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Deaf Professionals Exploration Paper

Brigid Bendig & Kayla Millan

Department of Occupational Therapy, Rush University

Sociocultural Aspects of Care

Dr. Linda Olson

1 April, 2022
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Deaf Professionals Exploration Paper

Although future healthcare professionals are receiving more education on culturally

effective care, there are still many healthcare providers that are not comfortable including culture

within their practices. Understanding an individual's culture is important in many professions;

however, it is extremely important in healthcare, as culture informs many aspects of an

individual's life. Culture involves values, language, traditions, and behaviors of an individual

(Olson, 2022). Therefore, it is vital that healthcare professionals, who inevitably work with

individuals from a variety of cultures, can provide culturally effective care. Providing this care

requires personal exploration and openness to accept differences, while expanding our

knowledge about cultures different from our own (Olson, 2022). While culture in practice is

becoming a more prominent focus of healthcare education, there are still cultures neglected in

the healthcare world and other professions.

One specific culture that is often neglected is the Deaf culture. Despite making up

roughly 5% of the world wide population, Deaf and hard of hearing (DHH) individuals still face

discrimination and disparities in their daily lives (WHO, 2021). In order to provide culturally

effective care to DHH individuals, one must first expand their knowledge of Deaf culture and the

Deaf community. An important aspect in understanding a DHH individual’s lived experience is

understanding their relationship with the Deaf community. In general, those who identify with

the Deaf community are individuals that ascribe to Deaf culture (NDC, 2019). These individuals

view themselves as a separate culture and as a linguistic minority, as they use American Sign

Language (ASL) to communicate (NDC, 2019). This communication style is very visually

descriptive and focuses on physical attributes of both surroundings and individuals (Wells et al.,

2016). DHH individuals may also use Pidgin sign, which uses ASL signs with English grammar
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or Signing Exact English which uses signs to directly translate English (Dynamic Language,

2022). Additionally, in order to interact with hearing individuals, many Deaf people have been

taught to read lips (Dynamic Language, 2022).

Individuals of the Deaf community refer to themselves as deaf or hard of hearing, as they

believe terminology like hearing impaired suggests there is something broken or that needs to be

fixed within the individual (NDC, 2019). Other common values, beliefs, and traditions within the

Deaf community are utilizing visual senses, forming connections and bonds within the

community, using technology to assist with access to information and communication,

promoting awareness of Deaf culture through the arts (music, literature, poetry, art, film etc.),

and specific communication strategies (NDC, 2019). Although the Deaf community is large and

growing in most big cities, it is important to remember that not all individuals who are DHH will

identify with the Deaf community (NDC, 2019).

Along with understanding the Deaf community’s contributions to Deaf culture, it is also

necessary to understand the lived experiences of DHH individuals. The lived experience of DHH

individuals is unique from any other cultural group. While each DHH individual has their own

journey, there are shared lived experiences that many DHH individuals can identify with,

creating the foundation of the culture and community. One major shared experience among DHH

individuals is known as dinner table syndrome. This terminology is used to describe what it is

like for a DHH individual to share a meal with hearing individuals (Listman & Kurz, 2020). This

scenario occurs when a DHH individual is excluded from table conversation because they

cannot actively participate in the same way (Listman & Kurz, 2020). Although this can occur in

any social situation, it is a common experience for a DHH child born into a hearing family.

Many DHH adults can still describe this experience and believe it significantly impacted their
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access to information and incidental learning opportunities, a common barrier for individuals in

the DHH community (Listman & Kurz, 2020). Therefore, being aware of this unique and

challenging lived experience is essential to understanding Deaf culture as a whole.

Another important lived experience is what it is like growing up deaf. While many DHH

individuals will have shared experiences from their childhood, there are also many factors that

can vary one’s childhood. Despite various differences, individuals who grew up DHH emphasize

the importance of family support. For some DHH individuals, they grew up in supportive

households, which means their families learned ASL, were involved in their education, provided

resources, and advocated for their DHH child (Listman & Kurz, 2020). Some parents even found

special ways to connect with their DHH child. For example, one individual described how his

parents would take him out to eat separately for quality time, as they realized large family

outings made it challenging for him to communicate and be involved (Listman & Kurz, 2020).

On the other hand, there are a majority of DHH individuals whose parents do not learn ASL or

struggle to involve their DHH child even when they know ASL (Listman & Kurz, 2020).This

creates a completely different experience, as these individuals often find their second family

within the Deaf community early on (Listman & Kurz, 2020). Therefore, acknowledging

experiences DHH individuals had growing up is extremely important, as these experiences

contribute to Deaf culture and the formation of the Deaf community.

Lastly, to better understand a culture, it is important to understand why the culture is

valuable. For DHH individuals, Deaf culture and community provides a second family, a place

where each individual, regardless of their background can feel a sense of belonging (Listman &

Kirz, 2020). The Deaf community not only provides support and resources for individuals but it

fosters relationships. For example, one individual described how the Deaf community was
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supportive through difficult and emotional times (Listman & Kurz, 2020). As stated by a DHH

individual, “the Deaf community is a powerful support network and I think it is a value in our

culture. We help each other a great deal” (Listman & Kurz, 2020 p. 245). This being said, we can

expand our knowledge of Deaf culture by combining our understanding of DHH individuals'

lived experiences and our understanding of their community.

Like any other culture, there are subgroups within Deaf culture that exist. These

subgroups identify with the culture as a whole but also have shared lived experiences specific to

their group. Deaf professionals is a subgroup within Deaf culture that share the experiences of

being DHH and a working professional. Although DHH individuals have adapted to working in

settings catered to the hearing, their work life experiences are still vastly different. One of the

main reasons it is different is due to needing interpreter representation within the workplace,

which affects their sense of self (Wells et al., 2016). While an ASL interpreter is necessary for

some DHH individuals to communicate and do their job, it can disrupt their sense of self and

their role in the conversation, as they are only “known in translation” to the hearing individual

(Young et al., 2019). Additionally, the need to rely on an interpreter at work, can impact the

DHH individuals ability to form relationships with their coworkers, as hearing individuals feel

that the interpreter impedes their ability to get to know their DHH coworker’s personality

(Young et al., 2019). Therefore, even when a DHH individual has the accommodations they need

at their workplace, their work environment may be unintentionally isolating. To further explore

Deaf culture we will focus on the lived experiences of Deaf professionals in the fields of film

and healthcare. There are many other professions we are not able to dive into in this short

ethnography; however, we chose to highlight films and healthcare given the recent Oscars and

increase in Deaf films and the COVID-19 Pandemic. We were able to collect data on these fields
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through reviewing past research, watching relevant films, conducting an interview, and reflecting

on past educational experiences.

Deaf Actors & Film

The portrayal of Deaf characters in film has shifted throughout the past century.

Unfortunately, it is common to hire hearing actors to portray Deaf characters, which leads to

misrepresentation (Lerner & Sayers, 2016). According to Lerner & Sayers (2016), there are few

films that include a Deaf main character and even fewer which portray Deaf communities or

Deaf relationships. Additionally, even when films do include ASL, the scenes are often cut in

such a way that the signs can not be seen (Murphy, 2017).

Common tropes which are often used in films with Deaf actors include the myth of

heightened sensory powers and Deaf individuals as symbols of isolation. Both of these tropes

spread misrepresentation about Deaf culture and deafness. They present sign language as an

inadequate language to form human connection and spread the inaccurate belief that Deaf

individuals have “heightened sensory perception” (Lerner & Sayers, 2016, p. 5 ). Sadly, even if a

Deaf actor is hired for a role in a film, the choices to use these or other tropes, or how the film is

edited is often out of their control. If more Deaf actors, directors, and producers, were hired in

Hollywood, more films that correctly depict the Deaf community would be made.

The Oscars

There was a huge breakthrough of Deaf films at the Oscars this year. Three films were

nominated for awards: “CODA,” “Audible,” and “Drive My Car” (Gelt, 2022). CODA received

awards for best adapted screenplay, actor in a supporting role, and picture (Academy of Motion

Picture Arts and Sciences, 2022). To gain a better understanding of Deaf actors and films, we

watched the Oscar winner CODA. The film is a moving story about a child of a Deaf adult
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(CODA) named Ruby (Heder, 2021). Ruby’s family (mother, father, and brother) are all Deaf

and she is hearing. Her family is the only Deaf family in town and she is expected to serve as an

interpreter for her parents (Heder, 2021). The scenes in which Ruby communicates with her

family are in ASL with English subtitles. Having seen few films portray ASL, it was incredible

to see the language come to life through the talented actors on the screen. Troy Kotsur, who won

the award for Best Actor in a Supporting Role, was the first Deaf actor to be nominated for an

Oscar since his CODA co-star Marlee Matlin who won in Best Actress in 1987 for her role in

“Children of a Lesser God” (Gelt, 2022).

It was interesting to witness how using ASL to act rather than English requires a different

set of skills. Troy stood out in the film in his role of Ruby’s father Frank by using his facial

expression and body language to bring his ASL to life. Especially at points where he was

discussing topics such as jock-itch or using condoms, he was extremely descriptive, painting a

picture with his motions and facial expressions rather than words (Heder, 2021). Even as viewers

with limited knowledge of ASL, we could see and feel his emotion.

The recognition CODA and other films received at the Oscars was a significant milestone

for the Deaf community, especially Deaf actors and film professionals. Supporting Actor winner

Troy Kostur had previously been recognized for his acting in the Deaf West Theater, with fellow

actors calling his sign language ''really creative and really beautiful” (Del Barco, 2021, p. 2).

Though this is not Kostur’s first role on screen, it is his biggest. Heder hopes that more writers

will begin writing roles for Deaf actors like Kostur but feels that they are “intimidated by having

a deaf cast or they don’t know how to make their sets accessible” and that by doing so “they’re

missing out on this brilliant performer” (Del Barco, 2021, p. 6). Hopefully, with a film like

CODA winning such an auspicious award like Best Picture, more writers, producers, and
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directors will begin creating films with Deaf actors in mind. Kostur’s co-star, Marlee Matlin,

stated that winning “validates that everyone is respecting our work as actors in every way” and

hopes that the win “opens the floodgates'' for more Deaf actors and movies to be produced in

Hollywood (Kindelan, 2022, p. 2). Doing so would spread more knowledge about Deaf culture to

the public.

Deaf Professionals in Healthcare

Healthcare Training & College

The second area we chose to focus on is Deaf professionals in healthcare. Although

“more than 15 percent of the general population experiences trouble with hearing loss, medical

students with hearing loss represented a mere 0.01 percent of United States medical school

graduates during the years 2001-2010” (Argenyi, 2016 p. 1050). This is most likely because the

process of matriculation into an institution of higher education, specifically medical school, is

not accessible for DHH individuals based on technical standard (TS) requirements (Argenyi,

2016). TS outline skills and abilities that an applicant or graduate must be capable of before

being able to matriculate into or graduate from the program. TS for medical schools often

include sensory and motor skills and other abilities that some believe are necessary for health

professionals (Angenyi, 2016). Although some medical schools have rewritten their TS or have

separate TS for DHH students, many schools do not. Therefore, “candidates with disabilities

might not be able to gauge whether a medical school will, in fact, be willing to allow them to

fulfill the technical standards using accommodations as intended by the ADA” (Argenyi, 2016 p.

1051). This alone can account for the underrepresentation of DHH professionals in the healthcare

field.
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As previously mentioned, one of the greatest barriers for the Deaf community is access to

knowledge and information. Unsurprisingly, this barrier also exists in educational settings as

“many academic medical centers lack the knowledge and expertise to support the effective

inclusion of this group in their institutions” (Hall et al., 2019). Additionally, many programs

utilize Ad Hoc interpreters, which are agency interpreters that come in to work with students and

staff on an as needed basis (Hall et al., 2019). While this accommodation seems fair and

efficient, DHH individuals “can spend 2 to 10 hours per week arranging their own

accommodations” (Hall et al., 2019 p. 2). Therefore, DHH students have a drastically different

lived experience within higher education, as they must advocate for themselves and waste extra

time making sure their accommodations are met so they can successfully learn.

In interviewing Laura Obara Gramer, a Deaf occupational therapist who graduated with

her Bachelor's degree from the University of Illinois at Chicago, she highlighted some of the

struggles she went through as a Deaf student. Laura said that she made her college decision

based on schools she knew were more accessible (L. Obara Gramer, personal communication,

March 16, 2022). She also said she wished captioning had existed in classrooms when she was in

school because she found it difficult at times to use a notetaker. She described it being strenuous

to use the service because everyone learns and takes notes differently and it was difficult to learn

from someone else’s notes (L. Obara Gramer, personal communication, March 16, 2022).

Deaf Healthcare Workers

Despite the barriers and challenges DHH individuals must overcome, many are able to

become successful healthcare professionals. The Rochester Institute of Technology (RIT)

publishes an online resource for the DHH individuals who are interested in entering the

healthcare field. Here they have information on different healthcare careers, what the job outlook
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is for them, and what kind of education you need to obtain to enter the field (RIT, n.d. a).

Additionally, the website has testimonials from both Deaf healthcare students and professionals

about their experiences in school and their career.

Kellye Nelson works as a nurse clinician at Johns Hopkins Hospital and a clinical

instructor at their nursing school (RIT, n.d. b). Nelson had to overcome barriers in her

educational career in order to get to where she is. She was able to attend mainstream schools

through high school with the use of her hearing aids and was the first Deaf student to attend

Spelman College. There, she had to advocate for herself to get the services and resources she

needed (RIT, n.d. b). Eventually, Nelson went on to obtain a master’s in public health as well as

a bachelor's in nursing (RIT, n.d. b). Today Nelson finds herself still educating her coworkers on

her disability, she says, “usually, people assume that I can’t do anything once they see the

hearing aids” (RIT, n.d., p.1b). However, she keeps a positive attitude and says most people are

receptive to learning and continuing to grow (RIT, n.d. b).

Dr. Scott Smith is another provider highlighted on the site. Dr. Smith is profoundly deaf

and has used sign-language interpreters his entire life (RIT, n.d. c). He received his medical

degree from Brody School of Medicine and then began his pediatric practice. Dr. Smith is able to

communicate with his patients, the vast majority of which were hearing, by using sign-language

interpreters (RIT, n.d. c), Smith says he has never had a negative interaction with a patient due to

his deafness and hopes that more Deaf individuals choose to go into the healthcare field in the

future (RIT, n.d. c). However, he says that there must be more funding and collaboration put

towards developing technology and improving interpretation services for Deaf healthcare

professionals (RIT, n.d. c).

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Laura shared that she also had to overcome difficulties working as a Deaf occupational

therapist. She said it was difficult to find internships that would accept her and she constantly

had to take extra steps to prove to employers that she could communicate with clients.

Additionally, she ran into some trouble with employers who did not provide her the

accommodations she had a right to under the Americans with Disabilities Act (L. Obara Gramer,

personal communication, March 16, 2022). Laura said that her favorite job was working on the

Deaf unit at Walter Reed Hospital in Chicago, where she could communicate with clients in

ASL. Finally, she shared that she felt her clients found joy working with her because she was

always looking at and facing them in order to read their lips (L. Obara Gramer, personal

communication, March 16, 2022).

Deaf Healthcare Workers and COVID-19

It is well known that the COVID-19 pandemic hit healthcare workers hard. From long,

demanding shifts to mental health crises, the past two years have been difficult for healthcare

workers across the globe. In addition to these struggles, Deaf healthcare workers have had to

endure many more.

One of the biggest issues Deaf healthcare workers still have to adapt to are masks. While

there are transparent mask options, they are not approved for use in the healthcare setting.

Additionally, while face shields or visors are widely available, they are also not protective

enough to prevent infection (Grote et al., 2021). One article published by Occupational Medicine

stated that the British government ordered 250,000 ClearMasks, however for a population of 11

million with hearing loss, this was extremely inadequate (Grote et al., 2021). Purchasing

transparent masks for Deaf healthcare providers was not a priority among healthcare institutions.

Even though 89% of Deaf providers felt that opaque masks made it difficult for them to
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communicate with patients (Mahase, 2021). Communication with colleagues became

increasingly difficult as well with providers reporting that some shouted at them while others

ignored them (Grote & Izagaren, 2020). The mask mandates denied the communication needs of

Deaf individuals, isolated them, and negatively impacted their mental health (Grote & Izagaren,

2020). Many providers felt more stressed at work after the introduction of masks due to

increased fear of making mistakes (Grote et al., 2021).

In addition to finding communication at work difficult, Deaf providers found it difficult

to advocate for their needs. A survey of Deaf providers in the UK found that 78% of respondents'

needs were not met by their employer and many were either working from home or moved out of

their patient interaction roles (Mahase, 2021). While some Deaf providers were given

occupational health assessments in order to make adaptations, 61% of respondents did not get the

adaptations or equipment they requested (Grote et al., 2021). In fact in some cases, providers

were left to fend for themselves. For example, Rosie Knowles, a Deaf provider who uses

lipreading to communicate stated in an interview that her “job became almost impossible” due to

the pandemic (Mahase, 2021, p. 1). While she was able to adapt and use telehealth, she had

extreme difficulty communicating over video due to poor internet connection (Mahase, 2021).

Knowles eventually applied for a grant to get a live captioner for her visits, but this took five

months (Mahase, 2021). In the meantime, she conducted visits outside so she and her patient

could remove their masks (Mahase, 2021). Knowles is not alone, doctors Helen Grote and Fizz

Izagaren also felt unsupported by their employers (2020). This lack of support, transparent

masks, and other communication equipment leads to a lack of independence and autonomy

among Deaf providers (Grote et al., 2021).

Deaf Interactions with Healthcare & Recommendations

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The Deaf community has been fighting for recognition for a long time, and Deaf

professions have overcome many barriers, especially in the film and healthcare fields. As

healthcare professionals, it is important to have an understanding of Deaf professional culture

because we will encounter Deaf individuals in our practice and possibly work with Deaf

colleagues. Given the Deaf community communicates in a variety of different forms,

communication is one of the most important things to consider when working with a client. It is

important to know that as a healthcare provider, you are expected, under the Americans with

Disabilities Act, to provide effective communication at your client’s request (for Deaf clients,

this is often interpretation services) (U.S. Department of Justice, 2014). While you may

frequently communicate with a Deaf client or coworker by using interpreter assistance, Laura

suggests it is alway important to ask your client how they would prefer to communicate with you

(L. Obara Gramer, personal communication, March 16, 2022).

Another important thing to consider as a healthcare professional is that the Deaf

community often experiences health inequities and adverse health outcomes at higher rates

compared to the hearing community. This includes “worse mental health, cardiovascular and

sexual health outcomes” (Malebranche et al., 2020 p. 1). Additionally, Deaf individuals often go

undiagnosed for conditions of high blood pressure and often have untreated “hypertension,

diabetes, hyperlipidaemia and cardiovascular disease” (Emond et al., 2015, p. 1). It has been

postulated that these outcomes are due to the Deaf community’s limited access to healthcare and

their difficulty interacting with hearing healthcare professionals (Emond et al., 2015). Even Deaf

professionals, who may be fluent in ASL, English, or both, may have difficulty communicating

with their providers. This is because of the language barrier which arises when seeking
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healthcare and the disturbing frequency at which healthcare providers deny their patients right to

effective communication (Hoglind, 2018).

Laura discussed the challenges she faces when making appointments and working with

healthcare staff who are not her provider. Additionally, she mentioned it can be difficult to

schedule with an interpreter because they have busy schedules (L. Obara Gramer, personal

communication, March 16, 2022). Finally, Laura mentioned a concern which we had not read

about in the literature; interpreters who are bad at their job. She has had several experiences with

new interpreters where they were interpreting poorly and interpreters who interpret too quickly.

As a result, Laura has learned which interpreters she prefers and now requests them whenever

she is able (L. Obara Gramer, personal communication, March 16, 2022).

Additionally, health literacy is an issue among the Deaf community. In fact, Deaf

highschool graduates often read at only a fourth grade level (Pollard et al., 2009). However, this

is an issue among educated Deaf individuals as well (Hoglind, 2018). Health materials, rather

than being published in English and distributed to Deaf clients, should be developed with the

Deaf community in mind. One way to do this is to develop a script about the health issue at hand

with Deaf writers and utilize Deaf, ASL speaking actors in health films (Pollard et al., 2009).

Doing so increases “the effectiveness and relevance” of the health materials for the Deaf

audience (Pollard et al., 2009, p. 237). Healthcare providers should also use the teach back

method when disseminating information to their clients in order to ensure their understanding

(Naseribooriabadi et al., 2016).

To improve Deaf healthcare, healthcare students must learn about the Deaf experience

and culture. Currently, there are limited curriculums in healthcare programs that introduce Deaf

culture and community. A study conducted in Germany found that 65.3% of medical students
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had no experience with a DHH individual (Kruse et al., 2021). Prior to participating in a Deaf

educational workshop, the medical students “did not indicate even basic knowledge of how to

successfully communicate with deaf and hard of hearing patients” (Kruse et al., 2021, p. 5).

Additionally, after the workshop, 73.7% of participants found that the topic was relevant for

medical students (Kruse et al., 2021). While medical students view this topic as important, they

have to seek education outside of their curriculum to learn about it. Laura also agreed that

healthcare students should be introduced to Deaf culture and disability during their studies in

order to provide culturally humble care to their clients (L. Obara Gramer, personal

communication, March 16, 2022). Another way to improve Deaf healthcare is to increase the

number of Deaf providers who can communicate directly with Deaf patients. This can be done

through the use of designated interpreters, who work directly for the organization, rather than

utilizing outside agencies (Hall et al., 2020). Designated interpreters are properly trained for the

medical field and after a trial period, are matched with a professional who they work well with

(Hall et al., 2020). This approach to interpretation services can not only improve interpreter-

provider relationships but colleague relationships as well (Hall et al., 2020). Introducing such a

program may also help students during their academic career as well.

One way that we as healthcare students can begin this education is to take an ASL class

from a Deaf individual, Deaf cultural center or Deaf organization. I (Brigid) have been enrolled

in ASL classes at the Center on Deafness in Northbrook, IL for the past few seasons. I am able to

take this course because I work with a Deaf client at my job and my employer supports my desire

to be able to communicate with him in his native language. This course is the first time I have

had a Deaf teacher and it has greatly enhanced my educational experience to learn from a

member of the community. My teacher has provided insight into growing up in the mainstream
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school system as a Deaf student, his experience learning to speak, how he taught himself ASL

after years of almost exclusively speaking English, and his exploration of the Deaf community. I

have also learned colloquial signs and phrases that I could not have learned from a textbook.

Additionally, my client, Adam (pseudonym), has also taught me many signs on the job. Our

communication has come a long way in the past few months as I further develop my skills and

Adam gets more comfortable signing with me. Even with my limited signing capacity, Adam and

I have been able to develop a wonderful working relationship, which goes to show that putting in

the effort can go a long way with your client.

Through this short ethnography, we have expanded our knowledge of the Deaf culture,

Deaf community, and Deaf professionals. As occupational therapy students, it is our

responsibility to continue to learn about various cultures to provide client centered, culturally

effective care. This is only possible if we work to understand our client’s identity and culture.

While we have discussed the Deaf culture in a broad sense and touched on the unique subgroup

of Deaf professionals, it is important to remember each individual has their own lived

experiences that should be valued. Whether treating a DHH client or working alongside our

DHH professionals, we must remember to not speak for, but advocate with these individuals so

that their needs can be met. Despite the obstacles faced by the Deaf community, these

individuals continue to bring awareness to Deaf culture in many ways. Whether it be working in

healthcare during the pandemic, accepting an Oscar, or simply using ASL in their daily lives we

hope Deaf culture and the Deaf community continues to receive the recognition it deserves.
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