Decmeber 14, 2001
This past summer I went for my annual eye exam and while I was sitting there I began to wonder how one would interpret in such a situation. The more I thought about the setting, the more interested I became in the logistics and overall difficulties that the setting may present. Also, I began to think about how important an eye exam of any kind must be to a Deaf person, since a Deaf person sees the world through their eyes and cannot rely on their ears like hearing people do. It is for these reasons that I chose to give my presentation on an annual eye exam. This paper will be divided into two basic sections, not unlike my presentation: a walkthrough of an eye exam without an interpreter and a walkthrough of an eye exam with an interpreter. In addition, I have included a short glossary of medical terms used throughout this paper.
Before the walkthrough of an exam without an interpreter I would like to mention a bit about how I conducted my research. I initially began by learning about a standard eye exam and had intended on interviewing my eye doctor, however, that did not work out due to our conflicting schedules. Therefore, most of my research on the eye exam itself was gained through the internet (http://my.webmd.com/content/asset/adam_ test _eye_exam-standard). Once I learned about the exam, I interviewed Robert Lee since I knew he had experience with medical interpreting (. He provided me with a great deal of information regarding the logistics and possible ways to alleviate any problems that may arise during an annual eye exam.
An eye exam, along with most medical appointments, typically begins with paperwork. If it is the patient's first appointment with a doctor, there will probably be some forms that need to be filled with the patient's general medical information, such as history of diseases or conditions of the eye, medications the patient is currently taking, and the patient's family history to name a few.
After much waiting, the technician will call the patient in and will perform a number of tests on the patient. Most often the technician will begin by asking if the patient is having any problems with their eyes or sight. Next, if the patient wears glasses, the technician will put the patient's glasses in a machine that reads the prescription in order for the technician as well as the doctor to get an idea of the patient's vision. Then it is time for the vision test, which is most often performed by the patient reading an eye chart with each eye individually and both eyes with and without glasses or contact lenses. The technician also tests the patient's perception, which is done utilizing pictures. There a typically a few of the same picture on a page and the patient has to pick out which picture "pops out" at them and seems closest to them as well as which picture seems the furthest away. Another test where pictures are used is the color blindness test. The test consists of colored dots arranged in a circle with a number in the center. The patient is presented with a number of these circles and asked what number they see in the circle.
Next is everyone's favorite: the glaucoma test. The test commonly consists of the patient sitting in front of a machine that sends a puff of air into each eye. This air puff test is sometimes used in conjunction with the same eye drops used sometimes during an ophthalmascopy, which allows for examination of more of the interior of the eye. It is important that patient's receive this test because it can lead to blindness.
After these tests, the patient typically goes back to the waiting room to wait for the eye doctor. When the eye doctor is ready to see the patient, the patient is brought into the examining room. This room can be small and has many machines in it.
The eye doctor may ask the patient some questions about their medical history and whether the patient has been having problems with their eyes or sight. The doctor will then test the patient's peripheral vision and eye movement by asking the patient to "follow my finger". Again, the patient will be asked to read the eye chart without their corrective lenses (if they use them) to test the patient's visual acuity. Depending on the outcome of the visual acuity test, the doctor may then perform the refraction test.
The refraction test is one in which the patient looks through a special device called a refractor. The refractor contains lenses of different strengths that can be moved into the patient's view. The doctor will ask the patient "which is better, one or two". After the lenses have been chosen, the patient reads the eye chart. It is through this test that the doctor can determine whether the patient needs corrective lenses for both those that have trouble seeing near and far.
Next, the doctor will perform a test called an ophthalmoscopy. This test enables the doctor can check for many diseases of the eye. The doctor will examine the patient's eyes using an ophthalmoscope, which is an instrument that allows the doctor examine the inside as well as the outside of the eye. It is essentially an illuminated microscope that consists of a mirror and reflects light into the eye and a central hole through which the eye is examined. Occasionally, the doctor will use eye drops to dilate the pupil during this test, which enables the doctor to view more of the eye. If the drops are used, this test is typically the last test performed since the patient's vision will be blurred and sunlight can damage their eye.
This ordinarily concludes an annual eye exam. Without an interpreter, an eye exam can move along quickly, however once an interpreter is brought into the situation, many dilemmas can arise. Before I raise some of these issues, it should be mentioned again that since Deaf people see the world through their eyes, the Deaf person would most likely have a different perspective on an annual exam. What we, as hearing people, consider to be just our yearly eye appointment, the Deaf person may feel anxious or concerned about whether the doctor may find a problem with their eyes. That being said let us take a look at what an eye exam would look like with an interpreter.
Here in Massachusetts, interpreters are most often contacted by the Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH) about a job. This is the case if the hospital, clinic or doctor's office where the appointment will be taking place does not have an on-staff interpreter. When the interpreter is contacted by MCDHH, they will ask a number of questions about the assignment. Such questions include: Where? When? Who is the Deaf person? What kind of signing style does the Deaf person use? What type of appointment is it? Is this the first time the Deaf person is seeing the doctor? Once such questions are answered and the interpreter has accepted the job, they will discuss their fee with MCDHH. There is no need for the interpreter to contact the doctor's office unless a problem arises.
On the day of the appointment, it is generally a good idea for the interpreter to arrive a half-hour before the scheduled time. This half-hour gives the interpreter the time to establish rapport with the Deaf person, since trust between the participants will help the interaction to go more smoothly. This time also allows the interpreter to become familiar with the Deaf person's signing style. If this is the Deaf person's first appointment with a particular doctor, the interpreter should be prepared to do some sight translation of any medical information forms.
As with any type of doctor's appointment, there will be a great deal of time spent in the waiting room and the interpreter should be prepared for this. When in the waiting room, the interpreter should follow the Deaf person's lead. If the Deaf person decides to read a magazine, it is ok for the interpreter to do the same. Robert Lee mentioned that in general, older Deaf people would be more apt to strike up a conversation, so the interpreter should be prepared for this.
Eventually, the technician will call the patient in for the tests that were mentioned above (visual acuity test, perception, color blindness, etc.). Before any tests are administered, it is a good idea for the interpreter to ask the technician if they have worked with a Deaf person and interpreter before. If the technician has not had this experience, the interpreter should inform the Deaf patient and allow them to make a decision as far as who they want instructions for each test to be given. If the technician has not worked with a Deaf person and interpreter before, it is allowable for the interpreter to make a suggestion that instructions be given prior to each test. This would mean that the interpreter would be consecutive interpreting before the event occurs. For example, the technician would give instructions for the glaucoma test to the Deaf person before the test is administered. For the glaucoma test, since the Deaf person would be looking through a machine and would be unable to look at the interpreter at the same time, it would be helpful if a system was setup by the technician and the Deaf person. For instance, before the test, the technician could ask the Deaf person to look straight through the machine at the red light and the technician will perform the test (the air puff) on the right eye, tap the Deaf person's hand, and then perform the test on the left eye. This way, the Deaf person is informed about what is happening.
After the technician performs the tests, the interpreter and Deaf person will most likely go back to the waiting room. Again, the interpreter should follow the Deaf person's lead as far as behavior in the waiting room.
Eventually, the Deaf person will be called in to see the doctor in the exam room. The interpreter should do as they did with the technician, ask the doctor if they have worked with a Deaf person and interpreter before. Again, the interpreter should leave the final decision as to how directions should be given up to Deaf person, but can make a suggestion that they be given before the event occurs.
The doctor will most likely look over the Deaf person's medical history and may ask questions regarding their medical history or whether they are having any problems with their eyes or sight. The interpreter should be prepared for the doctor to ask questions such as, "do you have any other health problems besides your hearing impairment?" The interpreter ought to understand that eye doctors have a pathological view of the Deaf community because they are specialists. This view is obviously much different than the view that interpreters or Deaf people have. If the interpreter is prepared for such questions and has possibly given some thought as to how they would interpret such questions, it will be much easier to convey the message to the Deaf person. In addition, Robert Lee mentioned that when such questions are asked, the interpreter should not "sugar coat" the question when interpreting it, as not to offend the Deaf person.
The eye doctor will test the Deaf person's visual acuity using the eye chart, however this time the lights will be off. Although there usually is some residual light in the room, the interpreter may want to ask the doctor if it is to have a few minutes so both the Deaf person and interpreter's eyes can adjust to the change. Also, it may be helpful if room is especially dark, for the interpreter to move towards the Deaf person, interpret and step back. This may enable the Deaf person to see the interpreter better.
As with the tests that were administered by the technician, the directions and explanation of each test should be given prior to the event.
The doctor will test the Deaf person's eye movement by asking to "follow my finger". This may seem straightforward to a hearing person, but the interpreter should mark in their interpretation whether the Deaf person should follow the doctor's finger with their eyes and head or just their eyes. There are many ways this particular instruction can be interpreted into ASL.
Depending on the Deaf person performs on the eye chart test, the doctor may chose to give the Deaf person a refraction test. This is the test where the Deaf person would look through a machine (called a refractor) that has many lenses for each eye. The doctor will change the lenses for each eye and ask the Deaf patient to read the eye chart through the lenses. Obviously, this can create somewhat of a logistical nightmare. As with the glaucoma test, the doctor should work out a system before the test is given with the Deaf person. Something along the lines of "when I tap your left hand, that means I have changed both lenses and I would like you to read the lowest line on the chart that you can see comfortably". This system will enable this portion of the exam to go more smoothly.
Next, the doctor will perform an ophthalmoscopy to check for disease. Earlier, it was mentioned that sometimes the doctor might want to use eye drops in conjunction with this test. Most often, if the doctor uses drops, this will be the last test of the exam because of the side effects (sensitivity to light and blurred vision). If the doctor chooses to use drops, the Deaf person will need to go back to the waiting room for 15 - 20 minutes for the drops to take effect.
As one can see, the logistics of this type of appointment can be difficult to sort out due to the nature of the appointment. A way to solve some issues that come up during tests utilizing machines that the Deaf person has to look through have been presented, however what about the logistics of where the interpreter should stand? Also, what if a CDI is present in the situation? Will the hearing interpreter stand in the same place as they would if they were the only interpreter?
It would be best for the interpreter to work around the doctor and Deaf person by allowing them to establish where they will sit or stand and then figure out where to stand, since the interpreter will have more flexibility than either the doctor or the Deaf person. The following diagram below is an example of where each participant may be sitting or standing. The eye doctor is in yellow, the Deaf person is in blue and the interpreter is in green. Each triangle is pointing in the direction that each participant is facing.
As one can see the interpreter is facing the Deaf person so that the Deaf person can see the interpreter fairly easily and vice versa. The interpreter may stand on the other side of the Deaf person at the same angle, depending on where the machines are placed in the room. If a CDI is present the participants may be placed in the following way (the interpreter, doctor and Deaf person are the same colors as above and the CDI is orange):
Notice that the interpreter's angle has changed a bit and is now in the direct line of sight with the CDI. This is because the hearing interpreter needs to see the CDI to voice for the Deaf person as well as to interpret what the doctor says in English into ASL. It is interesting to note how the source message gets interpreted into the target message. With a hearing interpreter the message going from English into ASL would be as follows:
From ASL to English it would look like this:
If a CDI is involved in the interaction, the source message being interpreted from English into ASL would look as follows:
|DOCTOR||HEARING INTERPRETER||CDI||DEAF PERSON|
|(English)||(English à ASL)||(see below *)|
*It should be noted that the CDI will interpret the ASL message given to them by the hearing interpreter, process it and interpret it into whatever form of sign language the CDI feels is best to convey the message to the Deaf person
The source message being interpreted from ASL into English would look as follows:
|DEAF PERSON||CDI||HEARING INTERPRETER||DOCTOR|
|(see below *)||(ASL English)||(English)|
*Conversely to the first example involving a CDI, the Deaf person will use whatever form of sign language is natural to them to convey their message to the CDI and the CDI will interpret that into ASL for the hearing interpreter.
In some cases, certain portions of the exam may not be interpreted through the CDI . For example, during the eye chart test, it would be inefficient for the Deaf person to sign a letter such as "E" to the CDI, who would sign the letter "E" to the hearing interpreter and the hearing interpreter would voice into English "E". In this case, the hearing interpreter can simply see the Deaf person sign the letter "E" and voice directly from them.
Another issue that someone interpreting in this setting should consider includes the fact that other medical problems may be discussed during the exam. For example, if a Deaf person has HIV or diabetes, these diseases will probably be discussed in great length due to the fact that both diseases can affect a person's eyesight. In addition, even if the patient has a clean bill of health prior to the eye exam, it may be possible for the doctor to detect a problem with the Deaf person's eyes. It is for these reasons that an interpreter should be prepared for anything to happen during an appointment.
Also, since we are in Boston, interpreters should consider the fact that many hospitals and clinics in the city are teaching hospitals. This means that an interpreter may have a schema for an exam with only the eye doctor, Deaf person and interpreter as participants, but if the exam takes place in a teaching hospital, there may be additional participants in the room during an interaction. Suddenly, a room can seem tiny when there are medical students, a doctor, a Deaf person and an interpreter present.
As one can see, interpreting an annual eye exam can present many issues and dilemmas for an interpreter. It is important that the interpreter have a schema for the assignment prior to accepting the job. I know that there are more issues that can present themselves than have been mentioned here and that most of us that are graduating in June will not be offered a medical job such as this one. However, after researching the topic of interpreting for an annual eye exam, I feel that I would be better prepared to accept an assignment of this in the future.
Glaucoma: An eye disease characterized by abnormally high pressure within the eye and partial or complete loss of vision.
Glaucoma test: The test performed to check for glaucoma, which most often is given by the eye technician (not the eye doctor). The test commonly consists of the patient sitting in front of a machine that sends a puff of air into each eye. This air puff test is sometimes used in conjunction with the same eye drops used sometimes during an ophthalmascopy, which allows for examination of more of the interior of the eye.
Ophthalmascope: An instrument that the eye doctor uses to examine the inside as well as the outside of the eye. It is essentially an illuminated microscope that consists of a mirror and reflects light into the eye and a central hole through which the eye is examined.
Ophthalmascopy: The procedure conducted by the eye doctor using an ophthalmascope to view the inside of the eye. Occasionally, the doctor will use eye drops to dilate the pupil during this test, which enables the doctor to view more of the eye. If the drops are used, the patient's vision will be blurred and sunlight can damage their eye.
Peripheral vision: Vision that one perceives near the outer edges of the eye.
Refraction test: A test performed in the eye doctor's office where the patient looks through a special device (called a refractor) at an eye chart on the wall. The refractor contains lenses of different strengths that can be moved into the patient's view. It is through this test that the doctor can determine whether the patient needs corrective lenses.
Visual acuity: How well a patient can see both near and far. It is usually tested using an eye chart.