The field of audiology is emerging throughout Africa, especially in Zambia, a country of approximately 14 million people in the southern part of the continent.
According to the World Health Organization (WHO), 360 million people around the world have disabling hearing loss, and most of them live in low-and middle-income countries (WHO Deafness and Hearing Loss fact sheet http://www.who.int/mediacentre/factsheets/fs300/en/).
In Zambia, a low-income country where 45 percent of the population is under 15 years of age, the ability to communicate effectively is important to breaking the cycle of poverty through education (Zambia Demographic and Health Survey 2007; Central Statistical Office: Lusaka, Zambia http://www.zamstats.gov.zm/report/Demo/2007%20ZDHS%20Final%20Report.pdf). The country has experienced its share of successes and challenges in healthcare.
Like many other countries in Africa, Zambia is facing an extreme shortage of hearing healthcare professionals. It has just five qualified otolaryngologists and one audiologist.
Over the last twenty years, the Ministry of Health has initiated and implemented changes that aim to make healthcare more accessible to Zambians through decentralization.
Therefore, responsibility has been spread across the different levels of the healthcare system, namely the Neighborhood Health Committees, District Health Management Teams, and Provincial Health Offices.
These centers and subsequent systems have been close partners in the development of audiology services throughout the country. The Institute for Ear, Nose, and Throat (ENT) and Audiology at the Beit CURE Hospital in Lusaka, the capital of Zambia, have spearheaded the initiatives.
GROWTH OF SERVICES, CLIENT BASE
In 2009, the Beit CURE Hospital ENT and Audiology Clinic was constructed with funding from CBM International and Irish Aid, and a generous allocation of land from the government of Zambia.
The clinic's mission is to be a center of excellence in providing a full spectrum of services from pediatric to adult care. The desire to offer quality services is coupled with the aspiration to provide training in basic ear and hearing care for healthcare professionals around the country.
Services have grown to include primary ear care, hearing screenings, diagnostic behavioral hearing evaluations, auditory brainstem response evaluations, hearing aid fittings and support, and referrals to related and necessary specialists, such as ENT doctors and surgeons, neurologists, speech–language specialists, etc., as available.
Since its inception, the client base of the ENT and Audiology Clinic has grown exponentially, with referrals coming from hospitals and clinics across the country.
A multidisciplinary team comprised of an audiologist, audiology technicians, nurses, and an ENT surgeon provide the spectrum of services at Beit CURE Hospital and through mobile clinics that travel across the country.
Fortunately, most services—except, in certain cases, hearing evaluations and hearing aid fittings—can be performed through outreach programs.
However, the services that are unique to the hospital cannot be conducted in other clinics due to a lack of qualified healthcare practitioners and resources. For this reason, it is imperative that referral systems be strengthened and audiology training programs developed and implemented through local directives.
EXPANSION OF TRAINING
At present, 30 clinical officers from governmental healthcare centers at the district level in Lusaka Province have received basic ENT and audiology training.
A further team of six clinicians have been taught how to use pure-tone audiometry and tympanometry, and to provide primary ear care at the referral hospital in the Copperbelt region of Zambia.
However, long-term objectives of the Institute of ENT and Audiology stipulate that training should expand to district and community teams throughout all provinces, ensuring that every major district healthcare center has access to primary audiology services.
It is our hope that each center would then have its own outreach program supporting the surrounding community clinics so that more of the population of Zambia would have access to ENT and audiology services.
At the present time, there is one district healthcare center that has implemented this ideology. Ndola, the capital of Copperbelt Province, now has its own ENT and Audiology Department at its provincial referral hospital, Ndola Central Hospital.
The Audiology Department currently receives financial and other support from Sound Seekers, a nonprofit organization based in the United Kingdom. In addition, Sound Seekers has donated a truck to the team known as HARK (Hearing Assessment and Research Center), which is used for regular outreach clinics.
This mobile clinic is intended to reach the various district and community clinics in Copperbelt Province that are either receiving sparse, periodic ENT and audiological services or no services at all.
About 27,000 children in grades one to nine at government schools in Zambia are deaf or have hearing loss (2008 Education Statistical Bulletin; Ministry of Education: Republic of Zambia).
In an effort to convince the government of the importance of hearing screening, the ENT and Audiology Department in the Copperbelt region of Zambia initiated a screening program for children in grades one and two of government schools around the capital city of Lusaka.
About 6,000 children have been screened for hearing loss since 2011. Of these children, 34 percent had hearing loss due to a treatable ailment, and two percent had sensorineural hearing loss, as shown in the chart.
Numerous children with mild to moderate hearing impairment were identified. In an ideal setup, these cases would easily have been rectified by surgery, medication, or hearing amplification.
However, due to the previous lack of services, many of these children were placed in schools for the deaf or categorized as having an intellectual difficulty. This occurrence is not uncommon in Zambia.
Very often, children with any degree of hearing loss—or other challenges, for that matter—are relegated to a corner of society away from the public eye. This reaction is due mostly to lack of awareness of the presence and effects of hearing problems.
The specific aim of this screening program has been to collect enough data to compel the government to develop policies for implementing universal hearing screening for all children entering grade one.
It is hoped that such policies will be the first step toward implementing other types of universal hearing screening, such as newborn screening.
THREE MAJOR CHALLENGES
The main challenges faced by the field of audiology and ENT in Zambia are related to equipment, monetary resources, and capacity.
As much as technological advances have provided better and more efficient diagnostic and hearing aid fitting equipment, most of the equipment is beyond the financial capability of many clinics in Zambia.
Despite the high number of children in the school system who are classified as deaf, the government has not yet prioritized the provision of audiology services to the general population.
Until the profile of hearing loss and deafness is raised, the development of audiology services will continue to rely on foreign partners to ensure growth.
CREATING SUSTAINABLE PROGRAMS
It is the hope of the ENT and Audiology Clinic in Lusaka to continue to strengthen and develop services and training throughout Zambia.
To accomplish that, our development plan begins with identification at the community level, progresses to treatment at the district level, and then advances to hearing evaluation and hearing aid fitting at the provincial level, finally reaching the establishment of centers of excellence at the University Teaching Hospital (UTH), which is the national referral hospital, and at Beit CURE Hospital.
Offering training through modern technology will help create effective and sustainable programs to ensure that any person with hearing loss in Zambia can readily access audiology services without having to travel many miles.
With the growth in telemedicine, the use of tele-audiology platforms to provide clinical staff with ongoing online training and support from local and international audiologists will be invaluable to the development of high-quality services. This platform will also enable regular supervision and assistance with difficult cases.
Currently, a phased-in approach is being used to grow services at remote sites, such as those in Ndola. The eventual use of otoacoustic emission/automated auditory brainstem response for screening, and the provision of hearing aid fitting and follow-up, are long-term aims.
Another part of the strategic plan of the ENT and Audiology Department is to expand upon existing structures by partnering with private and public entities that endeavor to see the development of ear and hearing care across the country and the African continent.
The team is looking forward to the future, trusting that tomorrow has much to offer in this new frontier called audiology in Zambia.
Audiology Without Borders
Our monthly Audiology Without Borders column 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 http://www.bit.ly/HJAudWB.