In Uganda, hearing losses secondary to infection or medication occur with little warning, and individuals who previously had hearing in the normal range find their lives completely changed. Through a multidisciplinary approach and yearly trips, CanHEAR Uganda aims to enable improvements in clinical care, education, advocacy, and research otolaryngology for our Ugandan colleagues.
The Ottawa-based nonprofit is a collaboration between the otolaryngology departments of three North American medical schools: University of British Columbia (UBC), University of Ottawa, and New York University School of Medicine. The team consists of a diverse mix of health care specialists, including audiologists, otolaryngologists, speech-language pathologists, nurses, anesthesiologists, and biomedical engineers.
CanHEAR Uganda started in 2000 through the work of Dr. Irwin Stewart, a UBC otolaryngologist. At that time, he was working on a yearly basis in East Africa. On his way home from a trip to Zimbabwe, he visited a colleague in Kampala. Ties were created with the local otolaryngology community, and the project was born.
The first official visit was in the winter of 2001, when a team from UBC performed a large study of the prevalence of hearing impairment in Uganda. Their cross-sectional survey demonstrated an 11.7% prevalence of disabling hearing impairment in adults and a 10.2% prevalence in children. In addition, the survey found that correctable causes such as dry perforations, cerumen impaction, and chronic suppurative otitis media resulted in disabling hearing loss in 17% of adult subjects and 41% of children (J Otolaryngol Head Neck Surg 2008;37:753).
After this study, the project truly got under way, with a push for education through temporal bone courses and, eventually, surgical visits, which started in 2006. The main goal of the visits has always been ensuring that an educational experience occurs with every patient encounter for our Ugandan colleagues. An internal audit in 2010 demonstrated that over the course of five years—10 separate visits—just under 200 otologic procedures had been performed using an operating room microscope, which simply did not occur prior to the CanHEAR project. Interestingly, once the local Ugandan otolaryngologists learned these new surgical techniques, they performed almost 100 of the cases independently, without the help of visiting surgeons.
The audiology team's mission is to establish optimal, sustainable hearing healthcare services. Depending on the distinct factors of each individual case, recommended next steps for a patient may include amplification, a consultation for surgical treatment, or manual communication. The members of the service perform otoscopy, tympanometry, audiometry, counseling, evaluation of hearing aid candidacy, and hearing aid fittings and follow-up care. They work in close association with the otologists on pre- and postoperative patient assessments. The audiology team also teaches, provides clinical skills training, and offers year-round consultative support.
Since 2009, about 80 patients have been fit with hearing aids donated to CanHEAR Uganda. Before our visits, hearing aids were only available to patients who were treated in a private clinic and able to pay in full, keeping this technology out of the reach of most. Now, one of our next challenges is to work with the team at Mulago Hospital to put in place follow-up guidelines and protocols for these patients.
The biomedical engineers who participate with the CanHEAR team have been crucial in allowing for successful visits to occur. They often troubleshoot equipment issues for the local institution, helping even beyond the scope of the visit itself.
There is considerable need for audiological care in Uganda, where patient presentation is dramatically different compared with North America. CanHEAR Uganda focuses on the otolaryngological and audiological healthcare priorities identified by our Ugandan partners. Together with these partners, we strive to improve the quality of human communication in practical and sustainable ways by building upon past successes and identifying future needs.
Audiology Without Borders
This column highlights the works of humanitarian hearing healthcare programs and is edited by active humanitarians Jackie Clark, PhD, and King Chung, PhD. Dr. Clark is a clinical associate professor in audiology at the University of Texas at Dallas and a research scholar at University of the Witwatersrand in Johannesburg, and Dr. Chung is an associate professor of audiology at Northern Illinois University in DeKalb.
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