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Masks, Travel, Disability, and … Health Literacy?

by Lorraine Thomas, MA


Black woman wearing a face mask in an airport

We’ve all been there. Caught up in some absurd moment that leaves us shaking our heads in disbelief. And later, upon reflection, an image begins to form; we’re able to see parallels between that experience and our work.

For me, the absurdity came while traveling—during a pandemic. The clarity came later. An analogy formed; suddenly I saw the correlations between an exasperating experience and my work in health literacy.

After nearly a year and a half of lockdown, I had the chance to fly home this summer. While I was happy to make the trip, I also felt trepidation. Being trapped for hours in a flying sardine can always unnerves me. But I also knew that, this time, all my personal interactions would be different: They’d be filtered—through masks. Masks are vital in helping us control the spread of COVID-19. I understand that. But I also understand that masks make communication all the more challenging. Depending on their design, they cover the nose and mouth, prevent one from speechreading, and effectively remove the opportunity for social cues.

As a hard-of-hearing person, this is especially true. No longer can I use speechreading to help make sense of the world around me. Even with assistive devices and a best-case scenario (minimal background noise and visual distractions), I probably “hear” about 60 percent of what is spoken.

So imagine me at an airport: harried ticket agents, intimidating immigration processes, chatty passengers, brusque airline personnel. And, oh yeah … masks! (And they wonder why I have anxiety.)

When critical information is overlooked

I wish I could say that my anxiety proved unwarranted, but … alas. It became particularly pronounced during check-in.

This statement was printed on my ticket: Deaf passenger. Does not hear. Also, it was highlighted—in yellow. Yet, somehow, the ticket agent missed it.

It was here that communication hilarity ensued (or, at least, some dark, bitter form of it). You see, I couldn’t read the agent’s lips (what with the mask and all). But, because the agents were well-ensconced behind a giant, plexiglass barrier, and because some of them weren’t wearing masks, I had the audacity to ask if he’d be kind enough to lower his mask. He would not. He would, though, increase his volume—repeatedly.

And so there we were … me pointing animatedly at my ticket (on which my needs were clearly disclosed) and him disregarding my pointing while yelling louder and louder.

I’m not sure how long that went on until, finally, I simply pointed at my ears and shook my head

Cue the lightbulb.

Once the light dawned, the ticketing staff were most apologetic (if not slightly misguided). They commended my ability to speak (because, oddly, deafness equals inability to talk). And they presented me with some … creative ASL signs.

Finally, I was physically escorted to the security gate, where a stewardess (sans mask) patiently and carefully explained the complexities of seatbelt fastening and life-preserver retrieving. (It was almost as if my passport didn’t disclose my robust history of past travel.)

When less is more

When I arrived for my return flight, I recalled all the commotion of my previous trip. Was there, I wondered, anything I could do to improve the experience? Was it possible to make the onboarding process more pleasant for everyone?

An idea began to form.

I remembered the ticketing staff’s weird misconception that being hard-of-hearing somehow meant that I couldn’t talk. And then, when I did talk, they couldn’t fathom my difficulty hearing (hence, bedlam).

I wondered if communication might be clearer if, perhaps, I didn’t share quite so much information. If I only divulged the most important information (in this case, my difficulty hearing), might that help the agents focus? I decided to try.

I decided, in fact, to not speak at all. Standing before the ticket counter, I said nothing. I simply pointed at my hearing aids.

At first, the ticket agent seemed flustered—so much so that she skipped a critical step in screening passengers. By forgetting to ask me to remove my mask, she neglected to verify my identify. But soon, after a quick exchange of handwritten notes, she regained her composure and took action.

She directed me to a chair to wait comfortably while she made arrangements. I became aware of activity around me. Staff spoke in hushed tones, regarding me occasionally with discreet glances, but … that was about it. No voices were raised (nor was anyone’s blood pressure). And the topic of masks was avoided altogether.

Soon, another agent escorted me to the security gate, and the next thing I knew, I was checked in. The whole process was calm, low-key, and efficient—and silent … blissfully silent. And on top of all that, they even granted me priority boarding!

The parallels to health literacy

It didn’t take me long to see parallels between this travel experience and health literacy. For one thing, continuing education will always be necessary. This is as true for aviation professionals as it is for those in healthcare.

Secondly, it’s critical that all people—be they world travelers or healthcare patients—receive information in a way that is accessible, is clear, and can be acted on. (Yelling instructions with increasing volume, for example, didn’t help me access the information.)

And finally, as professionals, we must be able to manage information. We must be able to distinguish between the nonessential and the imperative. Nonessential information may muddy the message, fostering confusion and inaction. Imperative measures (e.g., steps taken, information shared) are absolutely necessary for ensuring safety and wellbeing.

It was not essential for ticketing staff to know that I could talk. That information would have only distracted them from the main idea: I have difficulty hearing; I require accommodations.

On the other hand, confirming my identity was absolutely imperative. Because she didn’t take this step, the ticket agent neglected established protocol, potentially compromising the safety of everyone on our flight.

As professionals, we must recognize the ability of awkward or unusual situations to throw us off our game. We might be tempted to take shortcuts or to dilute key information.

But we can’t. No matter how perplexing the situation or how difficult the person, we must fulfill our obligations and deliver on our responsibilities. Whether in healthcare, aviation, or any other field, that’s what it means to be a professional.

How are masks like poorly designed health information?

Like masks, health information is there to protect us. But just as masks can present a barrier to understanding, so, too, can health information that’s poorly designed. Depending on the context, this could lead to dangerous consequences.

When faced with inflexible circumstances, we must learn to be flexible ourselves. Might airline staff have been provided protective equipment that didn’t compromise communication? Perhaps, but doing so was likely cost prohibitive. Workable solutions are, in fact, too often cost prohibitive. That’s where we get creative and devise effective workarounds.

Given the inherent nature of masks to impede communication, how might airlines mitigate those challenges?

  • They could create signs that are printed with key questions. That way, instead of communicating verbally, travelers could simply point.
  • They could create strategically placed signs that show sensory disabilities. Travelers could use these signs to alert staff.
  • Even better: Management could anticipate the predicaments that staff will likely face, and arrange training sessions to prepare them.

No matter the industry, improved communication always results in better understanding. Circumstances are very seldom ideal. But with a little ingenuity and creativity, we can find ways to work around even the most challenging obstacles. And these workarounds don’t need to be complicated to be effective.

So what does an effective workaround look like? It depends on the industry. In healthcare, workarounds succeed when they reliably move patients to their next point of contact, in a way that is safe, equitable, and, above all, practical.

About the Author

Lorraine's headshot


Lorraine Thomas (she/her) works at Holland Bloorview Kids Rehabilitation Hospital, Canada's leading pediatric rehabilitation teaching hospital located in Toronto, Ontario, Canada. Lorraine is a family support specialist and the hospital’s health literacy lead. Her lived experience of disability informs her interest in creating information and family education materials that are easy to understand and support family participation.



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