Hearing Aids De Ja Vu!

Nancy — Tue, 12 Mar 2013 09:38:00 +0000

This morning dawned unexpectedly quiet…. Always a welcome event here – and rare. So beautiful was the silence that i turned off the fan and reveled in it. Constant Karaoke… Must be a new bare somewhere, but every time I woke up last night, there it was again. This morning’s silence was almost deafening by comparison

My work mates are off in Kampala this week and I’m in Gulu trying to get other projects moving forward and somehow that has not proved fruitful, but the week is young. Trudged to the library this morning all ready to sort children’s books and it was totally locked. Where IS everyone??? So I went to the market instead, found a not totally wilted bunch of cilantro and look forward to ANYTHING with cilantro on it. There appears to be MO meat in Gulu… “it is not ready yet.” I don’t want to know what that means. Thank goodness for foil packed tuna in my care packages! It seems we may be getting the fallout from the Kenya elections. we were warned of it, but supply routes are down due to Kenya’s election turmoil. No yogurt, no pickles, no meat… odds and ends, but things that make life here a little easier.

Managed to get my power tuned back on. Most of Gulu was without power for 3-4 days last week. everything rotted in the fridge. When it did come back on, Umeme – the power monopoly – flippantly decided to disconnect mine. I got the bill one day, paid same and they unplugged me the next. No justification. Seemed I was going to have to pay them to reconnect, but managed to find someone reasonable there and they issued the reconnect order. Miracles never cease, they are sometimes just long in the coming. This all happening during the week of International Women’s Day. Did you know there was such a thing? Me neither ’till I came here. This is how I “celebrated” it:

My side of a conversation with my PCV friend Erin, from Padjule: “Really? Starkey – (the worlds largest manufacturer of hearing aids) – is coming to town? You’re meeting with them? How come? When? Can I come? How in the world are they going to fit hearing aids in Africa??? This I have to see.”

And so it began – but first a little background.

In a former life – in my twenties – when I’d come back from Europe totally broke and on food stamps because-I-couldn’t-find-a-job-ANYWHERE-not-even-waitressing – I had to take a job placement test at the Department of Public Welfare…. If they were going to give me an emergency ration of food stamps, they were damn sure going to try to get me employed. Before I went trekking off to Europe after my first divorce, I‘d quit my job as an audiologist doing diagnostics for an ear, nose and throat clinic in Austin, caught the cattle-car-$100-Icelandic Airlines flight to Amsterdam and visited my sister in Tunisia. Before I left, I’d humored a friend of mine and under some duress had told him my ideal version of the job I’d like. I told him it would be a job “managing a state-funded program for delivering hearing aids and related services to indigent elderly.” Where I came up with that I’m not sure – such a program did not exist at the time. He suggested I plug in a salary, so I did and it was unreasonable for a young audiologist with no administrative experience and almost as little experience working with hearing aids and the elderly, except that I’d tested hundreds of them. So I plugged that order into the great job-bank-in-the-sky and left for Europe, not giving it another thought.

When I came back to Austin, it was after Nixon’s impeachment, the first oil crisis, I had no money, no job and no prospects for any of the aforementioned. So I dragged myself into the exams one morning after having been out most of the preceding night and took an absolutely horrid standardized job test and did so badly I was convinced I would never be employed. A few weeks later, I received in the mail, a letter from the Department of Public Welfare, the gist of it being: would I like to “come interview for a “newly developed Title XIX (medicaid) program tasked with delivering hearing aids and related services to the indigent elderly of Texas.” And – the salary was precisely what I’d plugged into my formula a year before as I was packing my bags for Europe. Really – you can’t make this stuff up.

So – somehow, I beat out several other very seasoned audiologists with administrative experience and got the job. It was trial by fire, but I learned a lot in the three years I ran it before leaving again – this time to live on a sailboat for a year, cruising during storm season in the Gulf of Mexico and the Bahamas. I was beginning to suspect I had come from gypsy stock. Anyway, that was the last time I’ve had anything to do with hearing aids or audiology directly.

Fast forward a few decades and a few countries… When the news about Starkey coming to Gulu found my ears, I felt history repeating itself. Of course I had to see how a fairly high-tech process requiring testing, medical screening, fitting, hearing aid batteries and counseling was going to work in a third-world environment where virtually NONE of that could reasonably be accomplished. Coming from the audiologist’s background where testing and “proper” fitting rules, I first viewed this with a lot of skepticism. I’d been told that this is the brain child and passion of Bill Austin, the founder of Starkey Hearing Foundation and that he approaches it with evangelical zeal. He devotes most of his time and talents now to traveling around the world and dispensing hundreds of thousands of hearing aids to hearing impaired kids and adults in response to Clinton’s Global Millennium Initiative.

I’m glad to report that there’s been a lot of humbling and many reality reality checks between the arrogance of my twenties and the walk along this impossibly dusty road, past the cuk-madit (main market), numerous boda stands and a slew of Ugandan’s amused to see a Munu walking that road. When I finally arrived at Saint Monica’s orphanage and clinic, it was the scene of much going on. There were tents set up, with hundreds of men, women and children lined up or sitting in staging areas waiting for the next phase of what proved to be an orderly, well orchestrated process.

Making all this happen were about 30 Americans and at least as many Ugandan volunteers milling around with red Starkey shirts and blue Global Health Corps t-shirts. There were also a few beefy guys around sporting Pros for Africa shirts. Quite a group. Global Health Corps is a Barbara Bush (daughter) initiative and Pros for Africa is consists of professionals from different areas, one of which if NFL football players. Witness Tommie Harris working with with a women (left).

The next image that came into focus was a long, skirted table with piles of what looked vaguely like a buffet of shrimp (wishful thinking…), but upon closer examination the piles revealed themselves to be hearing aids divided into “power groups,” from weak to mega-strong and then body-aids for those who are profoundly deaf.

Explaining that I was a Peace Corps Volunteer and former audiologist, I was warmly welcomed and invited to observe and be part of the process. What I saw there was a well-oiled machine: a very streamlined, practical process that – in the states- would be scoffed at, but was a fairly brilliant adaptation to the realities of the third world. (Left: Brady Forset, Executive Director, dong a fitting.)

Lack of medical care means ear infections don’t get treated and what starts as a correctable temporary hearing loss, turns into a permanent one. The Quinine given for treatment of Malaria is ototoxic and if given in too large a dose (common) you’re malaria (that time) may be cured, but you’ve lost your hearing forever… and so it goes. Here, the mere opportunity to hear something overrides the first-world concern of “is it perfect?” While we were there, one child considered to be retarded immediately started mimicking the fitter’s vowel sounds when the hearing aid was turned on. Instead of being an outcast, with little hope of developing speech or integrating with his community, he’ll have a chance at a normal life. Others might just be a bit more tuned in, but here, that can save your life.

Without going into a lot of detail there are a few really critical elements to the process of fitting a hearing aid. In the States you would start with an elaborate battery of diagnostic and fitting tests to determine type and configuration of hearing loss. These would be performed in a multi-thousand dollar sound-proof booth with the latest tests including speech discrimination, etc. Then you would test various hearing aids, “tune” them to reflect test results, re-test, etc. etc. Anyone not doing all this would be considered incompetent or at the least unprofessional. It’s a snobbery I know well and a luxury not possible here.

As with every other service delivered in the environments of developing countries, grass roots, practical and sustainable processes rule the day. Just training people to respond accurately to a test – if you had an even remotely quiet place to conduct said test – would take too long and your high tech results would still have to be matched to real world limitations. So here, the process looks more like this:

· A med-tech (very skilled by the way) examines the ear canal with a photographic otoscope, where the ear canal shows up on a screen. His job was to clear the canal, check for infection and send them for meds if he found something. This is not a task for the squeamish: many were totally occluded with wax that looked like tar and other stuff that had stuck there while they were trying to clean it them selves. Others have active infections. More than a few, which I did not see, had bugs that had taken up residence in the canal.

· Ear molds were – for the most part – pre-made by an advance team that had come months earlier, taken impressions and sent the impressions for manufacturer elsewhere. Those who arrived later without having been part of the earlier process, were fitted a well as possible from a selection of stock molds.

· Some interesting screening was done to determine which power-model of an aid would be optimum, based on behavioral feedback. Even in the States – with all of the technology in the world, fitting of a hearing aid is still an art-form because of the variations in how people perceive sound and a myriad of other factors, both technical and perceptual. Getting useable feedback from folks who’ve never had something in the ear, who may never have heard, who not only don’t speak YOUR language, but often are non-verbal can be an adventure in subtlety. Entire conversations here can be had with raising the eyebrows, so figuring out what that means when tuning a hearing aid can be – well – confusing.

· After fitting, they receive some group counseling and get a bag to keep their batteries in. This is interesting: into each bag goes a handful of rice to absorb any excess moisture from the batteries being used. A year’s supply is supplied by Raovac. Once they can do everything on the checklist (put the batteries in, fit their ear-mold properly into the ear, turn it on, clean the earpiece, etc.) they are released with the contact of a local “support partner.”

The downside is, that people here – even the partners, don’t know much about hearing aids and the recipients themselves will be hard pressed to find help for the kinds of issues that routinely come up. Two questions I was asked a few times were:

· Will the hearing aid fix what is wrong with my/my child’s ear?

· Are their any harmful side effects to using a hearing aid?

The really tough questions won’t show up until everyone is gone home. So the system isn’t perfect, but no system here is and this one is pretty impressive.

A few hours into the process, the wind began to whip up a nasty dust storm followed by a grand Gulu downpour. Chaos ensued: people scattered to move under tents, thousands of dollars of equipment had to be packed and people still ushered through the process. And so the day ended in mud and lakes of water. A classic early flirt with rainy season!

In a few months, I hope to help with a group being brought in from Erin/s region in the east. Whodathunk I’d be doing this again after all these years. You just never know where life will take you.

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Hearing Aids De Ja Vu!