The majority of people with hearing loss live in developing countries—the very countries that are home to more than 80 percent of the world's population (Otol Neurotol 2010;31:31-41).
Few countries have structured, accessible, and effective auditory health programs or other tools to help reverse the effects of hearing loss. Additionally, not many nongovernmental organizations (NGOs) or other healthcare agencies focus on auditory care.
Medical Ministry International (MMI) is one NGO that is concerned with hearing health. Through its expanding auditory program, MMI is working to lessen the impact of hearing loss in underserved areas of the world. The organization's auditory projects create greater access to hearing screenings, audiological evaluations, cerumen management, and hearing aids for the poor.
LAYING THE FOUNDATION
In the early 2000s, MMI identified the need to develop audiological services in the Dominican Republic. At that time, there were two full-time audiologists in the country, both of whom were serving the higher economic class in the capital.
In 2001, MMI began a partnership with Ears Inc., an Australian charity that specializes in training and equipping people in developing countries to provide audiology services. That year, Ears Inc. President David Pither travelled to an MMI hospital center in the Dominican Republic to lay the foundation for a comprehensive hearing healthcare program dedicated to helping the poor.
During this project, a soundproof booth was installed in the clinic, and two local trainees were taught to do basic evaluations. After seeing how great the need for hearing healthcare is in the Dominican Republic, Ears Inc. and MMI decided more needed to be done.
I made my first of many trips to the MMI center in the Dominican Republic in 2002, spending three months mentoring and training audiology technicians in basic hearing evaluations and hearing aid fitting.
As the program grew, short-term training trips were deemed insufficient given the need. Working under the auspices of MMI and Ears Inc., I moved to the country to work full time on the development of the audiology program and of a two-year curriculum for audiology technicians to be presented to the Ministry of Higher Education.
In 2006, a three-month pilot program in audiometric testing was conducted in order to prove to the Universidad Federico Henriquez y Carvajal and the government that the MMI center was capable of conducting a quality training program. The following year, the university accepted the two-year audiology program, and students began enrolling in the course.
At present, the program runs as a two-year university-approved diploma course, but work continues with the Ministry of Higher Education to get full accreditation and governmental recognition.
Since 2007, 15 students have graduated from the audiology technician course. Graduates of the program are employed in three MMI clinics in the Dominican Republic, as well as private ENT offices and audiology clinics throughout the country.
The training has not only changed the availability of quality audiological services in the Dominican Republic, but it is also having a wider impact. Two graduates have returned to their home countries of Fiji and Haiti to provide audiological services to their people; another will soon be returning to work in her home country of Ethiopia.
KEEPING COSTS DOWN
MMI clinics target their services to the poor and disenfranchised in a community. However, clinics are self-sustaining, as patients pay for services.
In the Dominican Republic, MMI and Ears Inc. have developed an earmold laboratory and hearing aid repair center that operate alongside the audiology clinic, making it possible to provide services, repairs, and ear molds at affordable costs for all residents.
For example, a basic audiological evaluation costs less than US $15, an earmold about US $15, and an entry-level digital hearing aid fitting around US $200, including three appointments.
Device repairs are done by an in-house technical support staff and laboratory teams. Having this on-site repair service means considerable savings for patients (standard shipping to a repair center in the United States costs approximately $50, not including the costs of the repair itself), while also creating local business opportunities for the community.
In 2010, the MMI audiology program was awarded a grant from the Hear the World Foundation that provided for technician training in calibration services. This skill set has allowed for on-site calibration and equipment maintenance/repair, which is much more economically feasible for a clinic that provides services to the poor.
This year, Hear the World provided additional funds that will permit the purchase of real-ear-to-coupler difference (RECD) equipment to further improve device fittings in infants.
MMI and Ears Inc. are now partnering to develop training curriculum for MMI project staff so that they will be able to conduct hearing screenings, otoscopic examinations, and other audiological services during outreach projects in their regions.
The pilot phase of this program will focus on the South American countries of Colombia, Peru, and Ecuador. By 2015, MMI plans to expand such training to all partner countries. Additionally, the organization is working to develop and expand audiology services in the various MMI health centers around the world.
As this program continues to expand and affect more locations around the world, Medical Ministry International is looking to engage with more hearing healthcare professionals who are able to train, mentor, and support specialists in developing countries.
Audiology Without Borders
Our Audiology Without Borders column, featured each month in the HJ eNewsletter, highlights humanitarian hearing healthcare programs.
The column is edited by active humanitarians Jackie Clark, PhD, and King Chung, PhD. Dr. Clark is a clinical associate professor 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.
Let us know about your humanitarian program! Send the details to HJ@wolterskluwer.com—manuscripts should be about 1,000 words, and photographs are also welcome (300 dpi in jpg, tif, or gif format).
Read past Audiology Without Borders columns in a special collection at bit.ly/HJAudWB.
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