Images of pregnant women in the last throes of labor filled the projection screen, and sounds of childbirth--moans of pain, barked orders of "push!" and the wail of a newborn baby--flooded the room filled with expectant couples.
Sheri and Emilio Fernandez, like the other couples, watched the intense film with rapt attention, but for them it was a silent movie.
The Fernandezes, who are deaf, shifted their eyes between the screen and the ever-moving hands of a woman sitting in front of them, translating the powerful sounds into sign language.
When the film showed a nurse putting a stethoscope on a pregnant woman's abdomen, the pulse of the fetal heartbeat was translated into a beating motion over the ear. "Push!" became a hand-on-fist pushing gesture. The infant's cry was translated into fingers tracing tears down a face contorted with a silent wail.
"Forget the whole thing, I don't want to do this!" Sheri Fernandez, 21, jokingly gestured in sign language to interpreter Alicia Speare as a woman on screen panted her way through a painful contraction.
To Understand Everything
But the truth is, the Fernandezes are thrilled to learn natural childbirth and prepare for their baby, due Aug. 24. With natural childbirth, communication among the expectant mother, labor coach, physician and nurses is imperative, and if expectant parents cannot hear, then fear, frustration and miscommunication reign, Speare said.
The Fernandezes, though, will understand everything that is said, from the onset of labor until mother and child are wheeled out the door of Chapman General Hospital in Orange, thanks to Speare's unusual program, which provides interpreters for deaf patients.
Special Task Interpreters for the Deaf (STID) provides interpreters for hearing-impaired patients for all medical procedures at Chapman General Hospital and for appointments with staff physicians. It is the only hospital-sponsored program for the deaf in the county--which has about 230,000 people, or one-tenth the population, who experience some degree of hearing difficulty--and one of the most comprehensive programs in the nation, Speare said.
Health care is a particularly difficult issue for the deaf, advocates for the deaf said. There is a lower level of awareness of health care among the deaf, advocates said, because so much medical information comes through the media, and anything transmitted over the radio or television is lost to them. And if the information is written, "they have to see it the same number of times as a hearing person hears it, (for it) to have the same impact," said Johanna Larson, a community educator with Orange County Deaf Equal Access Foundation (DEAF).
The deaf are unfamiliar with many medical or anatomical words that might be used during a doctor's visit, Speare said. English, to a deaf person, is a second language, and many words--such as abdomen or cyst--may not exist in the deaf person's sign language.
When deaf patients go to the doctor, "they have no idea what will happen," said Pauline Annarino, director of Life Signs, an emergency sign language interpreter service in Los Angeles County.
"They have no basis for deciding what is right or wrong, for knowing when to say, 'Stop doing that.' They can't anticipate anything," Annarino said. "Compound that with the problem that they can't get any clarification; they can't ask: 'Is this going to hurt? How many times do I take the medication? When do I come back?' "
It is estimated that 80 to 90% of a doctor's diagnosis is based on the interchange between physician and patient, deaf advocates said. True, the doctor and deaf patient can communicate through notes, they said, but that is a long, tedious process that discourages full communication. Beside, doctors are not known for legible handwriting.
Some deaf patients will take a relative with them to interpret, but that undermines the independence of the deaf person, advocates said. Relatives will often edit what the doctor says if the condition is sensitive or embarrassing, or they become privy to information that the patient alone should have, they said. And even the best lip readers miss about 70% of what is said. advocates said.
Always at Hand
Under Speare's program at Chapman, an interpreter accompanies a deaf patient through tests, examinations, physical therapy sessions, childbirth preparation classes, labor and delivery or any other medical procedure requested, as long as it is connected with the hospital or its staff. If a deaf patient comes to Chapman General's emergency room, an interpreter is called, no matter the hour. The same interpreter stays with the patient for subsequent appointments and procedures to develop trust and rapport during intimate examinations, Speare said.
Even the operating room is not off-limits. The interpreter stays with the deaf patient through the entire surgical procedure if local anesthesia is used, translating everything that is said.
"If the doctors tell a joke, we transmit the joke," Speare said. "The doctors have learned . . . not to say anything they don't want the patient to hear."
If general anesthesia is used, the interpreter stays in the operating room until the patient loses consciousness, and when the patient awakes in the recovery room, the first face he or she sees is the interpreter's.
During stays at Chapman, deaf patients are provided closed-captioned television, and TDD's (Telephone Devices for the Deaf) are connected to phones. The patient's deafness is written on the charts, wristband and even on a sign over the bed so that all hospital workers know not to attempt to communicate by speech.
For Mabel Giambaresi of Cypress, deaf since birth 61 years ago, the special services during her bladder surgery several months ago at Chapman were so gratifying, "I'm really anxious for more surgery," she said, her eyes brimming with emotion.
"I never felt so comfortable, with so much peace of mind. I understood everything that was going on," she said. "When I woke up from surgery, it was such a comfort to see Alicia standing there."
She remembered a totally different experience, during gall bladder surgery about eight years ago. Giambaresi, who was taught to speak by her deaf parents, recalled that her glasses and dentures had been removed for the operation, and her hands and arms were immobilized by intravenous tubes.
When Giambaresi awoke from the surgery, a nurse was "nice enough" to write a note to her. But without her glasses, she could not read; without her dentures, she couldn't tell the nurse she needed her glasses; with her hands and arms full of tubes, she could not even gesture.
"I got the feeling that she (the nurse) thought: 'That stupid girl can't even read.' I tried to tell her, but I couldn't," Giambaresi said.
Her mother had a more horrible experience during cataract surgery, she said. Proud of her ability to read lips, her mother never asked her physician to write notes, Giambaresi said. Her doctor had told her mother in the operating room to not move, and her mother thought he meant to remain motionless during the surgery. Unknown to her, he had meant she must remain completely still after the surgery, or her eyes could be damaged.
Back in the hospital room with her daughter after surgery, her mother was so happy to have the surgery behind her that the two enthusiastically conversed with each other, her mother moving all about, Giambaresi recalled.
The next day, when Giambaresi returned to the hospital, she saw her mother had both eyes bandaged. A nurse curtly told Giambaresi that the doctor had ordered her mother to remain completely still, and now because she had disregarded the order, she possibly was going to lose her vision, Giambaresi recalled.
"I got so angry when I found out," Giambaresi said. The doctor should have made certain, through a note or through communication with the family that the crucial information was understood, she said. "That was a big mistake that doctor made." Fortunately, fears that her mother would lose her vision were unrealized.
Other examples of miscommunication between doctor and patient spurred Speare to begin her fight for a hospital-sponsored program for the deaf about five years ago. A free-lance sign-language interpreter at the time, she began to get called to doctors' offices by deaf patients and "realized there was such a need. People were going away from doctors' offices with a prescription and not understanding . . . what their diagnosis or prognosis was," she said.
For two years, Speare approached hospitals with her proposal to provide interpreters and other amenities but was repeatedly turned down.
She finally sold the idea to Chapman General Hospital in 1983 but only after agreeing to work one year for free. If the program was a success, then a retainer would be discussed. Initially, the program was limited to obstetrics, but after half a year, she was receiving so many other requests from the emergency room, for surgery and for other medical procedures, "I couldn't turn them down." At six months, she was granted a retainer--$200 a month. It has been augmented since then, she said.
Her patient load has grown from one or two a month to 25 to 35 patients a month, which she handles with the help of another interpreter, she said. It continues to grow as patients from outlying areas as far as Northridge and Riverside learn of the program and change physicians, she said.
Giambaresi said she had been going to UCI Medical Center for five years before switching her to Chapman. Although satisfied with her care at the medical center, she had grown tired of losing her resident doctor to graduation at just about the time that she had finally worked out a communication system with him, she said. In addition, she said, there were times when she would sit in the waiting room for entire mornings and afternoons because she couldn't hear the nurses call her name for her appointment--despite the fact that she had told the receptionist that she was deaf.
Once, so frustrated with the situation and the waste of time, she grabbed her chart and a big red felt marker and wrote "TOTALLY DEAF" on the chart cover so the staff would know next time. "Believe it or not, even that didn't work," she said.
Accompanied by Speare, deaf patient Karyn Ayala, 18, of Fountain Valley, had no such problems when she sought treatment recently for a persistent sore throat from her physician, Dr. Ronald D. Turner, at Chapman Medical Plaza in Orange. Assisted by Speare's signing, the physician quickly asked Ayala several questions about her symptoms, checked her breathing with a stethoscope, took a throat culture and advised her to treat the pain with aspirin and cool drinks and to watch for signs of fever.
For Ayala, who will return to Cal State Northridge as a sophomore this fall, having an interpreter wins hands down over her old system, which was to bring a family member to her doctor's appointments.
"The doctor would talk to my mom," who wouldn't immediately interpret but would promise to tell her daughter everything later, Ayala said. "Then, when we would leave, my mom would forget what the doctor said." Her mom would remember the basics, but "nothing in depth. I prefer to know everything the doctor says."
Aside from Chapman's program, there are few other services for deaf patients in Southern California, which has the largest deaf population in the nation. UCLA Medical Center has two interpreters who handle about 250 patients a month, primarily for outpatient appointments, tests and surgery on the facility's grounds. The Greater Los Angeles Council on Deafness will refer clients to free-lance interpreters upon request, and Orange County DEAF has recently received money to provide medical interpreters for emergency medical situations.