospitals must provide effective means of communication for patients, family members, and hospital visitors who are deaf or hard of hearing. Hospitals cannot charge patients or other persons with hearing disabilities an extra fee for interpreter services or other communication aids and services. Effective communication is particularly critical in obstetric healthcare settings such as the prenatal care clinic or labor and delivery units where miscommunication may lead to misdiagnosis and improper or delayed treatment. As a general rule, it is always inappropriate to ask family members or other companions to interpret for a person who is deaf or hard of hearing. Family members may be unable to interpret accurately in the emotional situation that often exists in medical situations.


There are several ways other than signing in which a health professional can communi- cate with a person that is hard of hearing. One of these is speech-reading (lip-reading). Health professionals can help speech-reading communication with hard-of- hearing people by following a few basic rules. These rules, often coupled with technology, make a difference in being understood. The rules are


• find a well lit environment away from noise to conduct the conversation; • get the person’s attention before beginning to speak; • face the person when speaking to them; • state the subject matter up front;


• keep food, gum, and hands away from the mouth, so the patient can more easily speech-read;


• speak normally, perhaps slow down a fraction, don’t speak louder; • if the patient misses what is being said, repeat it in different words.


These rules sound simple but remembering them and using them consistently take practice. It takes effort by both parties to the conversation and, more importantly, assertiveness by the person with the hearing difficulty to ask for what they need. One problem with lip-reading is that only 30 to 40 percent of English sounds are readily visible on the lips. People who are deaf and hard-of-hearing report misunderstanding


VOICES FROM THE COMMUNITY: CROSS CULTURAL EXPRESSIONS OF GRIEF AT THE LOSS OF AN INFANT 61


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