Characteristics of Study Participants
These results represent the experiences of the 22 individuals (12 females and 10 males) who are DHH in Botswana when accessing healthcare services. The age of the respondents interviewed ranged between 18 to 40 years and the mean age was 29 years. Majority of the respondents were teachers (13), 2 cleaners, 2 students, 2 gardeners, 2 hotel porters and I child caretaker. 10 respondents had attained Junior level of education, 4 senior level, 2 vocational and 4 tertiary level of education. 4 respondents were interviewed in Tati and 18 in Francistown.
Four themes were derived from the data collected and these are; Quality of healthcare services; Barriers to healthcare access; Utilisation of healthcare services; and Recommendations (Table 1).
Themes derived from the data collected
Experiences of individuals who are DHH
1. Quality of healthcare services
• Treatments and medications
• Maternal services
• Counselling services
2. Barriers to healthcare services
• Distance to see a specialist
• Communication barrier
• Privacy and confidentiality
• Lack of health information
3. Utilisation of healthcare services
• Provision of interpreters
• Provision of health promotion and education to individuals who are DHH
• Provision of HIV testing centres for individuals who are DHH
Quality Of Healthcare Services
In relation to medications and treatment offered in healthcare centres, majority of the participants raised a concern that they are not given the best healthcare services as many of them indicated that they are given medications without any explanation of how to use them. However, they appreciated the instructions that are on the medication containers as they have pictures and some writings on them hence, they can read and understand how to take the medications. Some of the participants stated that healthcare personnel perform some medical procedures on them without any explanation of why they are carrying out those procedures as per the below comment:
“I do not like injections and being put on drips because they do not tell me why they put those things on me, they just put them or inject me. I hate it when doctors just do things on me without telling me why.” (Female, 27)
One of the respondent was worried that he does not trust the medical prescriptions that he is given as he felt that the communication between them and the healthcare workers is so poor that they just prescribe medications without a clear understanding of what they are suffering from as shown by the comment below:
“Sometimes they give me wrong medication because communication will be so small, so sometimes they don’t understand at all. I will be trying to explain deep what I am suffering from and they will be understanding only few...the doctor does not write anything for me to read, most times it’s only me writing while he reads.” (Male, 37)
When explaining their pregnancy and birth giving experiences at the hospital, majority of female participants who had given birth had received poor sexual reproductive health services from the healthcare professionals. The only antenatal care that they are given at the healthcare centres is the checking of their health and that of the baby through tests and ultrasound scans. When it comes to how they are supposed to care for themselves and the baby during and after pregnancy, no information is shared with them. This was stipulated in the comment below:
“When giving birth the doctor will be showing me what I should do (sarcastically imitating breathing exercises told to do by doctors) and I will be just copying...They show me the needle and show that they are going to stitch me. They do not teach me how to care for the stitches…My mother taught me everything when I got home” (Female, 37)
However, one female participant stated that the use of pictures is helpful during child delivery as she was able see what is expected of her in the delivery room.
Individuals who are DHH have no access to counselling services in the healthcare centres in Botswana. Most of participants, except one participant did not know that there are Social workers and psychologists who offer counselling in the healthcare centres, rather they used doctors who offered lay counselling. None of the respondents who mentioned having acquired counselling from the doctors were referred to a professional counsellor. The following comment by a participant shows this dissatisfaction:
“I always tell the doctor when I am at the hospital that I have stress and the doctor will say, “sorry you will be okay” then I will go home…..No, I have never been referred to a Social worker, I always talk with a doctor…..Yes, I will have went because I was stressed and the doctor did not help. He just said I will be okay.” (Female, 27)
Barriers To Healthcare Access
All the participants had stated that healthcare facilities are available in the areas that they are in and are within reach as they are a walking distance. Even though that is the case, four participants who need to see an audiologist on yearly basis complained that the audiologist is in Gaborone (capital city, which is 435kms from Francistown). The following statement was made by the participant:
“…in Francistown, there is no audiologist, we always have to go to Gaborone for the audiologist…We are Deaf, we sometimes need to see an audiologist…it is very hard for us because we have to pay bus fare, and where are we going to sleep in Gaborone, so it is a problem. What are you going to eat? We are going to be poor.” (Male, 37)
All the participants had stated that the doctors fail to communicate with them when they seek their services. Most of the doctors resort to assisting individuals who are DHH through written communication, which majority of the respondents in this study had stated that they did not fully understand. As much as the healthcare service providers are unable to communicate with DHH population, individuals who are DHH had observed that when they are assisted by the same doctor many times, the communication between them and that doctor improves. However, after establishing this level of understanding with the doctor, the doctor will be moved somewhere else and they must go through the same communication challenge again with the new doctor as highlighted in the following comment:
“There will be an old doctor who understand and communication is better but when the new person comes, communication becomes hard. If only one doctor helps us, it will be easy to communicate.” (Male, 33)
Majority of the participants indicated that at times they are accompanied by a friend or family member when seeking healthcare services. Most of the participants except three participants have no problem with having a third party in the consultation room. However, in relation to HIV/AIDS testing, majority of the respondents do not want a third person in the testing room for confidentiality reasons hence, they had shown disappointment concerning the closure of the HIV/AIDS testing centres that were specifically meant for individuals who are DHH. As shared in the sentiment below:
“Before, HIV testing centres for the Deaf were there, we were happy because we had testing services in Francistown. We celebrated its opening and now that it is closed, we do not know why?... In some of the things that are secretive like HIV/AIDS testing, I want only the person who is testing me not a third person, so if there is a need to call someone to help with communication, I will not go and test.” (Male, 37)
Majority of the participants complained about not being educated about health issues at the hospital or clinics as it is the case with the hearing population. For instance, of all the participants interviewed, only five respondents (1male and 4females) knew about other methods of pregnancy prevention while the rest only knew about the use of a condom. However, the respondents accredited schools and Botswana Association of the Deaf (BOAD) for health information.
“We do not know about sexual things while the language people know. The doctors have never taught me about pregnancy. The people who can hear get information about pregnancy prevention because they speak the same language as the doctors but with us the Deaf, we use sign language and the doctors do not know sign language, so I was never taught about pregnancy prevention methods. I only knew after I had my child.” (Female, 37)
When explaining about the type of health education they receive from BOAD and schools, HIV/AIDS, cancer and healthy living (healthy eating and exercising) were the only examples that the participants mentioned. It was stated that BOAD host educational workshops for individuals who are DHH once a year.
Despite all these challenges, majority of the participants except three stated that they utilise healthcare services as it is better to seek help than being home while one is sick. The following sentiment was shared by one of the participants:
“When I am sick, I go to the hospital because I have no choice. What if I do not go because of no communication and stay home and die? Its better I go to the hospital and try using signs. I respect the doctors and I am open to them about my sickness.” (Male, 37)
Utilisation Of Health Care Services
Despite the poor services and the barriers that individuals who are DHH are faced with when accessing healthcare services, individuals who are DHH always visit the hospital to seek health services when they are sick. Individuals who are DHH had shown some resilience and determination towards living healthy lives and get help no matter how little it is from the healthcare services.
When I am sick, I go to the hospital because I have no choice. What if I do not go because of no communication and stay home and die? Its better I go to the hospital and try using signs. I respect the doctors and I am open to them about my sickness – Male, 37
Only three participants mentioned that they are at times demotivated to seek healthcare services because of lack of communication and privacy.
Many participants suggested that they be provided with interpreters in the hospitals however, some participants felt that it is best if healthcare providers can communicate using sign language as this will make things easy for them. One of the participants mention that:
“If we have an interpreter, they may spread our secrets. Therefore, the doctors should learn sign language so that we communicate directly with them as they do with those who speak.” (Male, 26)
In relation to health education, majority of the participants had shown interest in being taught about health issues. They want to be well informed about sexual reproductive health and what is expected of them during pregnancy. One of the participants suggested visualised method of education about pregnancy and giving birth as this will be easier for them to understand what happens when one gives birth. Seven out of 12 female respondents had children.
“There are no teachings about giving birth and what to do when pregnant for the Deaf. If there were videos that show what happens when one is pregnant and what they are supposed to do when giving birth and after giving birth, it will be better as we will be able to learn.” (Female, 37)
Majority of the participants recommended the re-opening of HIV/AIDS testing centres that have sign language interpreters. They indicated that they benefited a lot from the HIV/AIDS testing centre that was opened specifically for them as they were able to communicate with the service providers without any barrier and they were offered HIV/AIDS information.
“We used to have an HIV testing centre for the Deaf and it has been closed. The government should open it again.” (Female, 23)