Newborn hearing screening is now a reality in the islands of American Samoa, the only part of the United States that lies below the equator. The seven islands, located in the South Pacific approximately 2,400 miles southwest of Hawaii, are 199 square kilometers and are home to 69,000 people. The annual per capita income is only $7,084, and the majority of families live in poverty.
American Samoa became an unincorporated territory of the United States in 1890 by deed of cession signed by local chiefs. The United States Navy had authority over American Samoa until 1951 when it was transferred to the Department of Interior. Congress has never issued American Samoa any explicit directives on governance, and its residents are US nationals, not citizens.
American Samoa is an extremely rural area with limited resources for people with hearing loss, and was the last US territory to implement newborn hearing screening. Hearing screening for newborns had a fortuitous beginning when Part C early intervention coordinator, Jean Anderson-Asuega, PsyD, attended an Early Hearing Detection and Intervention meeting where she met Irene Forsman, MS, the US Health Resources and Services Administration program coordinator for newborn hearing screening. Ms. Forsman explained that funding opportunities might be available for the territory. Dr. Anderson-Asuega also met Jill Craig at the meeting, a pediatric audiologist and equipment representative. Ms. Craig and Wendy Switalski, AuD, began making quarterly visits to the territory to provide pediatric audiology services.
In 2009 a partnership was developed with the Center on Disability Studies at the University of Hawaii in Honolulu to help with applying for an HRSA grant and a Centers for Disease Control and Prevention grant to establish data and a tracking system. Both grants were successful, and funding became available in the summer of 2009.
The program began in January 2010. Grant funds went toward purchasing a new hearing test booth, ordering new diagnostic equipment, obtaining screening equipment, developing procedures, and providing training to implement universal hospital-based screening. (Figure 1.) Quarterly audiological visits were conducted to provide diagnostic services.
A deadly tsunami struck the islands on Sept. 29, 2010, resulting in significant damage and deaths. Island resources were shifted to meet emergency needs. The screening project floundered for the next 12 months as a consequence.
The program was reenergized in 2011 through a contract with the Center on Disability Studies to manage the project, ensuring personnel recruitment, ordering of supplies and equipment, and scheduling of audiological diagnostic visits. Dramatic success was seen in 2012. The initial refer rate dropped to 2.5 percent following training provided by the National Center for Hearing Assessment and Management's regional audiologist, Yusnita Weirather, AuD. The Helping Babies Hear program was well underway by 2011 due to the low refer rate, dedicated screeners, and excellent program management. The program is set to achieve the Healthy People 2020 objectives for newborn hearing screening, meaning that all babies will be screened by 1 month of age, diagnosed by 3 months of age, and begin early intervention services by 6 months of age. Extensive training for the Part C staff in early intervention techniques for deaf infants has been provided by Ms. Nancy Rushmer, MA.
Resources continue to be insufficient. No full-time audiologists or on-site ENTs provide complex surgical services, and no supply system for hearing aid distribution or hearing screening program exists in the schools. The possibility of hearing-impaired infants receiving cochlear implants remains far into the future. The healthcare system's resources and the only tertiary care hospital, the Lyndon B. Johnson Tropical Medical Center, are strained by the community's high prevalence of diabetes, obesity, and hypertension.
Global ENT, a humanitarian group of otologists, has been magnanimous in providing ENT services to the territory over the past few years. This year, the group learned of a young boy with bilateral severe mastoiditis who needed emergency surgery. Through the efforts of James Marrone, MD, the chief of pediatrics at LBJ, Global ENT found an ENT specialist, Charles Weingarten, MD, at Northwestern University in Chicago, IL. Dr. Weingarten was willing to fly to Pago Pago, the capital of American Samoa, to perform the surgery. The boy, now age 9, is doing well. His chronic middle ear disease had not been previously identified, and he had no history of treatment or previous audiological services.
Things are moving forward, however. American Samoa is not only on its way to developing a system of care for children but also for adults with hearing loss. Although much remains to be done, none of the results could have been accomplished without the contributions of pediatric audiologists Jill Craig, Wendy Switalski, and Yusnita Weirather; without the humanitarian efforts of Global ENT led by Richard Wagner, MD; or without the support of Ms. Forsman at HRSA, John Eichwald, MS, at CDC, and Karl White, PhD, of the National Center for Hearing Assessment and Management.
All of this external support would have been meaningless without the efforts of the competent, caring people in American Samoa who have worked diligently to improve services. Among these heroes are Dr. Jean Anderson-Asuega, the EHDI coordinator; Ruth Te`o, MA, (Figure 2) and the entire Part C Helping Hands Program; Maina Saula, audiometrist; as well as the staff of the Lyndon B. Johnson Tropical Medical Center, including Malaelai Tuioletai, MO, the ENT medical officer; Dr. Marrone, the chief of pediatrics; Alo Anesi, MO, the medical director; Mr. Mike Gerstenberger, CEO; and Seiull Elisapeta Ponausuia, MPH, the acting director of health.
Responding to needs when almost no resources are available takes a village of caring, committed, passionate people from around the world, and no finer village can be found than in American Samoa.
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