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Humanitarian Outreach in Otology

Wagner, Richard MD

doi: 10.1097/01.HJ.0000525533.79302.3f
Audiology Without Borders

Dr. Wagner is an otologist and the founder and director of Global ENT Outreach (GEO). Along with a select group of ear surgeons, he visits ENT surgeons abroad to teach needed surgical skills and provide humanitarian surgical services at absolutely no cost.

Over 150,000 people die annually from complications of ear disease, mainly from untreated meningitis or brain abscesses secondary to cholesteatomas or chronic otitis media. To address this global shortfall in ear care, Global ENT Outreach (GEO) is making strides to save the lives of those who are at risk.

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GEO is one of a handful of non-profits dedicated to the field of otology. Since its founding in 2001, GEO has been providing otologic care to the underserved communities in developing countries and training local doctors to perform ear surgeries. The group's primary focus is to educate overseas otology physicians so they better understand the disease processes affecting the ear and learn how to provide safe and effective surgical care to their populations.

GEO grew from a core group of four otologists into a far-reaching organization of doctors and advisor-consultants brought together by the common goals to educate fellow physicians and to provide humanitarian otologic services to unserved and underserved communities.

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ADDRESSING SURGEON SHORTAGE

GEO otologists have worked in developing countries in all continents, except the Middle East. Although each country poses different challenges, the common theme is a general lack of skilled ear surgeons capable of performing quality ear surgeries. Africa and countries such as Ukraine often only have a few otology surgeons in the entire region, and the quality of care is not on par with that in developed countries. When there are skilled surgeons, they often reside in urban areas, leaving the rural population without access to care.

GEO's approach to training otology surgeons is divided into two main areas. First is the training on the complex anatomy of the ear for doctors to safely navigate through surgeries. This is being done in the group's temporal bone labs in Paraguay, Cambodia, Cuba, Peru, and soon in Ethiopia.

The other area is training local doctors to treat ear diseases and perform otologic surgeries. Ear surgery is a complex procedure performed under the microscope or through an endoscope in specially selected cases. It takes years of dedication and practice to be able to master the skills needed to perform good ear surgeries because otology is essentially neurosurgery of the ear.

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DELIVERING GLOBAL PROGRAMS

To date, GEO has worked in over 25 countries and with the support of a handful of volunteer otologists from Italy, the United Kingdom, Spain, Colombia, and the United States. GEO has collectively performed over 3,000 ear surgeries to correct reversible hearing loss or to eliminate life-threatening ear infections.

Selection of a program location is based on several factors, including:

  • The potential to support a long-term sustainable educational and/or humanitarian program
  • The likelihood for the doctors in the program location to manage patients when we leave
  • The mutual interest in helping the unserved, rather than being self-serving
  • The sense of connection between GEO and the host organization in the program location
  • The academic, governmental, hospital, or NGO administrative/financial support in the visited country

A must for any trip is to ensure that the program location has an operating microscope with an eyepiece that is suitable for otolaryngologic surgeries. Otherwise, the group would bring our own portable Zeiss microscopes along with other surgical instruments, implants, and drills. Most of the equipment were donated by industry partners.

GEO teams normally consist of a surgeon, an operating room nurse, an audiologist, and an anesthesiologist. The audiologist performs pre- and post-surgical audiologic check-up and work side-by-side with the rest of the team to deliver comprehensive care. In most countries, there is a shortage of trained audiologists. Nurses, technicians, and physicians often assume the role of the audiologist, and in many instances their training does not meet the standards. GEO is delighted to work with audiologists on a global level and integrate improved training and delivery of care.

The greatest challenge that GEO faces is not the distance between the program country and its headquarters in Seattle or one of the satellite offices in Spain, Paraguay, Italy, or the U.K. It's not the lack of patients who need care, nor the language barrier that comes with working with partners of different linguistic backgrounds.The real challenge is to find transparent and motivated partners who share GEO's vision to help those who need care so they may reach their full potential and also serve others. But as Churchill once said, “We make a living by what we get, but we make a life by what we give.” Like-minded people are always welcome to join the adventure of serving the world.

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