Trouble signs

For the past five years or so, we have been compiling, reviewing and extending the relatively scant scientific evidence about musculoskeletal injuries and sign language interpreting (SLI).

This topic hit the radar in the 1990s when a large proportion of staff interpreters at Rochester Institute of Technology in NY were going on extended leave for what was quickly deduced to be work-related musculoskeletal injury. RIT adopted a major adjustment in the work-rest schedule along with a number of other interventions, with the result that it was not clear which remedial measures should be recommended. Efforts to secure funding for prospective studies, the methodological gold standard, haven’t yet succeeded. The interests of the “silent” deaf community and the interpreters who mediate communication just don’t have the political momentum as a funding priority.

The work-rest schedule, effectively a 50% work ratio with no more than 90 minutes consecutive work, has generally been blessed by organized practitioners, albeit less enthusiastically by some employers and with somewhat inconsistent adherence by self-employed interpreters.

A 50% ratio just makes rational sense: evolution tends to extinguish things that are dysfunctional, and gestural languages would have evolved in a way that was comfortably sustainable in conversation, which tends on average to alternate expression and reception. Producing signs for prolonged periods, such as in lectures, deviates from the evolutionary predicate for the gestures involved in the language, making an epidemic of injured interpreters quite unsurprising.

Despite this policy change and demonstrated improvement at RIT, in the early 2000s it remained common for interpreters to be pressured to work in excess of these guidelines, so we partnered with the Association of Visual Language Interpreters of Canada to produce a health and safety guide for sign language interpreters, through funding from the Ontario Workplace Safety & Insurance Board.

In the process of preparing the Guide, we threw in a freebie: a survey of AVLIC members that had a whopping 2/3 response rate, high prevalence of diagnosed injury and some interesting coping mechanisms. Yet so far we have hit a brick wall to get the results published in a peer reviewed journal. We’ve seen analogous papers appearing on musicians and other sub populations and occupations, but reviewers seem to think sign language interpreting is too small and uninteresting a profession. With the estimated number of deaf people using sign language estimated to be 1% or over 300,000 Canadians, and most of the remaining 99% of Canadians unable to sign to be able to communicate with them, one would think the work of sign language interpreters to be of obvious importance. Yet so far this has not interested scholarly editors and reviewers, perhaps because most of them have probably never had any interaction with either deaf people or sign language interpreters.

We’ve even had to educate embarrassed peer reviewers that their critique had been based on confusing sign language interpreting with closed captioning. “Oh” says the peer reviewer, “that would have changed my evaluation. Oh well, too late now.” Thanks so much for that. I have even been asked why a deaf companion could not interpret for me, because after all, she can sign. Yes, I explain, but interpreting is not just signing. It is hearing, and then signing what is heard. (And speaking what is signed in response.) I am not sure which is more disconcerting: that the reviewers are so overconfident in their own knowledge that they skip over the section of the paper that clearly explains the interpreting process, or that they are so misinformed yet accept the crucial duty of peer reviewing.

The editorial feedback trying to get the paper published suggested that we needed to produce a “systematic review” of the literature on SLI injury. Systematic reviews are becoming the belle of the scholarly ball presumably because they avoid cherry picking literature that supports a particular case. In this situation where there is very little literature, most of it inconsistent, the benefits are more debatable. Quite a bit of work later, we discovered that the systematic review extraction retrieved fewer papers than we were already citing, and a formalized assessment of the scholarly merits of that work was pretty much what we had already described it as: moderate to weak. Having used up most of our journal-article word count explaining the ponderous systematic review methodology, there was no room left for the survey results. The paper should see the light of day roughly 24 months after we received the acceptance from the journal, almost five years after the survey data were collected and are still not published.

In the mean time, we regularly receive emails from deaf people denied workers’ compensation for heavy manual production line work because compensation adjudicators blamed their off-hours signing (without knowing how much of it they even did), emails from video relay interpreters denied compensation because the adjudicators thought they looked like they were getting a pretty good rest a few seconds or minutes at a time all day long, emails from deaf counsellors who advise deaf clients in sign language all day long, inquiries from deaf academics who wonder the implications for their lecturing, and yes, emails from interpreters whose employer ignores the preferred norms and assigns solo interpreting all day long. We’re unable to refer them to published findings all the while knowing more than we can substantiate.

We also know many things we still don’t know. There is some mythology that “deaf people don’t get it” or that “interpreters with deaf parents don’t get it”. We don’t have evidence in support of that folklore either. There is some logic to the argument, but we also see that deaf people, particularly deaf women DO have a higher prevalence of diagnosed hand-arm injury, although quite possibly due to the type of employment they have, if they are employed, probably in manual work, whereas deaf and hard-of-hearing men tend to have higher rate of back injury, probably being employed in more whole-body lifting work. That’s speculation on our part, because the data could not be analysed in detail by occupation. However, one thing we cannot say is “deaf people don’t get it”. Deaf people DO have a lower rate of access to medical care and may actually be under-diagnosed as a result. We also think deaf people are likely under-surveyed by the major population health surveys. These results can only underestimate the extent of the problem among deaf people.

What to do? More research. Our network is studying various work and rest schedules, different levels of experience and linguistic skill, and native signing versus adult sign language acquisition among interpreters. We enjoy great support of all the partners, and we have a rich network of scholars at multiple universities and different scientific backgrounds all contributing. We can use more understanding by peer reviewers of the extent and importance of this problem for equity — and the difference between sign and text, and deafness and blindness.