From a young age, Samuel Munana, now Executive Director of Rwanda National Union of the Deaf (RNUD), witnessed firsthand the challenges faced by the deaf community in Rwanda. He himself had been deaf since the age of eight, due to meningitis. Challenges he, and his friends within the deaf community, faced ranged from social stigma due to lack of adequate community education, to the barriers within their own educational paths – as many institutions lack alternatives to verbal teaching methods. ‘It’s upsetting to grow up in a community who believe you’re incapable of learning or performing decent tasks, simply because they can’t communicate with you.’ explains Samuel. ‘Children with a disability are more at risk of stigma, and schools are not equipped to meet their unique educational needs’.

Among other significant social and economic disparities that affect the deaf community in low-resourced areas, access to adequate, tailored health care remains an untackled challenge. Speech barriers limit deaf persons from effectively communicating with those providing care, and many specialists in this area work miles from rural areas where often the need is the greatest. Samuel remembers seeing some deaf patients who were unable to communicate with doctors or hospital staff due to the lack of translation services. This, he recalls, was daunting, and frightening, particularly when dealing with complex diagnoses  which, if untreated or misdiagnosed, could potentially be life threatening.

His passion for health equity originates from both lived and witnessed experiences as a non-hearing individual. Now, leading the RNUD, he and colleagues advocate for better access to health and education services for the Rwandan deaf community, alongside activities aimed at promoting Rwandan sign language through training healthcare professionals, parents, police officers, judges, and others.

A collaboration between the RNUD and UGHE was formed in late 2019, where past and present UGHE Faculty, Dr. Zahirah McNatt, Dr. Rex Wong, and Jenae Logan, met with Samuel and Gerald Mutema (his interpreter and team member) in Kigali to learn more about the organization. This visit culminated in the development of a research project conducted by two Master of Science in Global Health Delivery (MGHD) students, Lisa Berwa and  Marlene Mumukunde on the impact of Rwandan sign language training on health care providers in Rwanda. The research, delivered as part of their required degree practicum assessed how it affected the attitudes of healthcare providers towards their patients. ’I chose to work on this practicum because I believe that everyone has a right to adequate health services, and hope that our work has informed – even in the smallest way – advocacy and policy-making for the deaf community.’ explains Lisa Berwa. ‘This work represented my commitment to advocate for equity for a group that is usually forgotten about and often overlooked.’ Indeed, their final paper, according to Samuel, provided a series of actionable initiatives for how global health professionals and students can better understand and address the inequities faced by the deaf community.

Samuel says that the study’s findings are helping to improve the quality of Rwandan sign language training in Rwanda. Longer courses are now offered by the RNUD, deepening learners’ understanding of the nuances of Rwandan sign language, alongside efforts to broaden Rwandan sign language vocabulary for clinicians to include many more clinical interventions and encounters. He sees Rwandan sign language training as one of the most powerful tools available in raising awareness on the rights of deaf individuals who have, historically, been left behind. ‘People need to embrace the fact that being deaf is not an unusual thing, we have ideas like everyone else – the difference is that we cannot put them in spoken words.’ he says.

Aligning with its health equity agenda and beginning in mid 2021, the Department of Community Health and Social Medicine is now expanding this RNUD partnership further to equip UGHE’s medical students with Rwandan sign language skills  as part of its wider mission to promote tailored global health delivery and develop global health leaders that will transform social and healthcare systems to benefit the most vulnerable.

Samuel believes that it is crucial for medical practitioners to learn Rwandan sign language, which will enable them to equitably treat and provide care tailored to the unique needs of their patients. Whilst the busy schedules of health providers currently practicing are a barrier to intensive Rwandan sign language training, bringing this education forward to medical students remains a strong approach to address this gap in capacity in health centers and hospitals. He emphasizes that partnering with UGHE in delivering the course marks a crucial step towards upholding the deaf community’s rights to adequate healthcare services.