SURVEY RESULTS REPORT

Program under the Project " Promoting the initial legal aid and implementing the policy of medical examination and treatment for the Deaf (Deaf, Deaf, Late Hearing Loss)"
 
 
HCMC, May 2021
 
 
Appendix 1: List of surveyed hospitals
Appendix 2: Survey questionnaire for the hearing impaired
Appendix 3: Survey questionnaire for ordinary listeners (parents, facilitators)
Appendix 4: Survey questionnaire for hospitals
Appendix 5: In-depth interview questionnaire for Hospital Leaders, Medical Professionals
Appendix 6: In-depth interview questionnaire for school leaders
Appendix 7: Parent in-depth interview questionnaire
Appendix 8: Minutes of in-depth interviews with hospital leaders, health professionals
Appendix 9: Minutes of in-depth interviews with school leaders
Appendix 10: In-depth Parent Interview Minutes
Appendix 11: Communication Access Plan
Appendix 12: Classification of areas of expertise in sign language interpretation
 
 

LIST OF ACRONYMS
 
Patient                 : Patient
BS                       : Doctor
BTC                     : Vietnam Hospital Quality Criteria (Version 2.0)
Hospital               : Hospital
Social work         : Social work
Teacher               : Assessor
Teacher               : Teacher
Student                : Student
HSKT                  : Students with disabilities
Labor                   : Leader
MTLM                : (Person) Late hearing loss
NNKH                 : Sign language
PWD                   : People with disabilities
NKTh                  : Deaf people
Medical               staff: Medical staff
PDNNKH           : Sign Language Interpreter
PH                       : Parents
QLQ                    : Quality management
TKT                     : Children with disabilities

 
LIST OF TABLES
 
Table 3.1    : Media outreach plan
Table 3.2    : Classification of areas of expertise
Table 4.1    : Personal information sheet of parents – who supported the survey
Table 4.2    : Information panel of the hearing impaired who participated in the survey
Table 4.3    : Information sheet of health workers participating in the survey
Table 4.8    : Understanding of Parents – Supporters and Deaf people about Rights
 

 
LIST OF CHARACTERS
 
Figure 4.1       : Level of access to legal documents of parents - supporters
Figure 4.2       : Level of access to legal documents of the deaf
Figure 4.3       : The interest of parents, supporters and deaf people in understanding legal documents
Figure 4.4       : Ability to read and understand legal documents of parents, support people and deaf people
Figure 4.5       : The need for support in interpreting and applying legal documents of parents - support people and deaf people.
Figure 4.6       : Parent-supporter's approach to legal documents
Figure 4.7       : Access to legal documents of the deaf
Figure 4.9       : Knowledge of parents - supporters and deaf people about the Rights of the Deaf
Figure 4.10     : Difficulties of parents and supporters in accessing the rights of the deaf
Figure 4.11     : Difficulties of deaf people in accessing Deaf Rights
Figure 4.12     : Finding support from parents and facilitators in accessing the rights of the deaf
Figure 4.13     : Seeking assistance in accessing the rights of the deaf surveyed by the hearing impaired
Figure 4.14     : Needs of parents - support people and deaf people in understanding legal documents regulating the rights and benefits of deaf people
Figure 4.15     : Communication media/tools used by parents – facilitators and deaf people
Figure 4.16     : Support needs of parents – who assist in understanding information from media/media
Figure 4.17     : Support needs of deaf people in understanding information from communication media/tools
Figure 4.18     : Annual medical examination of the deaf through a survey of parents - supporters and deaf people
Figure: 4.19    : Location of medical examination and treatment for the deaf through a survey of parents - support people and deaf people
Figure 4.20     : Difficulties in medical examination and treatment for the deaf through a survey of parents - supporters and deaf people
Figure 4.21     : Difficulties of hospitals in providing medical examination and treatment for deaf people
Figure 4.22     : Health workers communicate with deaf people through parent-supporter and hearing-impaired survey
Figure 4.23     : Communication between medical staff and deaf people through parent-support survey
Figure 4.24     : Communication between medical staff and deaf people through survey of deaf people.
Figure 4.25     : Assessment of medical staff on communication with BNKTh
Figure 4.26     : The level of understanding the communication content of the hearing impaired child/child/client to communicate with the hospital staff through the parent-supporter survey
Figure 4.27     : The level of understanding the content of communication with medical staff of the hearing impaired
Figure 4.28     : Medical staff support deaf people during medical examination and treatment through parent-supporter survey and hearing impaired person survey
Figure 4.29     : Interpreters in the process of medical examination and treatment for people with disabilities through a survey of parents - support people and deaf people
Figure 4.30     : Demand for sign language interpreters at the hospital through a survey of parents – support people and deaf people
Figure 4.31     : The need for a policy to prioritize medical examination and treatment for the deaf through a survey of parents - support people and deaf people

 
THANK YOU
 
The survey group "Assessment of ability to meet the needs of deaf patients: A case survey of "Vietnam hospital quality criteria"" under the Project “Promoting the initial legal support and implementing the policy of medical examination and treatment for people with disabilities (deaf/hard of hearing/late hearing loss)” would like to thank the deaf brothers/sisters, parents , Teachers, Leaders, and Experts participated in answering and giving valuable comments to the survey.
The team would also like to thank the Oxfam Secretariat for providing quality and professional advice to the team to conduct this survey.
We would like to thank our colleagues from the Center for Education of the Deaf (CED) for their participation and support in the survey data collection process.
It would be remiss not to mention Lawyer Nguyen Thi Xuan Huong - the lawyer in charge of legal advice of the project who allowed the team to conduct the survey during communication sessions and provide legal advice to the community.
Finally, a big thank you to the European Union Donor, JIFF Foundation, Oxfam Foundation in Vietnam for sponsoring the Project as well as for this survey.
 
Best regards.
Survey Team
MSc Duong Phuong Hanh – Founder/Director of CED
Dr. Pham Thuy Duong – Research Assistant, Project Officer
CN Trieu Thuy Mi – Project Manager
LS Nguyen Thi Xuan Huong – Project Lawyer
MSc Nguyen Linh Tan – Data processing specialist
 
 
This document is an activity of the Initiative "Promoting initial legal support and implementing the policy of medical examination and treatment for the deaf (Deaf, Deaf, Late Hearing Loss)" within the framework of this document. of the Justice Initiative Promotion Fund (EU JULE JIFF). EU JULE JIFF is one of two components of the project "Strengthening Law and Justice in Vietnam" (EU JULE) funded by the European Union (EU). The project aims to contribute to strengthening the rule of law in Vietnam through a more accessible and reliable Justice system.
The opinions, analysis and recommendations contained herein do not necessarily reflect the official views of the European Union and Oxfam in Vietnam.
 

1. PROJECT SUMMARY
   1. Project basis

Ensuring that people with disabilities (PWDs) have access to departments/rooms, facilities and medical examination and treatment services in hospitals is the duty of society and the health sector, contributing to improving equity in medical examination and treatment. Healing; contribute to the protection of human rights.
“Vietnam Hospital Quality Criteria” was issued in 2016, in which, “Chapter A2. Conditions of facilities to serve patients”, Criterion A2.5 “Patients with disabilities have full access to medical examination and treatment departments, rooms and services in hospitals”. At the level 5 scale, items 10 and 11 on quality are clearly explained in the Criteria as:

• Having interpreters for deaf patients or having a plan to cooperate and sign a contract with an interpreter in the case of medical examination and treatment.
• Ensure that interpreters for NBKTh are available within 90 minutes upon request.

However, in fact, after 4 years of implementation, this practice has not been popularized in district/city public hospitals in Ho Chi Minh City. In addition, many deaf people have not yet grasped the legal policies related to their rights.
The results of the national survey on children with disabilities in Vietnam in 2016-2017 by UNICEF showed that hearing impairment accounted for 0.22% of disability types in children by function (right figure).
Ho Chi Minh City has no more than 20 scientific translators compared to the number of hospitals of 102, not counting the Preventive Medicine Centers and the ward/commune health stations in all districts. The number of NTDs in HCMC is 3,550 (data from Ho Chi Minh City Department of Labour, Invalids and Social Affairs in 2006). The number of people with AIDS in Vietnam is 2,451,536 people (2009). These are all old data from more than a decade ago. The actual number is probably much higher now. Thus, if implemented correctly, we are seriously lacking PD NNKH.

1. Project activities

The project "Promoting the initial legal support and implementing the policy of medical examination and treatment for people with disabilities (deaf/hard of hearing/delayed hearing loss)" aims to help hospitals meet the requirements of the organizers. The project is implemented by CED - the first unit and organization of NKTh to conduct a survey to evaluate the effectiveness of the implementation of the set of criteria to contribute ideas to the Ministry of Health. The project focuses on 3 main activities: communication, education to raise public awareness, initial legal support for people with disabilities and policy advocacy, proposals and recommendations for competent management agencies. .

1. Raise public awareness:

• Communication to People with Disabilities: Coordinating the Law to advise on legal policies, benefits for people with disabilities, the International Convention on the Rights of People with Disabilities, the Law on Children, the Law on the Elderly, the Law on Social Insurance.
• Training on “Skills to support UTIs in hospitals” for health workers (nursing, technicians), community health students, social workers: 180 people.
• Sign language interpreter training: 60 people.
  1. Initial legal support for NKTh:

• Listening, through contact sessions with PH, NKTh.
• Advice, support in person or by phone, consultation via hotline, Facebook, at CED, and other channels.
• Connecting the network of NKth Club, Special School, Social Work Group, Interpreting Group.
• Document operations and dissemination.
  1. Recommendations for state management agencies:

• Researching 20 hospitals, 200 patients, and doctors about the current situation of medical examination and treatment, policy implementation, and knowledge of patients with disabilities about the laws and their rights. From there, there is a basis to advocate for policies and transmit research results to relevant agencies and associations of NKTh.
  1. Project Features

The project that CED is implementing is one of five ongoing projects in Ho Chi Minh City and 21 projects across the country within the framework of the Ministry of Justice's program to advise on legislation by the Justice Initiative Promotion Fund (EU JULE). JIFF (referred to as JIFF Foundation) is funded through Oxfam. The JIFF Fund is one of two components of the project "Strengthening the Law and Justice in Vietnam" (EU JULE) funded by the European Union to contribute to strengthening the rule of law in Vietnam through the legal system. reliable and accessible justice. This is an international cooperation project with prestigious organizations, governments, related levels such as the Ministry of Justice, the City People's Committee (Departments and departments), central and local associations.
The profound goal of the project is to advocate for policies, advise and amend some Laws in the future and 2022. The project scale is narrow, in-depth, focusing on legal issues in the field of law. healthcare and medical examination and treatment. The limitation of the project is that the operation period is short, only 12 months, from September 2020 to October 2021, while effective advocacy projects usually take 2 to 3 years.

1. Recommendations to expect

• Add hearing aids and cochlear implants to the list of beneficiaries of health insurance.
• Supplementing solutions to support UTIs in medical examination and treatment at the hospital.
• Supplementing "skills to support UTI in hospital" in medical school.

 

2. OVERVIEW

Vietnam has 2.5 million (data of the Central Housing Census 2009) people with hearing loss/disabilities, if classified by means of communication, it will include: Deaf people who communicate with sign language, not speaking, representing this community is the World Federation for the Deaf (WFD); Hard of Hearing (Hard of Hearing) can talk regardless of hearing (hearing through lip reading/lip-reading, hearing with hearing aids/hearing aids, cochlear implants/Cochlea) International Federation of Hard of Hearing People (IFHOH); Late-Deafened people speak but do not know sign language, cannot read lip signals, do not benefit from hearing aids, the only communication is “talkie/text” and represented by the Association of Late-Deafened Adults (ALDA). Support for people with disabilities in the process of social integration must depend on the limitations in communication of each type.
The Convention on the Rights of People with Disabilities (CRPD) was adopted by the United Nations General Assembly on March 13, 2007 and was closed by the National Assembly of the Socialist Republic of Vietnam. XIII, 8th session adopted on November 28, 2014, emphasized that people with disabilities have the right to enjoy the highest medical standards without discrimination (Article 25 – Health). These medical standards include: providing special medical services. In Vietnam, the Law on Persons with Disabilities No. 51/2010/QH12, stipulates in Chapter III: Health Care, Article 22: Medical Examination and Treatment, Section 1: The State ensures that people with disabilities have medical examination and treatment, treatment and use of appropriate medical services.
Regarding medical examination and treatment for people with disabilities (PWDs) in general and people with disabilities (PWDs) in particular, “Vietnam Hospital Quality Criteria (Version 2.0)” is the most recent sub-law document with standards. Article A2.5 “Persons with disabilities have full access to medical examination and treatment departments, rooms and services in hospitals”. Out of the 83 criteria of the Criteria (BTC), only criterion A2.5 is the regulation on support for people with disabilities and specifically on support for people with disabilities (criteria A2.5, items 10, 11), it is only at the level of 5 (optional) about having an interpreter for NBKTh. On the other hand, there are no criteria mentioned to support NKTh who do not know sign language. In addition, there are no criteria to identify people with hearing loss and late hearing loss at the hospital for support. People with disabilities do not seem to have received enough and fair attention in accessing medical services during medical examination and treatment.

1. Survey objective

This survey aims to:

• Find out the difficulties when implementing Criterion A2.5 related to supporting UTIs in the hospital to have recommendations to supplement and complete the Hospital Quality Criteria (BTC).
• Find out the best solution to support NTDs (deaf, hard of hearing, late hearing loss) during medical examination and treatment at the hospital.
  1. Meaning of survey
     1. Scientific significance

The survey results help clarify the following aspects:

• Perception based on the Rights of NKTh.
• Solutions to improve the quality of life for people with disabilities.
• Improve policy enforcement.
• Contribute ideas in editing and supplementing relevant policies.
  1. Practical significance
• For the State: the survey results through actual evidence will help the State have an objective and comprehensive view on the issue of medical examination and treatment for people with disabilities in order to issue appropriate amendments and supplements.
• For BV: the survey results will help BV (1) Get a suitable strategy that meets criteria A2.5; (2) Information and resources available to apply for and enforce A2.5 criteria.
• For people with disabilities and their families: the survey will help people with disabilities and their families understand their rights and priorities from policies that have been enacted to improve quality of life by ensuring their rights.
  1. Survey question

• What regulations and support services do advanced countries in the world have for people with disabilities in hospitals?
• How has BV implemented BTC related to NKTh support?
• Is the A2.5 criterion sufficient to protect the rights of NKTh?
• What are the difficulties or what support do you expect to receive during the medical examination and treatment process?
• How do people with disabilities understand their rights in medical examination and treatment?
  1. Survey scope
     1. Field of investigation: Actual situation of implementation of "Vietnam Hospital Quality Criteria" for hearing impaired patients.
     2. Respondents:

1. Interview via Questionnaire survey

• Leader of BV: Head of Planning and Organization Department, Head of Department
• Health workers at 20 hospitals (Appendix 1): Nurses, technicians, social workers at hospitals, pharmacy staff, office staff (HCN/KHTC)
• NKTh in Ho Chi Minh City: belonging to Deaf/Deaf Clubs in Ho Chi Minh City, deaf students at some specialized schools including parents of deaf children

2. In-depth interview:

• Department/Health Department Specialist: The team will try to find an experienced specialist to participate in the assessment of the implementation of the Criteria at the hospital.
• BV has many comments on the Survey
• NKTh/Parents have many suggestions for the Survey
  1. Survey location and time: The survey was conducted in HCMC during the period from October 2020 to March 2021.
• Survey method
  1. Approach

• Rights-based approach: The survey is designed from the ground up on the most basic rights of people with disabilities, and also identifies the responsibilities of relevant agencies in ensuring the rights of people with disabilities.
• Participatory approach : survey to mobilize the participation of stakeholders such as hospital, dialysis community. Voices and opinions of the project's target audience (PWDs, PWDs, children with disabilities) will be encouraged, respected and conveyed to competent authorities and communities and organizations related to PWDs. .
• Bottom-up approach : survey to strengthen internal resources for disadvantaged groups, and collect evidence to help promote good policy practice on intervention project issues.
  1. Data collection methods

The survey uses both quantitative (questionnaire) and qualitative (in-depth interviews, expert opinion) data collection methods.

• Research document : Regulations and support services for UTIs at hospitals in some advanced countries in the world.
• Survey through questionnaire : (Appendix II and III) :

• 20 questionnaires for leaders/officers in charge of hospital quality assurance: priority is given to hospitals specializing in obstetrics, ENT, public diseases and hospitals in the CED network.
• 200 NKth: priority is given to deaf people in clubs, deaf associations and students in specialized schools, etc.

• Survey method:

• On-site survey at media sessions, deaf clubs, special schools.
• Online survey (using Google form)

• Survey location:

• At Deaf/Deaf Clubs: Ho Chi Minh City Deaf Club (Ly Nhon Primary School), Ho Chi Minh City Deaf Club (108 Ly Chinh Thang).
• Special School: CED, Center for Sponsorship - Vocational Training and Job Creation for People with Disabilities in HCMC.

• depth interview : After the questionnaire collection process is completed, the questionnaires that have a lot of information or have specific needs will be selected for in-depth interviews (up to 10% for each type of questionnaire).
  1. Survey framework

The survey methodology is summarized in the research framework below:

Field/Object	Main question	Methods – Tools
Leaders, officials and medical staff at the Hospital	What regulations and support services do advanced countries in the world have for people with disabilities in hospitals?	Document study
	How has BV implemented BTC related to NKTh support?	Quantitative – Questionnaire Qualitative – In-depth interview
	Is the A2.5 criterion sufficient to protect the rights of NKTh?	Quantitative – Questionnaire Qualitative – In-depth interview
NKTh	What are the difficulties or what support do you expect to receive during the medical examination and treatment process?	Quantitative – Questionnaire Qualitative – In-depth interview
	How do people with disabilities understand their rights in medical examination and treatment?	Quantitative – Questionnaire

 

1. Methods of processing and analyzing data

Survey using Excel/Google Form software to analyze quantitative data.
The survey used direct signature (with the permission of the interviewee), transcript analysis and information matrix in Excel to process qualitative data.

1. Research limitations:

- The study only surveyed subjects who agreed to participate in the study and maybe some subjects did not have problems that the survey group needed to collect information about.
- Countries around the world do not have a set of criteria for assessing hospital quality like Vietnam, so they cannot compare to see the gap in the criteria or draw any experience for Vietnam when taking care of the hearing impaired. .

1. Research/Survey Ethics

The survey was conducted on a voluntary basis, with consent and respecting the anonymity of the participants. Survey is committed to meeting Oxfam's integrity and transparency requirements.
 

3. THEORETICAL BASIS
   1. Guide to support deaf patients around the world

Health care for people, PWDs in general and PWDs in particular, has always been focused on in developed countries.
United States : According to the American Association of the Deaf (HLAA, 2018) if health and healthy living are always important factors, clear communication with doctors and health workers is of primary concern. Patients are always encouraged to ask many questions about their individual health status and back and forth with the doctor and health care worker until everyone has a clear understanding.

• Collect information about hearing loss : In order to communicate effectively, people with disabilities are required to provide information about hearing status, what support is needed in communication and related services on the Information Request Form such as: under.

Table 3.1: Media outreach plan

Please notify all medical staff and record in the Medical Examination Book
NAME OF PATIENT	DATE OF BIRTH:	MRN: (for hospitals)
You are? € People who can't hear People who are deaf People who are deaf and blind People who are visually impaired
What device do you use? Hearing aids Right Left _ Cochlear implant Right Left _ Other transplants:……………………………………………………………………………………………….
What do you need the hospital/office to provide? € Pocket talker € Phone with subtitles (hospital use only) € Text phone (hospital use only) € Video phone € Other notification or support device: ………………………………………………………………………………………………
What service do you need? € Communicating with pens and writing € Speech-to-text translation (CART) € Sign Language Interpreter € Tactile Interpreter € Remote video interpretation € Other:……………………………………………………………………………………………….
In the waiting room When it's my turn to see the doctor:                                               € Please provide vibrating pager, if available.                                               € Please come talk to me, face to face.                                               € Please write and give it to me.
For follow-up appointments/information, please contact me by: € Patient portal Email Text Postal mail _ € Cell phone Home phone Work phone Video phone € Relay Program
Note:

(Source: Hearing Loss Associate of America)
 

• Listening devices : Encourage the patient to bring or provide the patient with Assistive Listening Devices such as: Amplified phones, phones with speech-to-word software (Captioned phones), speakers pocket (Pocket Talker) used with microphone, headset; or writing tools such as: white board with eraser (Dry Erase Board), writing paper, tablet (Tablet); or speech-to-text software (Communication Access Realtime Translation (CART).
• Interpretation services : interpreting foreign languages or speech directly at the hospital or remotely.
• Guidelines for communication in the hospital : instructions on how to find support during hospitalization and upon discharge, as well as instructions on communication in a department.

The American Association of the Deaf (NAD, 2021) also has specific instructions in the covid situation when the deaf need to enter the hospital as follows: on-site NNKH interpreting; video interpretation; read lip cues with transparent mask; write down on paper; type subtitles or CART (speech-to-text typist; or use speech-to-text software.
On the government side, the California State Office of Social Services has provided documents on some basic medical symbols (ODA, 2015) for health workers with information on how to communicate as follows:

• Must get the patient's attention first (tap on the shoulder or wave).
• Eye contact (face to face).
• Spell out words without symbols in the document.
• Use facial expressions, gestures, etc.
• Speak directly to NKTh at a moderate pace while making signs.
• Make sure the patient can see the health worker's mouth.
• Summarize if the patient does not understand.
• If with all the above methods but still do not understand, write it down on paper or draw a picture.
• The most important thing to remember is “Patience is a language to understand each other”

This document also clearly states that it is only for one-on-one communication and temporary support pending the arrival of the PDNNKH.
Japan : Zennancho is Japan's Association of Deaf people and has a guide for people with disabilities when entering the hospital. This document is for sale and some key information is as follows: What is a hearing loss, how to communicate and difficulties of people with disabilities when entering the hospital; Information about preparing for an appointment, seeing a doctor, paying, accessing information in the waiting room, ... Pharmacy: from giving a doctor's prescription, waiting for the name to be called, receiving the medicine and listening to the instructions on how to use the medicine; Guidelines related to hospital admission and surgery; Equipment support, NNKH translation information, etc..
United Kingdom : The British Association of Late Deaf People has compiled a 4-page document (NADP, 2020) instructing health workers on how to communicate with deaf patients. Specifically, the instructions for communication speak slowly and clearly; face to face with the patient not looking at the computer screen; text-to-speech telephony service (Text Relay Service); texting; do not sit behind a mirror or reflective object; always have paper and writing on hand; ask the patient to keep up with the exchange and check the information with the patient; Make notes on paper for the patient to bring back to make sure there is no misunderstanding what was discussed during the appointment. The guide also covers how to communicate via lip reading. The Royal National Institute for Deaf People (RNID) also has a website that guides people with NKThings on how to access BV services so that legal requirements are met. Guide to information section for doctors, nurses, communication tips etc…
While the United States relies on the Americans with Disabilities Act to explain the services provided, other countries, although not talking about the Law, are geared towards the rights of people with disabilities. In particular, all guidelines are in the form of Handbooks or manuals and are issued by the NKTh organization itself at the National level.
In summary, in order to effectively support people with disabilities in medical examination and treatment at the hospital, organizations of people with disabilities and the Department of Social Affairs in charge of people with disabilities compile guidelines for people with disabilities and for health workers.
Contents of the guide:

• Collect/Provide information about hearing impairment
• Support Services:

• PDNNKH on-site or via video;
• Caption; read lip cues with transparent mask;
• Write/draw pictures on paper; …

• Hearing aids (carried or provided).
• Instructions on how to communicate specifically in some departments from making an appointment to see a doctor, admission to discharge.
• Provide handouts on some basic symbols while waiting for PDNNKH to arrive.
  1. Guidelines for supporting deaf patients in Vietnam

In Vietnam, related to support for UTIs during the medical examination and treatment can be seen in the following two factors: the hospital has a function in treating ear diseases including hearing loss and the maternity hospital has newborn hearing screening services. Although the survey team has not found any official guidelines related to supporting people with disabilities in medical examination and treatment, they also shared information about "Experience in medical examination and treatment for people with hearing loss" of Dr. Dang Ngoc Tran. The brief content is as follows:
Due to the specific characteristics of the Otolaryngology (TMH) circuit, when examining and treating diseases related to the upper respiratory tract in adults and children, doctors absolutely wear masks when examining patients.
(1) For the elderly with age-related hearing loss; And people who can read and write before, with normal hearing, now have hearing loss due to illness or injury, they should speak slowly, speak in short sentences, do not shout too loudly, because the louder the sound, especially the female voice. the higher the patient, the more difficult it will be to hear and cause ear pain; or communicate with the patient in the form of notes.
(2) For people with congenital deafness: if someone lives with the patient or takes care of the patient from the time the patient is born until now, it is very good, the first visit is not available, the next follow-up visit must be accompanied by the patient. patients, except in cases of force majeure, the patient lives alone or is an orphan.
+ If the patient has a sign language interpreter, or a relative can communicate with the patient through body language and provide the patient with information about the change in the patient's health status.
🡪 Listen to your loved one/or support person speak.
🡪 Observe how the patient expresses his or her problem.
🡪 Take medical history and examine (use simple words, local words, folk words, descriptive pictures).
+ Patients traveling alone: patients who have received early intervention can speak, can hear, read and write.
🡪Listen to the patient
🡪 Ask about the time the patient was diagnosed and intervened
🡪 Many patients think that health care workers look down on them and don't realize as much as the average person, but in reality, no health worker looks down on hearing impaired people.
There was a misunderstanding from the family and the patient. When a person loses hearing, the central hearing system will also decline and is proportional to the degree of deafness; People with acquired deafness, if not treated, often have Alzheimer's disease; If a person is born deaf without intervention, the brain area can be considered as dying over time, delayed intervention, that brain area is also weakened, so IQ and EQ will also be affected, decreasing compared to those who are born deaf. is considered normal.
🡪 That's why health workers often ask about the time of disease detection and intervention to see the patient's integration level, find communication methods.
🡪 Take medical history and examine.
In all situations, it is important to avoid having a loved one, support person, or patient define or conclude about their symptoms. This situation is very dangerous, will lead to subjective psychology in health workers and lead to wrong diagnosis. Attempts to have the patient express or describe the symptom, even with the least amount of information, in combination with the physical signs will still avoid diagnostic errors.
In addition, Dr. Dang Ngoc Tran also shared "Reference documents to support translation of medical services at the hospital" including 77 medical questions related to: Shortness of breath, Chest pain, Cough, Fever, Digestion, Problems with Teeth, Ear, Nose and Throat, Eyes, Gynecology, Menstrual disorders, Breast problems to be concerned with in women, Hand and foot problems.
Regarding the guidelines for supporting people with disabilities in the hospital, the Center for Research in Education of the Deaf (CED) offers the course "Skills to support the deaf in the hospital". The program is provided to students who are medical staff (doctors, nurses, technicians, social workers, physician secretaries).
Knowledge : know the classification of hearing loss according to the means of communication, difficulties and support solutions.
Skills : have basic sign language skills, medical sign language, communication skills, support skills. Developed a process to support hearing impaired patients at the hospital.
Attitude : having the right perception of how to communicate, behave and provide proper support. (Duong Phuong Hanh, 2020).
Support for people with disabilities in some hospitals in Vietnam is currently in two forms: (1) having family members or specialized teachers to teach deaf people; (2) The BV signs a PD contract with an individual or a unit providing PD NNKH service.
Most recently, through the implementation of the project "Promoting the initial legal support and implementing the policy of medical examination and treatment for people with disabilities (deaf/hard of hearing/late hearing loss)", CED has developed a Textbook. Medical sign language (Duong Phuong Hanh, 2021) includes the most common medical questions and is converted into scientific language clips distributed to health workers, hospitals, teachers and parents. This support tool will help reduce some communication barriers in the process of medical examination and treatment for people with disabilities.
Lessons learned for Vietnam: From the information provided above, it can be seen that the support for people with disabilities in medical examination and treatment in Vietnam also has similarities with the International such as the Organization. of and because UTI is a pioneer in providing information and guidance on skills to support UTI in hospitals. However, Vietnamese hospitals also need support and a plan:
- Prepare support tools, supporting information, direct the establishment and foster skills for separate specialized groups as well as build a process to support the deaf at the hospital according to the specific functions of each hospital.
- The Ministry/Department of Health needs to review Criterion A2.5 to ensure that the support for deaf people who do not use scientific language is also evaluated for quality.
- The Ministry/Department of Health needs to have an official document specifying the collection of information to identify UTI in the hospital.

1. Vietnam Hospital Quality Criteria (Version 2.0)
   1. BTC content

The set of quality criteria for Vietnamese hospitals in 2016 was revised and supplemented with a number of criteria and sub-sections from the set of criteria for evaluating hospital quality, which was piloted under Decision No. 4858/QD-BYT dated December 3. 2013 by the Minister of Health.
Hospital quality criteria are tools for independent quality accrediting units to conduct quality assessment and certification according to Articles 50 and 51 of the Law on Medical Examination and Treatment No. 40/2009/QH12; Article 10, Article 11 of Decree No. 87/2011/ND-CP dated September 17, 2011.
The set of Vietnamese hospital quality criteria (Session 2.0) includes 83 official criteria divided into 5 parts A, B, C, D, E including:

• Part A: Patient-oriented (19 criteria)
• Part B: Human resource development (14 criteria)
• Part C: Professional activities (35 criteria)
• Part D: Quality improvement (11 criteria)
• Part E: Specialty criteria (4 criteria)

Each section A, B, C, D, E is divided into chapters. Each chapter can be considered as a quality standard.
In each chapter there are several criteria. Each criterion deals with a defined problem, built on five quality ladders (five levels of assessment) .

• Level 1: Poor quality (not implemented, not yet conducted to improve quality or violated legal documents, regulations, regulations, decisions).
• Level 2: Medium quality (some inputs have been established).
• Level 3: Good quality (completely completed input factors, have output results).
• Level 4: Good quality (with good output, research, re-evaluation of work and results done)
• Level 5: Very good quality (with good output results, applying assessment and research results to quality improvement, approaching the quality of hospitals in the region or advanced countries in the world) ).

Out of 83 criteria, only criterion A2.5 is required to provide support services for people with mobility and visual impairments. Particularly for the deaf, support services are presented at level 5 as follows:
Vietnam Hospital Quality Criteria (Version 2.0):
Chapter A2: FACILITIES OF FACILITIES SERVING PATIENTS
Criterion A2.5: Persons with disabilities have full access to medical examination and treatment departments, rooms and services in hospitals.
Level 5: Index 10: There is an interpreter for the deaf patient or there is a plan to cooperate and sign a contract with an interpreter in case a hearing impaired patient comes for medical examination and treatment.
Indicator 11: Ensure that interpreters for the hearing impaired can be provided within 90 minutes upon request.
How much each BV registers for each criterion depends on the BV's service provision capacity. In other words, if the BV registers Criterion A2.5 at level 3, it cannot require the BV to provide NNKH translation services.

(Source: Vietnam Hospital Quality Criteria)

(Source: Vietnam Hospital Quality Criteria)
 
BTC also presents the concept of BV quality as follows:
All aspects related to the patient, the patient's family, health workers, capacity to perform professional and technical skills; input factors, operational factors and outputs of medical examination and treatment activities.
Some aspects of hospital quality are service accessibility, safety, patient-centred, health-care worker-oriented, professional qualifications, timeliness, convenience, fairness, efficiency, etc.
 
 

1. BTC Evaluation Process

According to the Department of Medical Examination and Treatment, Ministry of Health (2018), the evaluation process of hospitals implementing BTC includes the following issues:
Auditor : is a person of the management agency, must undergo training and must register to receive an auditor code. Teachers must be trained, trained in quality management of hospital including:

• Quality management organized by the Ministry of Health (from 3 days or more);
• Hospital management organized by the Ministry of Health, with quality management content;
• Quality management integrated in hospital management classes, nursing management ... (Classes are organized by units with continuous training codes);
• Quality management organized by the hospital itself or by units inside and outside the health sector (no continuous training code);
• The quality management in foreign countries;
• Participating in the national conference on hospital quality management organized by the Ministry of Health or other specialized seminars and conferences on quality management;
• Having an international or domestic teacher's certificate in quality assessment;
• Take quality related classes like ISO,TQM, 5S, KAIZEN, PDCA or others.

Team members self-inspection and quality assessment :

• Team leader: Director of BV
• Deputy Delegation: Deputy Director of BV
• Secretary of the delegation: LD staff or staff in charge of quality management
• Delegation members: Department/team staff and quality management network members; Labor of functional departments, clinical and paraclinical departments and doctors, nurses and staff in the hospital.

The composition of the quality inspection and evaluation team of the Department of Health :

• Head of the delegation: Leaders of the Department of Health, Ministry of Health, branches
• Deputy Director: Director or Deputy Director of the BV under the management agency (not under the assessed BV)
• Secretary of the delegation: professional department of the Department of Health and the head, deputy or staff in charge of quality management of the affiliated hospitals.
• Delegation members: Specialists of departments of the Department of Health; Health Ministry, branch; Heads and deputy heads of faculties, departments, doctors, nurses of other hospitals.

Evaluation method: One criterion is evaluated according to 5 levels;

• The sub-categories are evaluated according to the method:

• Observing the current situation, monitoring activities (QS);
• Look up records, books, computers, documents, diaries, documents, data, ... (HS);
• Quick interview of health worker/patient/patient's family (reporter);
• Play the role of a patient to experience the reality of the hospital (developing);
• Comprehensive combination of all testing methods and skills.

Evaluation principles :

• Each subsection of the criterion is evaluated as either “pass” or “fail”, the sub-items at level 1 are evaluated as “yes” or “no”;
• An objective that is assessed as “passed” is the strict adherence to the “or no, or all” principle;

For example, the subsection “Clinical and subclinical departments with adequate handwashing facilities for health workers” is only classified as “passed” if all clinical and paraclinical departments in the hospital have hand wash basins. If any department does not have a hand wash basin it will be rated as “fail”.

(Source: MSc Nguyen Trong Khoa, Deputy Director of the Department of Medical Examination and Treatment, Ministry of Health)
In addition, the assessment of hospital quality management according to BTC is also based on the basic principles of comprehensiveness, fairness, professional prudence, information confidentiality, independence and evidence-based assessment. .
With criterion A2.5, the evidence to evaluate whether or not there is a PDNNKH contract.

1. Tool concept
   1. Patient's needs

According to Maslow, humans have five levels of need: physiological, safety, social, esteem, and self-actualization. Virginia Henderson's theory, applied in nursing training, presents 14 needs of the patient, including an additional expectation of medical knowledge and communication needs (College of Medicine and Pharmacy). Pastuer, 2019).

• Meet medical health knowledge: Every patient has a need to understand their condition, treatment, recovery ability, appropriate diet, etc. to self-coordinate in the treatment process. treat.
• Meeting communication needs: Nurses need to create conditions for patients to exchange and chat with surrounding patients to help relieve the spirit, contributing to effective treatment.

For people with hearing impairment, the method of communication and the services or supports that the hospital must provide will vary depending on the ability of the disabled person (deaf, hard of hearing) and on the complex nature of the communication content. (ADA, 2003).

1. Deaf people and means of communication
   1. Deaf people

Hearing loss ranges from mild to profound and affects people of all ages. Some people lose their hearing for many years, while others have sudden and complete hearing loss (NADP, 2020). Subgroups of Deaf people based on communication style include deaf people who use scientific language, people with hearing loss who can speak even though they can't hear, or communicate mainly through writing (ADA, 2003). Also classified according to the way of communication, Steven Barnett, (2002) said that there are 3 groups: people with hearing loss, deaf people who communicate verbally and deaf people who communicate using scientific language.
For deaf people, not only scientific language is concerned but also about deaf culture. Understanding people is understanding lifestyles, beliefs, beliefs, etc. If culture includes beliefs, behaviors, goals and common characteristics of members of a group or society (Ken). & Lynn, 2019), for deaf people, their diversity of cultures, languages and ways of seeing the world makes a difference in people's lives and this shapes deaf culture (Carol Padden & Tom Humphries, 2005).
According to the national literature, the term "deaf" or "hard of hearing" is often used to describe severe to very severe hearing loss. The distinction between congenital and acquired deafness determines only the time at which the deafness appears and the interventions. (Dang Ngoc Tran, 2021). Or classified according to the organization of the disabled people, including deaf people who communicate using scientific language; hearing impaired people with or without hearing and talking aids; people with late hearing loss communicate through writing (Duong Phuong Hanh, 2015).
Identifying or differentiating UTIs through communication will help health workers know how to communicate appropriately so that they can respond to deaf patients in order to find out enough and correct information in the diagnosis and treatment of the disease.

1.  Means of communication

• Sign Language : A language that uses hand gestures instead of sounds. Science language is created by deaf people to help them communicate with each other in their communities and absorb the knowledge of society (Wikipedia). Ursula Bellugi & Susan Fischer (1972) said that scientific literature includes factors related to the hand such as shape, position, movement, palm orientation. Signing can be done with one hand or two hands. With NAD (2000), NNKH is the visible language. Symbols with hand shapes and movements represent meanings and concepts of words. NNKH has a different grammar from written language.
• Lipreading /Speechreading is the ability to recognize different speech sounds by observing the movements of the lips, jaw, tongue, teeth and through information provided by reality and language (Catherine E. Shearer & Mary Ann Playford, 1997). Lip reading is the ability to understand speech messages through LISTENING with residual hearing, OBSERVING movements of lips, jaws, tongue and teeth; UNDERSTAND the nonverbal language of the interlocutor (expression of facial expressions, gestures, body language), ASSEMBLY different parts of a sentence into a meaningful message (Duong Phuong Hanh, 2015).

NDA (2000) suggests that people with disabilities (deaf and hard of hearing) respond to the information they see and process this information with their eyes, not with their ears. The appropriate methods of communication of mathematical language are scientific language, speech, amplification and writing. NKTh will use whichever means they personally find most comfortable and natural.

1. Sign Language Translator
   1. Interpretation concept

Interpreting is the participation of a third person with the task of conveying the information of one party to the other so that the maximum continuity is guaranteed if the two interlocutors disagree with each other. ^[1]. The English term “interpreter” is also defined as providing oral interpretation to two people of different languages.
There are two common types of interpretation: parallel and serial translation.

• Parallel translation: is a form of conveying messages at the same time when someone is speaking.
• Consecutive translation: is the form in which the translator will transmit the message into the target language after the speaker finishes speaking a piece of the original language and so on from one paragraph to another.

Ken & Lynn Finton (2019) also shared that scientific translation includes two forms of parallel interpretation (Simultaneous interpreting) and sequential interpreting (Consecutive interpreting).

1.  Degree regulation

There are two types of PD qualifications in AUSTRALIA (Jamina Napier, 2004) (Karen & Patricia, 2008): paraprofessional interpreters interpreting non-professional content (special terminology) distinctive, complex concepts, specialized literature); Professional interpreters are capable of interpreting all content of the dialogue. Diplomas and certifications for PD NNKH or speech are the same and there are levels I, II, III, IV or PD NNKH certification (Karen & Patricia, 2008). If the Netherlands has a four-year PD doctoral program (Maya De Wit & Irma Sluis, 2013), in Australia universities or vocational schools offer PD doctoral training in two types of full-time, two year or part-time four years (Karen Bontempo & Particia Levitzke-Gray, 2008).
In the UK, there are university-level interpreter training programs as well as training programs for certification (diploma) up to level 6. Level 6 certificate holders can interpret a wide range of in-depth content in many fields. different (Signamic, 2013).

 
Level 6 Certificate in Sign Language Interpreting
Table 3.2: Classification of areas of expertise

Education	Job	Medical and social health services	Law and justice
Adult Extra care Postgraduate Schools Court of SEN	Career Interview Train Job support	Protect children Community House Physical health Shift social services Social services at home	Court Interview memo Interview with the police Prison Meeting with a lawyer, legal advisor Court
Entertainment	Mental health	Other Specializations	Theater, art, television
Social events Indoor sporting events Outdoor sporting events	Clinical interview Clinical meeting Healing/healing	Children Conference Disabilities Disability Policy Driving test Gay/lesbian/bisexual Practice/Picture Frame Minimum language skills Other Sign Languages Politics Specific domain Phone Tutors Video Phone	The Deaf's Tavern Talks TV Opera House Seminar

(Source: Signamic, 2013)
Another relevant factor is the agency that grants the PD NNKH's degree. In the US and Canada, there are common certification requirements for the Commission of the Collegiate Interpreter Education (CCIE) for Interpreter Education (CCIE) for at least three years, administered by the Associations of Psychologists, the Board of Education Inspectors. education, Association of Science Language Teachers, ... grant.

1.  Quality regulations

The quality of professional translation is to translate the original content as accurately and completely as possible, without distorting the original message and trying to capture any factual information provided by the speaker under suitable external conditions. (Barbara Moser-Mercer, 1996). This external condition is interpreted as follows:
- Environment (location of interpreter, equipment, air quality, lighting, ...).
- The complexity of the translated content, the problem to be discussed.
- Change in translation problem.
- Conflicting nature of programs/meetings.
Discourse characteristics (text density, emotion, coherence, ...).
- The transfer (speech speed, pronunciation (voice), vibrancy, presentation, ...).
The quality of NNKH translation is also considered as above. However, the quality of scientific research work is not only the correct, sufficient and fast translation of information, but also the attitude and behavior of the scientific writer. Attitude: understanding of deaf culture, respect for language values and experiences of deaf people. Behavior: using culturally appropriate behaviors means not being distracted by auditory stimuli, always using NNKH in the presence of deaf people, supporting the community in reaching out to the deaf and letting people in. Deaf "speaks for himself". (Ken & Lynn Finton, 2019).

1.  Professional ethics standards

In the UK, interpreters are required to register to agree to the principles of the Code of Ethics. The interpreter must:

• Do no harm;
• Honest;
• Take responsibility for your own words;
• Act justly and fairly;
• Information security;
• Respect personal choices

In summary, PDs are required to have appropriate qualifications and are issued by educational or vocational institutions with specialized functions. The quality of speech language teaching is also assessed as speech PD, but has its own requirements for understanding Deaf culture, respecting language values and experiences of deaf people, so that deaf people can "speak for themselves" as well as lead the way. lead the conversation.
 

4. SURVEY RESULTS
   1. General information about survey subjects
      1. Quantitative results

The study was conducted with 226 questionnaires, which are summarized in Table 4.1. General information sheet about survey subjects. In which, Male accounted for 26.11%, Female accounted for 72.57% and Others accounted for 1.33%. The respondents in the survey accounted for the majority of parents - supporters with the rate of 37.17%, the support people accounted for 34.07%. The age of survey participants is mainly from the age group of 21-50 years old, accounting for 55.27%.
 
Table 4.1: Personal information sheet of parents – who supported the survey

TT		Properties	Quantity	Ratio %
first	Sex	male	59	26.11%
		Female	164	72.57%
		Is different	3	1.33%
	Total		226	100%
2	Age	18-20	thirty first	14.22%
		21-30	55	25.23%
		31-40	sixty four	29.36%
		41-50	43	19.72%
		51-60	15	6.88%
		Over 60	ten	4.59%
	Total		218	100%
3	Subject	People with disabilities	first	0.44%
		Parents	84	37.17%
		Teacher	28	12.39%
		Social work student	13	5.75%
		Supporter	77	34.07%
		Is different	23	10.18%
	Total		226	100%

(Source: Survey data of the Center for Research and Education of the Deaf (CED), October-December 2020)
Table 4.2 presents information of 181 PWDs participating in the survey with 55.25% male, 42.54% female and another 2.21%. The age group participating in the survey is from 18 to 40 years old, accounting for the majority with the rate of 88.67%.
Table 4.2: Information panel of the hearing-impaired people participating in the survey

TT		Properties	Quantity	Ratio %
first	Sex	male	100	55.25
		Female	77	42.54%
		Is different	4	2.21%
	Total		181	100%
2	Age	18-20	28	28.87%
		21-30	30	30.93%
		31-40	28	28.87%
		41-50	ten	10.30%
		51-60	0	0%
		Over 60	first	1.03%
	Total		97	100%

(Source: Survey data of the Center for Research and Education of the Deaf (CED), October-December 2020)
Table 4.3 presents information of 24 medical staff from 23 hospitals in Ho Chi Minh City who participated in the survey with 29.17% male, 70.83% female. The age group participating in the survey is from the age group of 21-40, accounting for the majority with the rate of 87.5%.
 
Table 4.3: Information sheet of health workers participating in the survey

TT		Properties	Quantity	Ratio %
first	Sex	male	7	29.17
		Female	17	70.83%
		Is different	0	0%
	Total		24	100%
2	Age	18-20	0	0%
		21-30	twelfth	50%
		31-40	9	37.5%
		41-50	4	8.33%
		51-60	0	0%
		Over 60	first	4.17%
	Total		24	100%

 

1. Qualitative results – in-depth interview

The topic has conducted the following interviews with 3 groups of subjects including: hospital leaders, school leaders and parents. Details are as follows:

• Hospital leaders:

• Becamex Hospital, Department of Otolaryngology.
• Hospital of Ethnic Medicine and Pharmacy.
• Department of Health, Department of Medical Profession.
• Gia An Hospital, Operation Support Department.
• Mekong Obstetrics and Gynecology Hospital, Customer Care/Social Work Department.
• Trung Vuong Hospital, Department of Otolaryngology.
• An Sinh Hospital.
• School leaders:

• Special School May 15, District 11.
• Dong Thap Disability School.
• Special School for Humanity.
• City University of Pedagogy. HCM, Faculty of Special Education.
• Anh Duong Inclusive Education Development Support Center, District 12, City. HCM.

• Parents: 5 parents of children with NKTh are currently students, have graduated from university and are working.

Thus, with the quantitative method combined with the qualitative research method of in-depth interviews, the survey respondents have a certain understanding of the current situation about the ability to meet the needs of hearing impaired patients. when implementing, apply "Vietnam hospital quality criteria". These are also the subjects directly involved in the implementation of the criteria and enjoy the benefits that the criteria brings. Since then, the evaluation and response to the survey is objective and reflects the accuracy of the actual application and implementation of the set of criteria of the individual, at the unit as well as the evaluation of a number of measures that have not yet been evaluated. The author proposes to increase the efficiency, promote the initial legal aid and implement the policy of medical examination and treatment for PWDs (Deaf, Deaf, Late Hearing Loss) in Vietnam in the current context.

1. Popularity of knowledge about Law
   1. Level of access to legal documents

For parents and supporters: Figure 4.1: Accessibility of parents - supporters to legal documents shows an overview of the level of access to legal documents in Vietnam of children. parent – support person. In general, the accessibility to legal documents of the majority is at a low level – Never heard (20.27% of the Law on People with Disabilities, Circular 01 accounts for 33.33%, Circular 03 accounts for 29.28% and the highest is The set of quality criteria for Vietnamese hospitals with 62.67%) and the majority at the level of knowing but not accessing (Law on People with Disabilities: 52.25%, Circular 01: 42.34%, and Circular 03: 40.09%).
Figure 4.1: Level of access to legal documents of parents - supporters

(Source: Survey data of the Center for Education Research for the Deaf (CED), December 10, 2020)
For the hearing impaired: Figure 4.2 shows that the accessibility of people with disabilities to legal documents accounts for most of them at the level of Never heard (42.46% Law on People with Disabilities, Circular 01 accounts for 51.93%, Circular No. 03 accounts for 55.31%, and the highest is the Vietnam Hospital Quality Criteria with 80.56%) and the level of knowledge but not accessible (Law on People with Disabilities: 43.58%, Circular 01: 29.28%, and Circular 03: 29.61% and Vietnam Hospital Quality Criteria: 11.67%).
 
 
Figure 4.2: Accessibility to legal documents of the deaf

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
Thus, based on the statistics in two Charts 4.1 and 4.2 , it can be seen that both parents - support people and people with disabilities have not had access to legal documents for the deaf, especially for the deaf. with the Vietnam Hospital Quality Criteria has the lowest accessibility (Never heard 62.67% for parents and supporters, 80.56% for the deaf).

1. Interest in understanding legal documents

Figure 4.3: The interest in understanding legal documents of parents, support people and people with disabilities shows that parents, support people and people with disabilities have a desire and interest in learning legal documents. (Parents - support people: 71.82% and deaf people: 54.80%) as well as expect this attention to be increased when the need arises.
Figure 4.3: Concerns of parents - supporters and deaf people
to learn legal documents

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)

1. Ability to read and understand legal documents

Figure 4.4: The ability to read and understand the content of legal documents of the survey respondents with the percentage of readers understanding 50% of the content of legal documents or less accounts for the majority. Particularly for people with dementia, the rate of not understanding accounts for 28.45%.
 
Figure 4.4: The ability to read and understand legal documents of parents – supporters
and the deaf
 
 
 
 
 
 
 
 
 

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)

1. The need for assistance in interpreting and applying legal documents

The statistics in Figure 4.5 show that survey respondents need assistance in interpreting and applying legal documents in their lives. 65.6% of parents – support people have support needs and 48.59% of PWDs answered yes. In addition, the survey also found that the option sometimes needed support at 22.94% for parents - support people and 28.81% for people with hearing loss. This also speaks to the need for assistance in case of legal problems.
Figure 4.5: The need for assistance in interpreting and applying legal documents of parents – support people and deaf people.

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)

1. Access to legal documents

Figure 4.6: Parents' approach to legal documents shows that the two channels that survey respondents can most easily access legal documents are: Press television ( Accessible: 26.17% and Accessible but not very understanding: 46.73%) and Social Networks (Accessible: 24.76% and Accessible but not very understanding: 47.09%). The highest level of self-access and understanding belongs to the information channel of the School, the organization of the ASD and because of the disabled person accounts for the rate: 21.03%. Through this channel, the reachable rate also reached 38.79%. In general, in the group of information channels to reach parents - support people, the information channel of schools, organizations of NKTh and because of NKTh has been and is doing better.
Figure 4.6: Access to legal documents of NKTh through the PH-NHT . survey

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
Figure 4.7: The approach to legal documents of the illiterate shows that among the information channels, the information channel of the school, the organization of the illiterate has a proportion that helps the surveyed subjects to continue approach is 42.7%. The family is also an information channel to access legal documents with the rate of 36.87%. The highest rate that NKTh can access legal documents is through social networks with the rate of 43.33% who can access it themselves but do not understand much. Meanwhile, TV channels, newspapers and online legal advice channels do not seem to be effective in helping people with disabilities access legal documents: 44.44% do not have access to legal advice. Direct law and 41.99 not accessible through television channels, newspapers.

 
Table 4.7: Access to legal documents by the deaf

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
Thus, with two survey statistical tables, Chart 4.6 and Chart 4.7 show that Social networks, schools, and organizations of NKTh and because NKTh are two useful information channels that help survey respondents can access to legal documents. However, different subjects will have different approaches, but in general, the ability to understand legal documents through channels is still low and not really effective.

1. Understanding the Rights of the Deaf

The statistics in Figure 4.8 show that there is a huge difference in the understanding of what the rights are for parents – support people and people with disabilities. With the understanding that the right is to enjoy, do and be required, the majority of parents - supporters chose all three of the above ideas with the rate of 88.72%. However, for NKTh when asked, the answer is not really statistically significant with the answers scattered in 7 options almost equally. Thereby also realizing the level of understanding about the rights of people with disabilities needs attention.
Figure 4.8: Understanding of Parents – Supporters and Deaf people about Rights

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)

1. Deaf rights

Statistical information in Figure 4.9 shows the level of understanding about the rights of people with disabilities with benefits: (1) Right to go to school; (2) Right to work; (3) The right to have a hearing aid to wear; (4) Right to interpreter assistance; (5) The right to live independently; (6) The right to equal treatment; (7) Right of access to information; (8) Right to access public transport (bus); (9) The right to be supported in medical examination and treatment. Most parents and support people have knowledge about the right to disabled people and the response rate is over 85% and the highest is 98.23% Right to go to school. Meanwhile, the level of understanding about the AWD's own rights is at a very low level, which is of concern. Only 46.41% of PWDs participating in the survey knew the Right to go to school, 32.6% of PWDs participating in the survey knew the Right to work, 11.05% of PWDs participating in the survey knew the Right to have hearing aids to wear and 9.94% of PWDs participating in the survey. know Right to have interpreter assistance. Most notably for other Rights: Right to independent life; Right to equal treatment; Right of access to information; Right to access public transport (bus); The right to be supported in medical examination and treatment has the rate of 0% understanding.
Figure 4.9: Understanding of parents – support people and deaf people
about the Rights of the Deaf
 

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)

1. Difficulty in accessing the rights of the deaf

Figure 4.10 shows the difficulties that parents-supporters face when accessing the rights of the deaf. In which, most of the difficulties posed by the research team have a high difficulty rate of over 60%. The highest is the difficulty of not knowing where to call for benefits when needed, accounting for 82.03%, followed by Not knowing how to claim benefits when needed at 79.19%.
Figure 4.10: Difficulties of people with disabilities in accessing their rights through the survey of disabled people

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
For AWD, the difficulties summarized in Figure 4.11 show that ASD also has many difficulties in accessing the rights proposed by the research team. Most of the difficulties are considered by NKTh to be at a high level with a rate of over 58% according to the obtained statistics. The biggest difficulty that NKTh faces is the cost of hiring a lawyer at the rate of 100%. In addition, the difficulty in accessing rights that are not met, cannot be solved is also high rate: 74.03%.
Figure 4.11: Difficulties of deaf people in accessing Deaf Rights

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
Thus, given the difficulties that parents - support people and people with disabilities may face when accessing the rights of people with disabilities, the research team has found that the difficulty level is high (ratio of people with disabilities). over 58% consider it difficult). Comparing the two groups of subjects, the parent-supporter group has more difficulties than the ASD (the result of the difficulty level has a higher rate), so it is necessary to pay more attention to this group of subjects. .

1. Seeking assistance in accessing the rights of the deaf

The issue of finding support in accessing the hearing impaired rights of parents and supporters is shown in Figure 4.12. Survey statistics show that most of the problems that the research team surveyed received the result Don't know where to find support with a high rate of over 70%. In which, the problem of Not knowing how to claim benefits when needed accounted for 86.11%. The problem Not knowing where to call for benefits when needed is also high with the rate of 85.58%. The problem When access to rights is not met, the problem is not resolved is also worthy of attention with the rate of 81.69%.
Figure 4.12: Seeking support of NKTh in accessing rights through survey of PH-NHT

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
For subjects who are schizophrenia, when participating in the survey, the search for assistance in accessing the rights of people with disabilities has the results shown in Figure 4.13. Most of the problems that the research team surveyed received the results Don't know where to find support at over 66%. In which, the issue of concern for NTDs is that not knowing where to call for benefits when needed has the highest rate: 76.8%. When access to rights is not met, do not solve the problem with the level of Don't know where to get help obtained with the rate: 72.63%. One point worth noting for NKTh is that there is no funding to hire a lawyer with the results obtained accounted for 87.85% No opinion.
 
 
 
Figure 4.13: Seeking support of the hearing impaired
in accessing the rights of the deaf

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
From two Figure 4.12 and Figure 4.13 on the issue of seeking assistance in accessing the rights of people with disabilities, there is not much difference and there is agreement. Don't know where to find support when accessing hearing impaired rights.

1. The need to learn legal documents regulating the rights and benefits for the deaf

The need to learn the legal documents regulating the rights and benefits for the hearing impaired of the survey respondents is shown in Figure 4.14. The survey results obtained a high percentage of the need to learn legal documents of parents - support people as well as people with disabilities (both over 82%). In which, parents - support people have a higher need to learn with the rate of 91.93%.
Figure 4.14: Needs of parents – support people and deaf people in understanding legal documents regulating rights and benefits for hearing impaired
 

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)

1. Communication media/tools and support needs

In order to find the means and tools suitable for a better view of the survey subjects, the research team conducted an investigation on the means/communication tools used by the survey respondents in Figure 4.15. . The results are as follows: There is a difference in the use of communication tools between parents and the deaf. TV, Facebook, Zalo and phones are the means used a lot by parents - supporters with the rate of over 68%, the highest is the Zalo tool accounting for 78.76%. Besides, the phone is also a popular vehicle with 62.39%. However, for the hearing impaired, the media and communication tool that the survey subjects have access to is TV with the rate of 55.8%. Other media and communication tools that the research team surveyed were also at a low level of less than 20%.
Therefore, the ability to access media and communication tools with ASD needs to be paid more attention in the current technologically developed era.
Figure 4.15: Communication media/tools used by parents – facilitators
and the deaf

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
According to the survey, the research team delved deeper into the survey respondents' use of media and communication tools about the need for assistance in understanding information from the media and tools. The research team investigated 5 methods to support the understanding of information from media and communication tools, including: (1) Sign language subtitles; (2) Vietnamese subtitles; (3) Sign language subtitles and interpretation; (4) Someone writes it down for them to read and (5) a family member explains it again. The results obtained in Figure 4.16 with a high rate at the Frequent level are in most of the methods that support the understanding of information from the media, the highest of which is Sign Language Subtitles. 78%. The Sign Language and Interpretation Subtitle method also had high results with a rate of 77.49%.
Figure 4.16: Support needs of deaf people in understanding information from media/media through parent-support survey

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
For the hearing impaired, Figure 4.17 shows the need for assistance in understanding information from media and communication tools as follows: Vietnamese subtitle method has the highest results 60.92% Frequently needed to help people participating in the survey can understand information from the media. Besides, the Vietnamese subtitle method and the sign language subtitle method and interpretation are two methods to support the need for information understanding for the literate people participating in the survey.
Figure 4.17: Support needs of deaf people in understanding information from
communication media/tools

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
Thus, with survey information from two Diagrams 4.16 and 4.17, it shows that two methods of Sign Language Subtitles and Vietnamese Subtitles help a lot for the literate in understanding information from media and communication tools. pine.

1. Examination and treatment for the deaf
   1. Healthcare

Annual medical examination and treatment information for dementia through a survey of parents - support people and people with dementia is summarized and shown in Figure 4.18 as follows: Most of the survey respondents answered Yes with the rate The rate is over 40%, in which parents - support people who take UTIs for annual medical examination accounted for 48.21% and PWDs who participated in the survey had annual medical examination was 47.46%. With the results obtained from the statistical survey, the annual medical examination for the visually impaired is still low, and there has not been much attention to health in the periodic annual medical examination.
A teacher said: “Every year, children are still examined at school or taken by their parents to medical facilities. However, data on the student's health status has not been linked and integrated between medical facilities, leading to the child's health information being forgotten during the examination, or having Yes, it will take a long time.”
Thus, it is necessary to pay more attention to health as well as to annual medical examination for deaf people.
Figure 4.18: Annual medical examination for the deaf through a survey of parents - supporters and deaf people
 

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
Information on PWDs participating in medical examination and treatment at the hospital was also confirmed by health workers Yes with a rate of 45.83%, of which, Trung Vuong Hospital, Department of Otolaryngology and Otolaryngology has the highest number of patients with UTI in 2020. Another hospital (don't give name) received 20 UTIs, the other three hospitals each received UTIs at 1/2/3. The number of hospitals that "do not record information" whether people with disabilities come to medical examination and treatment or not is 33.33%, hospitals without PWDs come for examination, accounting for 20.83%.

1. Place of medical examination and treatment

The location of medical examination and treatment of UTIs was surveyed, statisticized and summarized by the research team in Figure 4.19. The results obtained most of the survey respondents said that the location of medical examination and treatment at the District Hospital with the rate of 61.5% from parents - support people and 56.35% from the hearing impaired. A remarkable point is that the private - familiar clinic (doctor who knows how to communicate) is also chosen a lot with a rate of 34.96% from parents - support people. Meanwhile, for patients with UTI, choose No medical examination, indicating that the pharmacy buys and drinks with the rate of 41.44%. On the BV side, regarding the registration to meet the quality criteria for A2.5 criteria of the 24 surveyed hospitals, there were only 7 hospitals registered at level 5, namely Gia An, Binh Thanh, Xuyen A, France-Vietnam, and Obstetrics and Gynecology. Mekong, Institute of Ethnic Medicine and Pharmacy, Children's Hospital 2 and 1 hospital are not named. Regarding the district hospital, there is only Binh Thanh District Hospital that has registered to provide NNKH PD, so it is true that the hospital does not have NNKH PD or does not provide NNKH PD. From this issue, criterion A2.5 needs to be reviewed and edited at a more appropriate level so that NBKTh can support PD in all hospitals.
Figure 4.19: Location of medical examination and treatment for the hearing impaired through a survey of parents – supporters and deaf people

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)

1. Difficulty going to the doctor

Figure 4.20 summarizes the survey results of parents - support people and people with disabilities about difficulties in medical examination and treatment for deaf people. The results obtained are as follows: most of the survey respondents said that there are difficulties with the rate of over 62% for UTIs when going for medical examination and treatment. Therefore, difficulties for UTIs when examining and treating patients should be noted and taken care of.
 
Figure 4.20: Difficulties in medical examination and treatment for deaf people through survey
parents – facilitators and the deaf
 

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
The leader of a specialized hearing-impaired school said: “The children have difficulty in making medical declarations (especially during the epidemic season), making records takes a long time and is prone to many errors. During medical examination, children do not easily express their feelings and conditions (usually only respond with gestures, nods or shakes. It is also difficult for the guardian to be completely specific). In addition, children do not know how to "name" symptoms or body expressions correctly. Children almost only express their emotions with gestures, let the companion or the doctor guess. Because the doctor is afraid of being wrong, he can't hear the clear declaration, so to make a conclusion, he has to perform many tests and checks. The next consequence is easy to make patients and family members both costly and confusing. People with disabilities can talk, their ability to interact and deal with problems is better than those who don't know scientific language. But the difficulty of the type who do not know the language of science is that the interpreter sometimes has to use gestures to convey. This increases the percentage of errors and forces the translator to be as flexible + understand the patient as possible.”
The difficulty that patients with dementia encounters is added by the doctor: “Most of the patients with hearing loss are accompanied by family members who understand, through their family members. However, it is difficult for some patients to go alone, without a support person.”
A school leader with disabilities said: “The majority of deaf students cannot use verbal language but only use gestures or sign language, which in many cases parents do not understand. There is no interpreter, but teachers cannot always go to the hospital when children have medical examination and treatment needs. Therefore, in an emergency situation where a sign language interpreter is not available, there is an increased risk of diagnosing and providing the correct treatment for the child.”
The leader of the special school said: “Sometimes, the number of teachers accompanying them is not enough to translate for all the children who come to the clinic. Students do not cooperate with the doctor (they do not understand the doctor's request) or the doctor does not understand the student's response…. There are also cases where parents taking their children to the doctor do not have enough scientific knowledge to explain to their children the doctor's request."
A teacher added: “The common difficulty of UTIs when going to the doctor is not being able to speak, so the doctor's examination process takes a long time to accurately identify the disease. The next difficulty is that when the patient knows how to use sign language, the parents do not know, the district-level hospital, or the provincial hospital does not have a PD, a teacher to teach the child or has but cannot respond at the time. children in need of medical care. On the other hand, many students' ability to use scientific language to communicate is still limited, not to mention medical terms that are difficult for children. Even the PD of scientific research also encounters confusion when having to translate medical terms for students to understand. In emergency situations, the lack of quality STIs can increase the health risks of UTIs.”
Besides the difficulties, there are advantages for the hospital when examining and treating the deaf: “PWDs suffer from many disadvantages in society, so they often do not show discomfort or demand. Their satisfaction levels are largely very high. I have never had a problem with hearing impaired patients. For example, many sick people have to wait, ordinary people often ask why they have to wait and are uncomfortable, and schizophrenia is very patient, does not show discomfort in life, is always satisfied with what they have." – According to a doctor at the hospital added. Parents of children with NKTh also commented: “The doctors and nurses have too many patients, and the examination time is very short, so when you want to train your child to discuss his or her own problems with the doctor (for example, to If the child tells himself where he is in pain, where is the discomfort…), the doctor is not patient enough to listen and give him the opportunity to communicate on his own.”
The hospital side also gave the same answer when they said that medical examination and treatment for people with disabilities faced difficulties (over 50%), in which, for deaf people it was 58.33%, people with hearing loss and people with late hearing loss were at the same level of 50. %. Figure 4.21 shows the level of difficulty in providing medical examination and treatment for UTI from the hospital.
Figure 4.21: Difficulties of hospitals in providing medical examination and treatment for deaf people

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)

1. Identification of the deaf

In order to understand the ability to identify people with disabilities as well as have appropriate support solutions in medical examination and treatment for people with hearing impairment, the survey team conducted a deeper survey on whether health workers can identify and communicate with people with disabilities. or not, as well as the way health workers approach and support UTIs as follows:
Identification of patients with hearing loss – deaf, hard of hearing, late hearing loss – from the health worker's point of view is possible. Deaf people can be recognized 91.57%, people with hearing loss 70.83% and people with late hearing loss 58.33%. This identification comes from seeing hearing aids, self-reported hearing loss, family members speaking, through disability certificates, how the disabled person responds to sound, having assistance, and even being recognized from the past. age (older age).
For parents - support people, the survey results obtained in chart 4.22 show the problem of communicating with people with disabilities when going for medical examination and treatment as follows: 75.66% of parents - support people think that health workers cannot communicate with people with disabilities. NTDs and 43.65% for UTIs participating in the survey. Thus, the problem of communicating with NKTh in medical examination and treatment needs attention and attention.
Figure 4.22: Medical staff communicating with deaf people through survey
parents – facilitators and the deaf

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)

1. Communication aids to assist deaf people in hospitals

Figure 4.23 shows that health workers communicate with ASD through the parent-supporter survey as follows: The written method is chosen on a regular basis with a high rate of 97.35%; Listening and Speaking method has the rate of 59.13%. Gestures have a rate of 55.96% Occasionally. Most notably the notation method has a rate of 77.03% Never.
 
 
 
 
Figure 4.23: How to communicate between medical staff and the deaf through survey
parent – support person
 

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
For patients with disabilities participating in the survey, the results of the assessment of communication problems of health workers with disabilities are shown in Figure 4.24 as follows: 100% of patients with disabilities agree with the method of writing on paper. The Sign Language method has a rate of 73.48% Never used. Other methods that also have a high rating of Never at 61.11% include: Visual Assistance (video, illustrations) and Audiovisual.
One parent said: “For people with disabilities, there are countless different difficult situations when going to the hospital for medical examination and treatment by themselves. Most people with disabilities often go with their family members in case they need medical examination and treatment. Personally, I have a deaf brother who is 17 years old this year, but he is not fluent in communication because he knows very few words, as well as cannot read and understand books and newspapers. Her main language is sign language, so it is impossible to go to medical examination and treatment alone when in the hospital there have never been leaflets with instructions in sign language or specialist staff using that language. sign language. It's as simple as an eye exam, I understand and do as instructed, but the doctor can't communicate with me and guide me what to do next. Family members always followed closely just to do the job of the language interpreter during that process.”
Besides, another parent commented: “In fact, I observed that large hospitals only have items such as wheelchair ramps, toilets for the disabled using wheelchairs. … ie focusing only on the type of motor disability. While there are other forms of disability such as visual impairment, hearing impairment, etc., have not been paid attention to and supported.”
More notably: “During the time when Covid happened and everyone had to wear masks, I couldn't see the Doctor's face to be able to communicate by myself. At these times, parents must always follow to support.” (A parent should be clear).
Figure 4.24: Communication between medical staff and the deaf
through a survey of the deaf

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
In conclusion, with diagrams 4.23 and 4.24 about the means of communication with the deaf used by health workers through a survey of parents - support people and people with disabilities, it shows that writing on paper is a frequently used method. The use and use of Sign Language is still limited and has not been widely used in communicating with people with disabilities for medical examination and treatment.
Through interviews, the research team also received suggestions for communicating with deaf patients: “The patients who come to me are often adults who are suddenly deaf or have hearing loss, don't know it. NNKH. With these hearing impaired, it is possible to speak loudly for the patient to hear, or communicate verbally or visually. Hospitals should have someone with expertise to communicate with hearing impaired patients. For patients who do not know NNKH, it is possible to communicate with images.”
On the BV side, evaluate the communication with the patient according to the means of communication. Communicating with Aesthesia Very difficult 16.67% and Difficult 45.83%, Verbal communication with lip reading support is Very difficult 12.5% and Difficult 54.17%, while Communicating with ASD is said to be Easy to Pass Written Paper accounts for 54.17%, Images 41.67%. Figure 4.25 presents the results of the survey of health workers on the means of communication with patients with dementia.
 
 
 
 
 
Figure 4.25: Assessment of medical staff on communicating with deaf people

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)

1. The level of understanding the communication content of the hearing impaired

With communication methods, the research team continued to survey and assess the level of understanding of communication content of deaf children/clients to communicate with health workers in medical examination and treatment as shown in Figure 4.26 according to assessment. of parents - support people and Figure 4.27 according to the assessment of NKTh who participated in the survey are as follows:
For parents - support people, Figure 4.26 shows that among the communication methods, the written method has the highest rate of helping the ASD understand the communication content with the highest rate of 38.39% and the least understanding at the lowest level. 47.39%. Most of the methods give little understanding and high rate of full understanding. Thus, understanding the content of communication to communicate with health workers is still limited and requires a combination of communication methods.
An interviewed parent said: “When you go to any hospital for medical examination and treatment, you must be accompanied by a parent or a family member to the clinic, telling the doctor to fully understand your child's intentions. I can't say it all by myself."
 
 
 
 
Figure 4.26: The level of understanding the communication content of the hearing impaired child/child/client to communicate with the medical staff through the parent-supporter survey

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
For the deaf, the survey results show that the level of understanding of the contents of communication with health workers of the NBKTh is not really high with the Not understanding rate ranging from 35.39% (gestural gestures)) to 53.93% (hearing) speak). The level of understanding the content of communication for re-communication lies in the result of Little understanding accounting for 27.53% (Writing on paper; Sign language) to 50.56% (Gestures). Method of Writing on Paper; Sign language is the two methods to help patients with disabilities Understand all the communication content to communicate with health workers is not really effective with the rate of 23.03%.
Figure 4.27: The level of understanding the content of communication with medical staff of the hearing impaired

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
In general, through the survey on the understanding of patients with disabilities about the content of communication with health workers, there are still many difficulties and not really effective.
A doctor also expressed his desire to understand the content of communication with schizophrenia as follows: “I also want to take courses on schizophrenia, reading lip signals to communicate closely with patients. When the doctor is wholehearted, the patient will trust.”
Medical staff also said the effectiveness of NNKH in medical examination and treatment is as follows: "If there is an interpreter of NNKH, the inquiry as well as the doctor's guidance with UTI will be greatly supported".
Another doctor also said: “The hospital does not have human resources specialized in sign language. Most hospitals in Saigon do not have them. Patients who meet with a doctor are often accompanied by family members, the content of the exchange certainly cannot be as complete as if it could be exchanged directly with the patient. In the case of completely deaf people who can read and write well, they can communicate through paper.”

1. Support the hearing impaired

The chart 4.28 below summarizes the statistical results of the survey of parents - support people and people with disabilities in the assessment of health workers supporting people with disabilities during medical examination and treatment as follows: The obtained results all show that health workers have support disability support with the rate of 54.42% of parents - support people answered Yes and 50.83% of disabled people answered yes.
Figure 4.28: Medical staff support deaf people during medical examination and treatment through parent-supporter surveys and hearing impaired people survey
 

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
Figure 4.29 shows that UTIs are interpreted during medical examination and treatment through a survey of parents - supporters and UTIs as follows: Most people with dementia when going for medical examination and treatment are accompanied by an interpreter with a rate of 67.96%. yes of NKTh and 49.56% of parents - support people answered yes.
In-depth interviews with doctors at the hospital also added: "The hospital always wants to care for patients equally between normal (hearing) people and deaf people."
Besides, the health worker also suggested: “Hospitals not only have UTIs but also many other diseases. NKTh should bring their own set of support tools.”
Another doctor also added: “The responsibility of supporting UTI needs to be reciprocal and interactive, not only in the medical staff/hospital but also the responsibility of families, and social organizations. . People with disabilities themselves also need a basic level of communication. Communicating with NKTh has many ways, in addition to direct sign language, maybe through the phone, with children, their parents accompany them.”
A teacher interviewed said: “Most people with disabilities go to medical examination and treatment with family members to support part of communication.”
Figure 4.29: Translators in the process of medical examination and treatment for the deaf through a survey of parents - support people and deaf people
 

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
Through in-depth interviews, the research team also received suggestions: “In addition to supporting deaf patients to communicate with doctors, they also need support people and nurses in departments such as taking blood, receiving medicine, and needing people. assisting patients in performing subclinical problems or receiving and returning medicines at the hospital.”
The medical staff at the hospital also said: “Last year (2019) the Department accepted the CED's training certificate in supporting UTIs. In 2020, the Department also agreed to approve, without deducting points, but required that in 2021, there must be a contract of NNKH translation. The Department cares about the quality of communication with NKTh. They want the person who communicates with the disabled person to know the science of language, not just the person who supports social work. If possible, there should be a department specializing in UTIs, but currently the hospital is in charge. The social work staff on my side is full of concurrently, the administrative side, the agent side, and the patient support. Thus, the concurrent person has no expertise, is not specialized and is passive when supporting ASD. If the hospital does not have that department, but the center has it, it can be contracted, because it is difficult to get a multi-purpose person. It would be better to have a part that is not passive in supporting NKTh.”
According to another doctor's opinion, supporting UTI needs: "with the participation of three parties: the Department of Health makes a policy, acts as a bridge with the hospital and connects with capable training units (people) have expertise in sign language).”
In addition, another doctor suggested: “There should be a hospital specializing in the disabled, with a separate department for the deaf. From doctors, nurses and staff trained in sign language, gather the best support tools for the hearing impaired.”

1. Roadmap to support hospitals in implementing the Criteria
   1. Sign language interpreter at the hospital

Figure 4.30 shows the need for sign language interpreters at the hospital through a survey of parents - support people and people with disabilities as follows: Results obtained with a high percentage of survey subjects need language interpreters. sign at the hospital 61.95% of parents – support people answered Yes and 42.54% of patients with ASD answered Yes. Thus, there is a need for sign language interpreters at the hospital and better support for people with disabilities in medical examination and treatment.
A doctor also gave the following opinion: “Communication facilitators help remove difficulties in asking questions and treating patients. Having a support person will make the information provided to the doctor and the doctor's communication to the patient most complete. Otherwise, the communication content may be lacking, not having the desired effect. For me personally, the patient is also the customer. Having someone to support communication will increase service quality, and increase patient satisfaction with hospital care.”
health worker said: “Before there was no CED, it was difficult to access interpreters. During the CED training, I went to school, but (the Department) required someone who knew more in-depth science and technology.”
A school leader in charge of the hearing impairment shared: “The role of the interpreter is very important, decisive and influential, while people with disabilities, if they have access to all faculties/departments, will need to make demands. is very high in interpreters in terms of professional knowledge and interpretation techniques. Interpreters need not only accurate and reliable knowledge, but also smooth communication and coordination with doctors. Although this is an opportunity for people with disabilities/specifically hearing impaired, it is also a barrier in medical examination and treatment that is still left open and difficult to solve.”
Figure 4.30: Surveyed demand for sign language interpreters at hospitals
parents – facilitators and the deaf

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)
On the BV's side, regarding the issue of NNKH PD, there are two forms: having staff PD NNKH and having a contract PD NNKH. In the case of PD staff, 54.17% of hospitals do not have PD staff, 25% Yes are hospitals that have staff who take the course “Skills to support the deaf in the hospital” organized by the Center for Research and Education for the Deaf. hearing (CED) training, and 16.67% are intending. In the case of signing a contract for PD NNKH, the number of hospitals with similar Yes and No answers accounted for 35.5%.
With a high demand for PD from parents - support people and a high level of disability, but from the BV side, providing PD staff or signing a contract for PD NNKH without PD NNKH shows that the implementation of BTC is difficult. Complementing the lack of clinical PD, the survey team also asked about the hospital's ability to provide other support for patients with schizophrenia. The results show that 33.33% of BV has no other support. In case the BV provides other support, specifically as follows: pictures, writing paper, arranging staff to accompany you, support by gestures, etc.

1. Priority policy

The study to survey the need for priority policy for medical examination and treatment for dementia of parents - support people and people with disabilities is summarized and shown in chart 4.31 as follows: 94.69% of parents - support people responded. yes and 72.38% of people with disabilities said yes in the need for a policy to prioritize medical examination and treatment for the hearing impaired. Thus, the development of a policy of prioritizing medical examination and treatment for people with disabilities is very necessary in supporting and creating all favorable conditions for people with dementia to have good health as well as enjoy the benefits of people with disabilities that have been issued in the past. state laws.
One parent interviewed commented: “Policies to specifically support people with disabilities should be added throughout the process of accessing departments and rooms in the hospital and using medical examination and treatment services in the hospital. hospital."
Chart 4.30: The need for a policy to prioritize medical examination and treatment for the hearing impaired
through a parent-supporter and hearing-impaired survey

(Source: Survey data of the Center for Education Research for the Deaf (CED), October-December 2020)

1. Regulations on supporting the deaf according to BTC

The survey team conducted to ask the BVs about the A2.5 criteria, the BTC required at level 5 is difficult for the BV. Survey results, Very Difficult and Difficult together account for 20.83%, while 50% of BV consider it Relative. According to BTC, level 5 is for hospitals that have the capacity to provide services at the international level and thus those hospitals that do not have the capacity and need to register at level 5, like district hospitals, do not have NNKH PD. is fully still meets BTC. It is worth mentioning that the majority of deaf people with difficult living circumstances because they cannot work are unable to participate in medical examination and treatment at international standard hospitals. They can only use the services of district hospitals and cannot provide NNKH PD. Is this a disadvantage for NKTh? To this question, 29.17% of BV answered Yes, 16.67% said that there would be no disadvantage because they would use paper, writing, pictures, etc. The remaining 54.17% had no opinion.
Regarding other supports besides PD NNKH, when asked if they knew about the training program "Skills to support the deaf in the hospital", with the results obtained 45.83% BV answered Don't know, 25% Yes know and 29.17% Inquiring.
In the end, 41.67% BV shared, BTC needs to be supplemented with regulations to support the deaf in the hospital, while 50% have no opinion. And the specific regulations are: accompanying relatives, hearing aids, requesting a family member (provided email, phone).

 

5. CONCLUSIONS AND RECOMMENDATIONS
   1. Conclusion

The survey “Assessment of the ability to meet the needs of deaf patients: A case survey of “Vietnam hospital quality criteria”” with the survey sample number: 226 parents – support people, 181 patients, and 24 Hospitals, although not perfectly representative for each target group, partly shows that there is a need for practical support for people with disabilities to access thoughtful and effective medical examination and treatment.
Regarding access to legal documents :
- An alarming number of 62.67% of parents - supporters and 80.56% of deaf people do not know BTC.
- Other legal documents related to the rights of PWDs in general and PWDs in particular have not been accessed.
- 71.82% Parents - support people, 54.80% of deaf people have a desire and interest in learning legal documents and this interest increases when there is a need. Reading legal documents or not knowing where to find support when accessing these documents is a barrier. The government, the executive agencies need a strategy for the Law to enter into the hearts of people – to be implemented and supported.
- The survey team also found that the communication tool that parents - support people as well as NKTH use the most, convenient to disseminate the Law is TV with Vietnamese subtitles and NNKH subtitles.
Regarding medical examination and treatment for UTI : there are many related issues and should be considered as follows
Place of medical examination and treatment: Patients and their families choose District Hospitals for health care. This is understandable and logical because most of the people with disabilities are poor (poor or near-poor). While, PD service is only provided at world-class hospitals that have registered criteria A2.5.
- In order for patients to have access to medical treatment, it should have lower requirements for medical treatment - all medical conditions are required - so that patients can be cared for and monitored fully and accurately, thereby contributing to implementation of Goal 10 of the 17 Sustainable Development Goals of the United Nations is poverty reduction.
- Regarding the provision of medical treatment services, hospitals also have difficulties and expect to be supported so that they have an official PD, not a part-time social worker. The support includes having a budget for at least 01 NNKH PD (for district hospitals), being supported with funding and connecting with low price NNKH PD; create conditions for staff to go to intensive study on scientific research, etc..
For patients with disabilities, gender violence, especially sexual abuse, the hospital needs to arrange a safe and private examination space, making it easy for patients to cooperate in medical examination and treatment. as well as tell his story (Le Xuan Dong, 2021).
Identification of the deaf . Hearing aid declaration and carrying requirements are most expected.
- Disability declaration can be easily overcome if the hospital takes the initiative to obtain information about UTI from the patient receiving stage.
- Regarding hearing aids, not all patients with hearing loss can afford hearing aids and better quality (in case of too deep hearing loss) is equipped with cochlear electrodes.
- It is known that in Vietnam, families have to pay 100% of the cost for hearing aids, which are very expensive and have a lifespan of no more than 5 years. The Center for Research and Education for the Deaf (CED) has a fund to support hearing aids for deaf children from poor families, but the capacity to donate hearing aids is not more than 100 devices/year (50 children with hearing impairment). If hearing impaired children are detected early, wearing hearing aids early will give them the opportunity to hear - speak and communicate with health workers, helping the hospital reduce the pressure of implementing criteria A2.5, BTC.
Focusing on identifying deaf people suffering from gender-based violence and having solutions to support them, the screening and detection of domestic violence victims are specified in Clause 4, Circular 24/2017/TT-Ministry of Health. Asking people with disabilities about violence should go hand in hand with an effective response, including an initial response and, if necessary, referral within the health system or outside (Le Xuan Dong, 2021). .
Difficulty in communication : It is not always convenient to identify a patient with dementia to get appropriate support, both parents and support staff, and the hospital. The biggest difficulty is that people with disabilities cannot communicate with health workers or parents who are confused in communicating information back and forth between deaf children and health workers. PD NNKH is still a solution. This problem again forms a vicious circle: Which hospital has PD NNKH, if so, does the parent's pocket allow it?; Deafness (hard of hearing, late hearing loss) don't know what it is like…; Not to mention, scientific research in medicine is still very limited in Vietnam. With this difficulty, the most chosen supportive communication method is writing on paper, gestures, pictures, videos, reading lip signals, health workers model for patients to follow, etc... Therefore, communication methods This expectation needs to be added to BTC.
Evidence related to criterion A2.5 : “Last year (2019) Ho Chi Minh City Department of Health (hereinafter referred to as Department) accepted CED's training certificate in supporting UTIs. In 2020, the Department also agreed to approve, without deducting points. In 2021, there must be a NNKH translation contract. The Department cares about the quality of communication with NKTh. They want people who communicate with ASD to know scientific language, not just the person who supports social work”. CED started signing PD NNKH contract with BV in 2016 and has interpreted for 1 Japanese patient at France - Vietnam Hospital. Over time, CED realized that the problem was how to help health workers better understand UTI and provide appropriate support, not just sign a contract to PD and collect money. CED has designed a 3-day training program "Skills to assist the deaf in the Hospital" and is looking forward to working with the Department of Health to listen to expectations in order to improve the learning program both in terms of time and quality. This expectation is completely justified and is similar to the opinion of a doctor: “Supporting people with dementia requires the participation of three parties: the Department of Health sets the policy, acts as a bridge to the hospital and connects with other medical institutions. unit capable of training (people with expertise in sign language).”
Regarding the roadmap to support hospitals to implement the Criteria: it is suggested that “Policies to support people with disabilities should be specifically added throughout the process of accessing departments and rooms in the hospital and using medical examination and treatment services in hospitals”.
On the BV's side, regarding the issue of NNKH PD, there are two forms: having staff PD NNKH and having a contract PD NNKH. Either way, the hospital needs funding and a roadmap to complete the "Process to support the deaf in the hospital". In addition, in addition to the lack of scientific PD, there are other supports, such as: pictures, writing paper, arranging staff to accompany, support with gestures, etc. In the hospital support program for UTIs, CED has the capacity to provide information and help hospitals improve.
In summary : the implementation of any legal policy, not only with BTC, there are difficulties and problems, but there are always solutions if there is coordination between the parties: Legislator/law enforcement party – NKTh and family - organizations of and for people with disabilities such as CED.

1. Request

From the survey results "Assessing ability to meet the needs of deaf patients: A case survey of "Vietnam hospital quality criteria"" under the Project "Promoting initial and practical legal support". policy examination and treatment for the deaf (Deaf, Deaf, Late Hearing Loss)” conducted by the Center for Education Research for the Deaf (CED) with funding from the European Union through JIFF and Oxfam, the Project Team would like to present the following recommendations:

1. SIGN LANGUAGE TRANSLATION (NNKH): MINIMUM SERVICE OR INTERNATIONAL LEVEL?

 
Recommendation 1 : Indicators 10 and 11, level 5 of Criterion A2.5 should be moved to level 2 or level 3
Index 10. Having interpreters for deaf patients or having a plan to cooperate and sign contracts with interpreters in case hearing impaired patients come for medical examination and treatment.
Indicator 11. Ensure that interpreters for hearing impaired patients are available within 90 minutes upon request.
 
Recommendation 2: There should be a formal training program for sign language interpreters.
 

2. SUPPORT FOR THE LISTENING (deaf, hard of hearing, late hearing loss): TOOLS & SKILLS

 
Recommendation 3 : The set of criteria should be supplemented with appropriate support methods for each type of disability LISTENING through communication using scientific language; speaking and listening through lip reading; write down on paper; Picture; video clips; gesture gestures; ...
 

3. DISABILITY AWARENESS IS IMPORTANT

 
Recommendation 4 : The training topic "Skills to support the deaf in hospitals" should be included in the Bachelor's training program in Social Work and Community Health.
 

4. SKILLS TRAINING PROGRAM SUPPORTING THE HEARING PERSON AT THE HOSPITAL

Recommendation 5 : The Ministry of Health and the Department of Health of Ho Chi Minh City need to coordinate with professional social organizations in the process of developing skills training programs to meet the hospital quality assessment standards of the Ministry/Department. both in terms of time and quality of training.
 

5. HEARING DEVICES, CONTACT: need or not? What is the solution to reduce the financial burden for parents?

 
Recommendation 6 : Hearing aids and cochlear implants should be included in the list of goods for which Health Insurance is calculated.
 

6. ACCESS TO INFORMATION FOR PEOPLE WITH THE LISTENING

Recommendation 7 : Sign language subtitles and Vietnamese subtitles are required on all TV channels of the Central and HCMC.
 
After CED and the Project team held a workshop on Report on Survey Results on November 14, 2021 and a Conference on Policy Comments on December 9, 2021, with the participation of comments from all participants. The survey team adjusted the recommendations to the following key issues:
Recommendations related to BTC
1. BTC needs to move Indicators 10 and 11, level 5 of Criterion A2.5 needs to be moved to level 2 or level 3.
2. BTC needs to be supplemented with appropriate support methods for each type of disability LISTENING through communication using scientific language; speaking and listening through lip reading; write down on paper; Picture; video clips; gesture gestures; ...
3. BTC needs to add a symbol to identify NKTh at the hospital.
Recommendations related to NNKH/NNKH translation
4. There should be a formal sign language interpreter training program and policy for NNKH interpreters
5. Universalizing scientific language: schools teach scientific language to pupils and students.
Recommendations related to the skills of supporting UTIs at the hospital
6. Bringing the training topic "Skills to support the deaf in hospitals" into the Bachelor's program in Social Work and Community Health.
7. Experts of the Ministry of Health and the Department of Health of Ho Chi Minh City need to develop a skills training program that meets the standards of hospital quality assessment both in terms of training time and quality.
Recommendations related to communication support for people with disabilities
8. Hearing aids and cochlear implants are included in the list of goods for which health insurance is calculated.
9. Sign language subtitles and Vietnamese subtitles are required on all central TV channels and HCMC.
10. Disseminate the newborn hearing screening program, promote early detection, early intervention and early wearing of hearing aids.

 
REFERENCES
Foreign

1. Americans with Disabilities Act (ADA) 1990, ADA Business BRIEF: Communicating with People who are Deaf or Hard of Hearing in Hospital Settings , Disability Rights Section, Civil Rights Division, US Department of Justice, 2003.
2. Association of Sign Language Interpreters, Various Code of Ethics , Association of Sign Language Interpreters, 2013.
3. Barbara Moser-Mercer, Quality in Interpreting: Some Methodological Issues , ETI, Université de Genève, 1996.
4. Carol Padden & Tom Humphries, Inside Deaf Culture , Harvard University Press, Cambridge, Massachusetts, London, England, 2005.
5. Catherine E. Shearer & Mary Ann Playford, Living with hearing loss , 1997 (1986, 1988, 1990, 1993, 1997).
6. Commission on Collegiate Interpreter Education (CCIE), Accreditation Standards for Interpreter Education within the United State and Canada , 2019.
7. Cynthia B. Roy, Advances in Teaching Sign Language Interpreters , Gallaudet University Press, 2005.
8. Deaf Soceity, Workplace Gender Equality Agency, Australian Government, 29 July 2020.
9. Delys Magill, Healthcare Interpreting from a New Zealand Sign Language Interpreters' Perspective , 2017.
10. Gallaudet University, Legal Rights: The Guide for Deaf and Hard of Hearing , 2000.
11. Jemina Napier, Sign language Interpreter Training, Testing, and Accreditation: An International Comparison, American Annals of the Deaf, Volume 149, Number 4, Fall 2004, pp. 350-359 (Article), 2004.
12. Hearing Loss Association of America (HLAA), Guide for EFFECTIVE Communication in Health Care , 2018.
13. International Federation of Hard of Hearing People (IFHOH), Agreement on Terminology Between the International Federation of Hard of Hearing People and the World Federation of the Deaf , 2013.
14. Karen Bontempo & Patricia Levitzke-Gray, Imterpreting Down Under: Sign Language Interpreter Education and Training in Australia , 2008
15. Ken & Lynn Finton, Strategies in preparation for interpreter education , 2019.
16. Maya De Wit & Irma Sluis, Sign Language Interpreter Quality: the Perspective of Deaf Sign Language Users in the Netherlands, Dutch Association of Sign Language Interpreters, 2013
17. National Association of the Deaf (NAD), COVID-19: Deaf and Hard of Hearing Communication Access Recommendation for the Hospital , 2021.
18. National Association of the Deaf (NAD), Legal Rights – The Guide for Deaf and Hard of Hearing People , Gallaudet University Press, Fifth Edition (1982, 1984, 1986, 1992, 2000),
19. National Association of Deafened People (NADP), A guide to working with patients experiencing hearing loss, 2020.
20. National Institute on Deafness and Other Communication Disorders (NIDCD), American Sign Language , 2019
21. Office of Deaf Access (ODA), Basic Medical Sign Language , California Department of Social Service, 2015.
22. Royal National Institute for Deaf People (RNIDP), Communication Tips for Health & Social Care Professionals , 2020 .
23. Royal National Institute for Deaf People (RNIDP), Communicating with People who are Deaf or have hearing loss, 2020 .
24. Signamic Training & Consultation, Specific Domains, Various Quality Assurance Sysems, Various Code of Ethics , Signamic Training & Consultation, 2013.
25. Steven Barnett, Communication with Deaf and Hard of Hearing People – A Guide for Medical Education , 2002.
26. Zennancho, https://www.zennancho.or.jp/info/archive/
27. Steven Barnett, Communication with Deaf and Hard of Hearing People – A Guide for Medical Education , 2002.
28. United Nation, Convention on the Rights of People with Disabilities , 2006.
29. Ursula Bellugi & Susan Fischer, A comparison of sign language and spoken language, The Salk Institute for Biological Studies, 1972.

 
Domestic

30. Ministry of Health, Vietnam Hospital Quality Criteria (Version 2.0) , 2016.
31. Medical Examination and Treatment Administration, Ministry of Health, Some essential requirements for hospital quality assessors , 2018.
32. Duong Phuong Hanh, World of the Deaf , Youth Publishing House, 2010.
33. Duong Phuong Hanh, Living with Hearing Loss (Translated Book), 2012.
34. Duong Phuong Hanh, Handbook to support deaf people to integrate into the community, 2015.
35. Duong Phuong Hanh, Teaching skills to support the deaf at the Hospital , 2020.
36. Duong Phuong Hanh, Textbook of Medical Sign Language , 2021.
37. Dang Ngoc Tran, Screening for congenital deafness , District 1 Hospital, 2021.
38. Dang Ngoc Tran, Experience in medical examination and treatment for people with hearing loss , District 1 Hospital, 2021.
39. Dang Ngoc Tran, Frequently asked questions during medical examination and treatment, District 1 Hospital, 2021.
40. Le Xuan Dong, Some principles and notes for healthcare workers and patients, 2021.
41. Nguyen Trong Khoa, Guide to hospital quality assessment , Department of Medical Examination and Treatment Management, Ministry of Health.
42. Pastuer College of Medicine and Pharmacy, 14 essential needs of patients that nurses need to remember , 2019.

 
Legal documents

43. Law on Medical Examination and Treatment No. 40/2009/QH12.
44. Decree No. 87/2011/ND-CP dated September 17, 2011.

 
 

 
APPENDIX
ANNEX 1: Surveyed hospitals:
 

Stt	Hospital Name	Address	Labour	Private
first	Tan Hung General Hospital	871 Tran Xuan Soan, Tan Hung Ward, District 7 Phone: (+84) 28 3776 0648 Website: www.benhvientanhung.com		first
2	Gia An Hospital 115	5 Street No. 17A, Binh Tri Dong B, Binh Tan		first
3	Binh Thanh District Hospital	112AB Dinh Tien Hoang, Ward 1, Binh Thanh	first
4	Vinh An Duong Clinic	219 - 221 Duong Tu Giang, Ward 4, District 11 Phone: 028.3955.2647 - 028.3601.3080		first
5	Xuyen A Hospital			first
6	Frace-Vietnam hospital	6 Nguyen Luong Bang, South Saigon (Phu My Hung), District 7, City. Ho Chi Minh Phone: (028) 54 11 33 33 3rd floor, Bitexco Financial Tower, 2 Hai Trieu, District 1, City. Ho Chi Minh - (028) 62 90 61 67 Hotline 028 54 11 33 33 Fax: 028 54 11 33 34 Emergency: 028 54 11 35 00Email: information@fvhospital.com - saigonclinic@fvhospital.com Website: http://www.fvhospital.com/en/trang-chu/		first
7	Mekong Maternity Hospital	243A - 243B Hoang Van Thu, Ward 1, Tan Binh	first
8	Tan Phu Hospital	609 - 611 Au Co, Phu Trung Ward, Tan Phu District, City. Ho Chi Minh City Email: bv.tanphu@tphcm.gov.vn	first
9	Institute of Ethnic Medicine and Pharmacy	No. 273 - 275 Nguyen Van Troi, Ward 10, Phu Nhuan District, Ho Chi Minh City Phone: (028) 38443047 Email: v.ydhdt@tphcm.gov.vn Website: https://www.vienydhdt.gov.vn	first
ten	Children's Hospital Ho Chi Minh City	15 Vo Tran Chi, Tan Kien, Binh Chanh, HCMC. Phone: (028) 2253 6688 Fax: (028) 2253 8899Email: bv.nhidong@tphcm.gov.vn Website: www.bvndtp.org.vn	first
11	Vinmec Hospital	2 - 2 Bis Tran Cao Van, Da Kao Ward, District 1, City. Ho Chi Minh Phone number: (028) 3520 3366 Website: https://vinmec.com		first
twelfth	Oncology Hospital	- No. 3 No Trang Long, Ward 7, Binh Thanh District, City. HCM - No. 6 Nguyen Huy Luong, Ward 14, Binh Thanh District, City. HCM- No. 47 Nguyen Huy Luong, Ward 14, Binh Thanh District, City. HCM- Road 400, Cay Dau Hamlet, Tan Phu Ward, District 9, City. Ho Chi Minh City Phone number: (028) 38433021 - (028) 38433022	first
13	Children's Hospital 1	341 Su Van Hanh, Ward 10, District 10, Ho Chi Minh City Phone: (028) 39271119bvnhidong@nhidong.org.vnWebsite:http://nhidong.org.vn	first
14	An Sinh General Hospital	10 Tran Huy Lieu, Ward 12, Phu Nhuan District, Ho Chi Minh City Phone: 028.3845.7777Hotline: 093.810.0810Fax: 028. 3847.6734Email: info@ansinh.com.vnWebsite: http://www.ansinh.com .VN/		first
15	Children's Hospital 2	14 Ly Tu Trong, Ben Nghe Ward, District 1, City. Ho Chi Minh City Phone: (028) 38295723 - (028) 38295724. Website: http://www.benhvienhi.org.vn/	first
16	District 8 Rehabilitation Hospital	125/61 Au Duong Lan Ward 2, District 8	first
17	Trung Vuong Hospital	266 Ly Thuong Kiet, Ward 14, District 10 Email: bv.cctv@tphcm.gov.vn Phone number: 028 38656744 – 38642750 Fax: (84 8) 38650687 Website: http://bvtrungvuong.vn	first
18	Becamex International Hospital	Go Cat Area, Lai Thieu Ward, Thuan An City, Binh Duong Province. Email: contact@bih.vn Phone: (0274) 3 681 681 Website: https://bih.vn/		first
19	District 1 Hospital
			ten	8

 
Reference links:
https://toplist.vn/top-list/benh-vien-tu-nhan-tot-nhat-tai-tp-ho-chi-minh-10931.htm
https://smartbuddy.vn/bai-viet/top-10-benh-vien-da-khoa-nha-nuoc-tai-thanh-pho-ho-chi-minh  
 
ADDENDUM 2: Survey questionnaire for low-income patients (Attached)
ANNEX 3: Survey Questionnaire for Ordinary Listeners (Attached)
ANNEX 4: Survey questionnaire for hospitals (Attached)
APPENDIX 5: In-depth interview questionnaire for hospital leaders, health professionals (Attached)
ADDENDUM 6: In-depth interview questionnaire with school leaders (Attached)
APPENDIX 7: Parent In-depth Interview Questionnaire (Attached)
APPENDIX 8: Minutes of in-depth interviews with hospital leaders, medical professionals
ADDENDUM 9: Minutes of in-depth interview with School Leaders
APPENDIX 10: In-depth Parent Interview Minutes
APPENDIX 11: Communication Access Plan

ANNEX 12: Classification of areas of expertise in sign language interpretation