Lady Jean Wilson, OBE, founded and established the Royal Commonwealth Society for the Blind, which is now called Sightsavers, with her husband, Sir John Wilson. She is chair of the Hearing Conservation Council (HCC) and president of the UK IMPACT foundation. What follows is an excerpt from the keynote speech she delivered in May at the Fourth Annual Conference of the Coalition for Global Hearing Health in Nashville, TN.
Healthy hearing for all is a human right, as it says in the United Nations Convention on Rights of Persons with Disability. It is also a question of scale. Hearing loss is the most prevalent sensory disability in the world, and the most neglected. It is hidden both physically and politically. Unless decisive action is taken, the number of hearing-impaired people is going to increase beyond the present 360 million as a result of population growth in developing countries and aging in industrialized countries.
Avoidable deafness and hearing impairment, with all their consequences for human suffering and economic loss, need no longer be an inescapable part of our human predicament. Their prevention, on an unprecedented scale and at no great cost, is an option available to the international community.
Preventive ear care requires commitment, constant innovation, and a clear view of priorities. If we are going to change public attitudes, we need, as an American has said, a customer service-oriented mentality with respect for the local culture and mores.
We need to raise ear care as a priority within communities by gaining the interest and support of their leaders and spreading information at community gatherings, such as tribal meetings, religious occasions, and mothers’ clubs.
Who provides the initial care of a child's ears? The traditional birth attendant and the mother do. They may be illiterate but are quick to understand simple hygiene of the ear. The village health worker needs to know the danger of ototoxic drugs sold unwittingly to pregnant women in the local shop.
For those children who are fortunate enough to go to school, the teacher can be trained to recognize the early signs of ear problems, as is done in IMPACT's school monitoring program in India, Kenya, Zanzibar, and Bangladesh.
Early detection of ear problems must be included in primary healthcare, as it is in both static and mobile healthcare clinics by the IMPACT foundations in Bangladesh, India, Sri Lanka, Kenya, Pakistan, and Tanzania, with suitable referral.
Referral brings us to the greatest need of all—manpower at all levels, from the village health worker to the super specialist, with the essential need to maintain appropriate standards of clinical practice and create replicable models of sustainable action.
Throughout the developing world, there is a grave shortage of specialized staff. Even against that background, the lack of otorhinolaryngologists, audiologists, and ancillary staff is so acute that training must be the first priority.
If I may give one country as an example, take Malawi, where a population of 14 million is served by one ENT surgeon. I first met Wakisa Mulwafu when he was training in South Africa and was impressed that even then he had a vision of a national ear care plan for his home country. A representative of the Hearing Conservation Council has been working with Wakisa on a national ear plan that has been accepted by the Ministry of Health, and he will return this summer to assist with the beginning of its implementation.
The HCC also decided to fund the four-year ENT training of another Malawian doctor who will return home this summer as the second ENT surgeon in the country.
Since medical personnel are so few, clinical officers do outreach work from district hospitals but lack training in ear care. HCC has funded clinical officers to take their ENT diplomas in Kenya and is now assisting in the development of a training program for 15 officers in Malawi.
CBM has been assisting in Blantyre, Malawi; Sound Seekers is funding Malawians to take audiology training in Kenya; and Rebecca and Peter Bartlett are running an audiology course in Lilongwe, Malawi.
WINDOW OF OPPORTUNITY
I think we, the nongovernmental organizations, are the movers and shakers in planning, fund-raising, and social mobilization, and in the addition of that essential quality of immediacy and enthusiasm. Academic institutions add the rigor to idealism that we need for persuading governments in developing countries to support, coordinate, and finance ear programs within their whole health structure and legislative system. In those countries that give international aid, we need to communicate that prevention of deafness is not an isolated issue but is linked to the well-being of the people, with both humanitarian and economic justification.
The first essential steps toward global programs for the prevention of deafness and hearing impairment were evident in the resolutions of the World Health Assembly in 1985 and beyond.
There is now a consortium of five organizations funding the post of medical officer for hearing health in the World Health Organization (WHO), providing professional support and collaboration in the field. The organizations are: American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO–HNSF), CBM, Hearing Conservation Council, International Federation of Otorhinolaryngological Societies (IFOS), and International Society of Audiology (ISA).
Dr. Shelly Chadha has been in the post since December 2011 and has assisted with programs in 10 countries. Aiming for interdisciplinary coordination, she is collaborating with units within WHO, such as those for medical devices, immunization, child health, aging, and occupational and environmental health.
It is my hope that in 2015 we can initiate a second resolution at the World Health Assembly, illustrating the changes achieved by Shelly's work and the combined efforts of the Consortium in the field, thereby urging member countries to strengthen measures for the prevention of deafness and hearing impairment within their existing programs of health and development.
But to reach that goal we need more members adding their own achievements to strengthen the cause and help support this post of hearing health both professionally and financially. It has been said that the most powerful medicine in public health is money.
We now have a window of opportunity through action at the level of primary health and environmental control to achieve a massive reduction in the causes of deafness and hearing impairment in developing countries. Smallpox has gone, polio is on the way out, and immunization of the world's children is on the horizon. To all the revolutionary targets, quality of life is now being added as the justification of the whole development process.
It is up to us to take the lead and seize this opportunity together to promote systematic action, thrusting through all arguments, politics, and bureaucratic clutter to achieve a single, massive, and realizable goal—in the words of the Beijing Declaration, healthy hearing for all human beings.
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 http://bit.ly/HJAudWB.
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