Woman with long brown hair, wearing a gray shirt
Asal Bastani is a third- year student at the University of California, Los Angeles (UCLA), who aspires to become a physician-advocate in the future to help create equitable healthcare for marginalized communities. She is currently involved in researching the medical examiner-coroner system in relation to keeping police officers accountable for their actions in cases of police-related fatalities.  She is also a writer for Neurodiversity Health Chats lead by the UC-LEND project, which aims to decrease vaccine hesitancy in the neurodiverse community.

As COVID-19 safety mandates swept the U.S., 48 million individuals who are Deaf and hard of hearing faced a sharp increase in communication barriers. Mask mandates and social distancing made communicate via hearing aids, lip reading, and understanding social cues incredibly difficult.

But even before the pandemic, people with hearing loss already faced significant healthcare disparities that stemmed from factors such as insufficient access to medical outreach programs and lack of communication resources in healthcare settings. With the COVID-19 pandemic, accommodating the hearing loss community has severely decreased in priority, thus further exploiting health disparities. 

To learn more, I interviewed Zina Jawadi for Neurodiversity Health Chats, an AUCD-CDC-funded project, currently focusing on understanding and increasing vaccine confidence in neurodiverse communities. Jawadi is a UCLA medical student with hearing loss who uses her personal experiences to advocate for the hearing loss community, most notably, through her position with the Hearing Loss Association of America Board of Directors and with the UCLA DGSOM Disability and Chronic Illness Student Organization.

Jawadi highlights that the pandemic was a particularly isolating experience for people with hearing loss. A study by Cochlear Limited and the Hearing Loss Association of America (HLAA) identified that 67% of those affected by hearing loss had feelings of anxiety from communication barriers amplified by the pandemic. Notably, 95% of the hearing loss community reported that face covers inhibited their ability to communicate with others and 89% reported experiencing communication inaccessibility, including not having closed captions on digital platforms. 

This lack of prioritization in accommodating those with hearing loss caused a great decline in the quality of civic life in the hearing loss community. One example is lack of high-quality captioning in online meetings that has made it difficult to catch social cues and communicate with others. With this, essential services such as healthcare, that were being offered exclusively through online platforms, became widely inaccessible. Jawadi mentions that the popular online meeting platform, Zoom, did not have accessible closed captioning available until recently, despite persistent attempts amongst advocates to contact the company officials and petition for this service.

The good news is that the pandemic brought this issue to light and put pressure on online platforms to respond to such basic requests. After nearly 2 years of persistent advocacy on behalf of HLAA the Zoom platform finally made closed captioning free and available for all users in the fall of 2021, more than a year into the pandemic. But the closed captioning and transcription feature on Zoom can be considerably unintuitive to enable and use, in which Jawadi says she often has to guide others in using the feature.

Another example of the challenges experienced by the hearing loss community during the pandemic is in-person communication being barred by opaque face masks. The hearing loss community often relies on lip reading to understand verbal communication. Jawadi recalls recently seeing a patient in her clerkship who had obvious hearing loss, but the physician who was caring for her was oblivious to the fact. Opaque face masks make it impossible to lip read. For this reason, Jawadi is a strong promoter of normalizing clear facial masks. However, face masks with clear windows are notably much more expensive and inaccessible than ordinary opaque face masks, making them less readily available for widespread, public use.

Compounding communication inaccessibility in healthcare, medical professionals are rarely trained to accommodate for hearing loss. Hearing loss is an invisible disability: one of many physical, mental, or emotional impairments that go largely unnoticed. Thus, individuals with hearing loss are often not accommodated in clinical settings. For example, Jawadi notes that many people with hearing loss face accessibility challenges in vaccination clinics, with a lack of visual cues to guide patients through crowded and hectic COVID-19 vaccination clinics. She states that even a paper map of the patient route would help immensely for those who cannot hear verbal cues. During the pandemic, the popularity of communication accommodations for those with hearing loss has unfortunately declined in healthcare settings, making critical procedures, such as getting a COVID-19 vaccination an inaccessible experience.

Based on the research and my conversation with Zina Jawadi, I recommend the following for healthcare providers to increase communication accessibility for the Deaf and hard of hearing community: 

  1. Implement a digital board: Jawadi suggests that rather than calling the patients’ names to enter the doctor’s office, it is more accessible to use a digital calling board that visually cues patients when it is their turn by displaying their assigned number.
  2. Provide clear face masks: With the current mask mandates creating significant communication barriers, it is critical to provide alternative communication technology to those with hearing loss, including the use of clear masks and live transcription programs.
  3. Activate automatic captions in Zoom meetings: As the use of online meetings grows in popularity, it is essential to use platforms that provide free transcription and live closed captioning to make online communications accessible.
  4. Train doctors: Healthcare professionals need to be urgently trained to be cognizant of the hearing loss community when devising communication systems in healthcare. As the future of healthcare is being designed in medical school education, it is necessary for medical schools to train their future doctors with curricula to improve the attitude and knowledge of hearing loss in future healthcare workers. 

The focus on improving and educating the general population on how to accommodate those with hearing loss is pinnacle in creating an equitable society and improving the quality of life in the hearing loss community.