SESSION VIII: DISCUSSING THE ISSUE OF ENSURING THE RIGHTS OF PEOPLE WITH HEARING AND SPEECH DISABILITIES IN THE FIELD OF MEDICAL EXAMINATION AND TREATMENT IN VIETNAM TODAY
According to General Statistics Office statistics, as of the end of 2016 at the beginning of 2017, 6,225519 persons with disabilities aged 2 years or older in the country, including 933,896 persons with hearing disabilities and 836,247 people with communication problems . Due to health conditions, in practice, the demand for medical examination and treatment of persons with disabilities (including persons with hearing disabilities) is exceptionally high,  however, the access to medical examination and treatment services for persons with disabilities, especially those with hearing disabilities, is also difficult. This paper addresses several issues to contribute to the finalisation of legal policies and enforcement mechanisms to ensure the rights of people with disabilities to listen and speak in health care in VietNam during the current period.
Several generalizations of policies to ensure the rights of persons with disabilities (especially persons with hearing and speech disabilities) in medical examination and treatment under International Conventions and Vietnamese Laws
Convention on the Rights of Persons with Disabilities (CRPD)
As we all know, health care (including medical examination) is one of the essential services that persons with disabilities need to access. Therefore, the CRPD has set aside a fairly comprehensive framework for participating countries (including Viet Nam) to commit to ensuring the rights of persons with disabilities (including persons with hearing disabilities) in this area, based on basic principles such as: ensuring equality, non-discrimination and ensuring active support within the specific socio-economic condition per country.
Specifically, Article 25 of the CRPD affirmed: Member states recognize that the highest level of health care has been achieved without discrimination based on disability. Accordingly, commitment: Providing the disabled with the identical type of care and health program, quality, and level of free or reasonable price as others; providing special health services that the disabled need due to their disability; requiring medical professionals to provide health care to the disabled. by raising awareness of human rights, human dignity, self-reliance and the needs of the disabled, through training and propagation of medical standards for public and private health facilities, etc.
Overview of relevant legal policies ensuring the rights of persons with disabilities (including persons with hearing disabilities) in medical examination and treatment in Viet Nam
Currently, in addition to the 2013 Constitution, policies to ensure the rights of persons with disabilities in the health sector (including medical examination and rehabilitation) are stipulated in several documents such as the 2009 Law on Medical Examination and Treatment, the 2008 Law on Health Insurance (amended and supplemented in 2014; the 2010 Law on Persons with Disabilities), and others. The main scopes of the above legal documents are in three major policy groups:
i) First, to affirm the rights of PWD (including persons with hearing and speech disabilities) to ensure equality with the non-disabled, without discrimination in medical examination, treatment, and access to health services (Article 1 of Article 3; Article 7-13 of the 2009 Law on Examination and Treatment).
ii) Second, persons with disabilities enjoy several priority rights in medical examination, treatment, rehabilitation, etc. (Article 23 of the 2010 Law on Persons with Disabilities, Clause 4 of Article 3 of the 2009 Law on Examination and Treatment of Disease; etc.);
iii) Third, there is a free health insurance policy for persons with severe and especially severe disabilities (Law on Health Insurance, Article 12).
Particularly for patients with hearing and speech disabilities, the Ministry of Health has issued the "Vietnam Hospital Quality Criteria" , including 83 quality criteria. In which, a hospital with a very good quality evaluation (Level 5) must: “10. Have interpreters for deaf patients or have a plan to cooperate and sign contracts with interpreters in case patients with hearing disabilities come for medical examination and treatment; 11. Ensure that interpreters for patients with hearing disabilities can be provided within 90 minutes upon request.
As a result, Vietnam's legal framework for medical examination and treatment as well as policies related to it has essentially guaranteed the right to medical examination and treatment for PWD (including individuals with hearing and speech disabilities) following the CRPD and the 2013 Vietnamese Constitution.
Several major inadequacies in policies and some challenging situations of persons with hearing and speech disabilities when receiving medical examination and treatment in our country
The gap in policies related to ensuring the rights of persons with hearing and speech disabilities in medical examination and treatment
Although there are policies to ensure the rights of persons with disabilities in all social life aspects, it is undeniable that in Vietnam today, legal policies ensure the right of access for people with disabilities. hearing and speech disabilities through the use of sign language in new areas of social life, mainly focusing on two areas: education and information and communication (established in the 2019 Law on Education, the 2019 Law on Persons with disabilities; etc).
As for now, sign language is not yet recognised as one of the official languages used for medical examination and treatment on a policy level of the law.
Article 23 of the 2009 Law on Examination and Treatment only stipulates the use of the Vietnamese language in the examination and treatment of foreigners and Vietnamese residing abroad; the issue of translating foreign languages into Vietnamese in examination, treatment, etc.
Hence, what is sign language? Is it a form of Vietnamese or a non-Vietnamese language, used in the medical examination?
Article 2 of the CRPD defines: “Language” as including spoken and sign language and other forms of non-verbal communication”. According to the provisions of Vietnamese law, sign language is affirmed as a constituent part of the Vietnamese language. Specifically, Circular No. 17/2020/TT-BGD ĐT of the Ministry of Education and Training promulgating the national standard on sign language for persons with disabilities has confirmed: The National Standard on Sign Languages for Persons with Disabilities stipulates the Vietnamese sign language system for persons with hearing and speech disabilities to use (Section A of Circular 17/2020/TT-BGD ĐT).
As a result, in light of both the CRPD's definition and current Vietnamese legislation, sign language (used following Vietnamese national standards) must be considered a component, a particular form of the Vietnamese language . However, the current issue is that the 2009 Law on Medical Examination and Treatment lacks regulations on the use of sign language in medical examination and treatment activities . This is a significant gap in the policy, which is not consistent with the content of Clause e Article 21 CRPD. States participating in the CRPD (including Viet Nam) are committed to implementing: "Accept and promote the use of sign language". This is one of the constraints of current healthcare policy, given the degree to which persons with hearing and speech disabilities have the right to use sign language in line with the spirit of the CRPD and the Vietnamese Constitution.
Several current situations about difficulties of people with hearing and speech disabilities in accessing medical examination and treatment services today
An acknowledged fact is: Presently, persons with hearing and speech disabilities face numerous difficulties in medical examination and treatment due to language barriers. According to the survey results of some persons with hearing and speech disabilities in the Northern and Central provinces, the percentage of PWD who have access to adequate medical services is still rather small, with only 7/100 people with hearing and speech disabilities having access to adequate medical services .
One of the primary reasons is that most hospitals in Vietnam have a serious shortage of sign language interpreters (SLI). Even at central hospitals in the metropolis, the use of SLI in medical examination and treatment is quite limited and still remarkably low compared to the PWD’s need . The scarcity of SLI in hospitals makes it challenging for both patients and medical practitioners. Patients with hearing and speech disabilities face many dilemmas leading to long waits for medical examination and treatment due to overcrowding or inability to examine. Furthermore, they may even face risks in the absence of SLI, since the doctor and the patient cannot communicate . Communication difficulties in the medical examination will be exacerbated for patients with hearing disabilities who cannot read or write Vietnamese or who have difficulty writing Vietnamese; no relatives accompanying them when going to the clinic. The institutional side likewise faces the lack of support from SLI in health care services, where the number of patients is large, the time allocated for doctors to visit each patient is quite limited; the majority of health workers do not know how to use sign language in health care; etc.
Recommendations to ensure enhanced access of persons with hearing and speech disabilities in medical examination and treatment
Policy Advisory Group:
First, consider adding to the Draft Law on Medical Examination and Treatment the policy affirmation: Sign language is one of the languages used in medical examination and treatment activities in Vietnam. Simultaneously, right in the Law, the National Assembly should assign the Government/Ministry of Health to detail this issue.
In addition, to ensure the feasibility of policies and laws (Government decrees), it is recommended to prescribe a roadmap for arranging SLI at medical examination and treatment facilities (public sector first). It is necessary to have an incentive policy for medical examination and treatment facilities to arrange SLI and use other supporting devices (computer-aided transcription services, written documents, etc.).
Additionally, it is crucial to advance the policy of socialising SLI production and supply as well as other assistive device manufacture and supply for persons with hearing and speech disabilities in medical examination and treatment activities (It is the responsibility of all organisations, institutions, and society as a whole, not only the health sector, to identify the issue of sign language interpretation in medical examination and treatment). In particular, it is necessary to have policies to encourage and promote the active role of enterprises and social organizations in coordinating training, fostering, and providing the SLI sources ;
Proposing solutions to ensure policy group
Measures to ensure policy should be undertaken concurrently with solutions to amend and supplement legislation. Specifically, it is vital to create propaganda campaigns and increase public knowledge of the rights of persons who have hearing and speech impairments during medical examinations. To offer an appropriate supply of health care services (and other services), it is necessary to improve SLIS training, with a focus on promoting fundamental medical knowledge and terminology for SLIS.
Additionally, it is crucial to improve education and promote sign language proficiency among healthcare professionals (especially employees of social work departments, nurses, etc.). This is to guarantee that medical institutions take an effort to assist individuals with hearing and speech disabilities in other critical or required situations (such as emergencies).
In parallel, medical examination and treatment facilities need to flexibly apply additional sign language forms in medical examination and treatment activities (directly, via video call, etc.); strengthening the application of online medical examination and treatment registration; Strengthening coordination between social organizations, businesses, and medical examination and treatment facilities, as a means to promote the SLI provision in medical examination and treatment activities.
Finally, step-by-step support for Vietnamese language interpreters for free for persons with hearing and speech disabilities belonging to poor, near-poor households, other difficult circumstances, etc.
 General Statistics Office (2018), National Survey of Persons with Disabilities 2016, Statistical Publishing House, Hanoi, p.68.
 According to the survey results of the General Statistics Office, 91.5% of PWDs got sick/diseased, injured or used medical services within 12 months.
 This set of criteria is issued together with Decision No. 858/QD-BYT dated November 18, 2016.
 In this article, we approach the concept of sign language from a legal perspective (according to the definition of CRPD and Vietnamese law), not approach this concept from the perspective of deep expertise in the language field
 Article 24 of the 3rd Draft Law on Medical Examination and Treatment (Draft dated May 7, 2022) continues to affirm the above content without mentioning the identification of sign language used in medical examination and treatment for people with hearing and speech disabilities.
 Survey results of Deaf and Community Connection Support Co., Ltd (SCDeaaf) on the post-Covid mental health situation of the North and Central regions of the deaf (for a period of three years, up to February 2022)), Source: TOT training manual - Mental health resource trainer for 05 Deaf Clubs in the North and Central regions.
 Vietnamese Federation on Disability (2020), Independent Report on the Implementation of the United Nations Convention on the Rights of Persons with Disabilities in Vietnam, Hanoi, p.32.
 The case of a deaf pregnant woman who went for antenatal care but was almost ordered to terminate the pregnancy since she could not explain to the doctor that she went for antenatal care while the doctor thought she was going to terminate the pregnancy; several health care providers do not use electronic bulletin boards, thus patients with hearing and speech disabilities are missed out on visits
(Sources: https://vovgiaothong.vn/thieu-phien-dich-vien-benh-nhan-dac-biet-thiet-thoi-ve-co-hoi-cham-soc-y-te; https://vnexpress.net/nguoi-diec-di-vien-3987999.html).
 According to preliminary statistics, in Vietnam, there are about a dozen businesses and non-public organizations that are providing support services for training, fostering and providing scientific translation such as Nắng Mới Company; Hanoi Sign Language Training Center; Education Research Center for the Deaf; etc. (Source: Seminar on Enhancing access to information for persons with hearing and speech disabilities at health facilities, hosted by ACDC in Hanoi, June 10, 2022).