I was invited by missionary friends in 1989 to bring testing equipment and hearing aid “stuff” to an island in the Republic of Vanuatu, which is located in the South Pacific and was once called the “Island of Lepers” by Captain James Cook. No ENTs or audiometrists were in Vanuatu at this time, and I fitted 27 hearing aids in three days and then spoke with the director of health about the country's needs. He admitted they did not know the extent of the residents’ hearing loss and ear disease, but the ministry held a meeting the previous week to put this on the following year's agenda.
I visited Vanuatu seven times over the next four years, mostly at my own expense. I set up a clinic at the Vila Central Hospital in 1994, and ran a three-week nursing course taught by an ENT I invited from Australia. The clinic was seeing up to 30 patients daily at that time. Word spread, and I subsequently made numerous trips by invitation to Vietnam, the Philippines, and Cambodia. Peter Bartlett, AuD, and I, on a trip to the Philippines in 1995, worked toward forming an association, EARS, Inc. — Educational Arts Resource Services — to share our vision.
Lessons Learned in Vanuatu
The Vanuatu experience taught me many things, such as training people outside their environment was to be avoided. Wherever possible, all materials and supplies should be obtained in-country. Our volunteers should train indigenous workers for the task and not complete the work themselves. No cash funding should be provided to recipient organizations, just equipment and expertise. Sustainability was an immediate requirement.
The initial model required an on-site visit to specific countries by invitation. A minimum of two people were trained within two to three weeks to make full custom acrylic earmolds and to conduct basic air conduction hearing tests and unmasked bone conduction in the healthier ear. An earmold laboratory cost about $700 with some of the equipment and most of the materials purchased locally. A supply of new, low-cost used BTE hearing aids or donated refurbished BTEs were provided.
A follow-up visit was made six to 12 months later to monitor progress and provide another level of training. We recruited volunteer audiologists and audiometrists to adopt a project where possible, and we did not undertake a new project unless we were prepared to return for at least two to three consecutive years. EARS, Inc., volunteers have traveled to India and Papua New Guinea, and we supplied donated hearing aids to a group in the Ukraine and later equipment to Tajikistan.
I turned my focus to Africa and Central America in 2011, working in Ethiopia, Botswana, Swaziland, Zimbabwe, Malawi, and the Dominican Republic. I was a board member for Godisa Technologies Trust in Botswana, which manufactured solar-powered hearing aids. (See FastLinks.). Our effect in different countries was proportionate to the level of commitment from local partners, the level of corruption from whatever source, and our capacity to manage these factors sensitively. Assimilating world views is a significant challenge.
Dedication in the Dominican Republic
Donna Carkeet, AuD, one of our members who volunteered in India and Cambodia, was enticed to work in the Dominican Republic in 1992. Her commitment to her work there was so strong that she undertook the challenging task of learning Spanish. She moved from Australia to England to gain experience in wider areas of audiology to increase her skills while still visiting the Dominican Republic on a regular basis. A clinic in Santo Domingo had been established using hearing aid supplies from Godisa in Botswana until its unfortunate demise.
EARS, Inc., finally showed signs of maturity during this time. We mostly provided training via short-term visits between a week and three months. All volunteers provided their own funding for travel and expenses, with some exceptions. Sponsors would occasionally provide equipment or cover some expenses. Contributions from clients of my private practice have been amazing, and we have also had some assistance from rotary clubs and churches. The Hear the World Foundation in recent years has provided invaluable assistance in the Dominican Republic and to our more recently established Malawi project. Still, none of our full-time volunteers in these countries draws a salary from EARS, Inc.
Dr. Carkeet, in September 2005, prior to living in the Dominican Republic, began the process of creating a two-year audiology course, which was to be run mainly in the Medical Ministry International hospital with which we had partnered and also in conjunction with one of the local universities. The course's accreditation was to be fast-tracked. Dr. Carkeet, of course, was writing the coursework in Spanish, and the first course began in May 2007. Fifteen students graduated in May 2012, and the accreditation process continues. Students in the course learn to make earmolds and conduct auditory brainstem response and otoacoustic emissions. They conduct screenings in the country's remote areas, including newborn hearing screenings, and dispense programmable hearing aids using real-ear measurement equipment.
The Future of EARS, Inc.
We currently have two audiologists in Malawi, Peter Bartlett and his wife Rebecca, also an audiologist, who have established a clinic at the African Bible College in Lilongwe. They are making plans to build a new audiology building and have begun working with trainees for Donna's course that was effectively pioneered in the Dominican Republic. They visited schools for the deaf, and had discussions with education and health departments to ensure local support and interest.
We are planning on conducting training in Egypt, and also have a trip planned to Burma this year. It is obvious many opportunities exist to provide audiology services in developing countries. I believe we have been successful by staying with our overall philosophy: never train people outside their environment; wherever possible all materials and supplies should be obtained in-country; all volunteers should train indigenous workers to the task and not complete the work themselves; no cash funding should be provided to recipient organizations; and ultimately, sustainability is an immediate requirement.
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