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Affordable, State-of-the-Art Hearing Care in Dominican Republic

Hunter, Nicole

doi: 10.1097/01.HJ.0000544489.70213.3f
Audiology Without Borders

Ms. Hunter has been a hospital administrator at Centro Cristiano de Servcios Medicos in the Dominican Republic for the past 20 years.

Elier Franco was only 2 years old when he was brought to Centro Cristiano de Servicios Medicos (CCSM) in 2016. Unable to walk or speak, he was found to have moderate to severe hearing loss, behavioral issues, and neurological damage due to an acute ear infection that came with extremely high fevers when he was 1 year old. At CCSM, he received two digital hearing aids, and began auditory and verbal therapy. His initial response was very poor since he was unable to follow directions and adapt to hearing aid use. But after much trial and error and with the support of his dedicated father, the audiology team incorporated music therapy, games, and videos into his therapy. Today, Elier can walk, follow instructions, name animals, count and recognize food, and has gained some fine motor skills. Elier is one of many that CCSM, a faith-based, non-profit center in the Dominican Republic, has helped since it first opened its doors in 1984.

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CCSM started with a focus on providing eye care for poor communities in Los Alcarrizos, Santo Domingo, Azua, and La Romana, but it soon became evident that audiology services were also needed. Educating local health professionals also became key as the center grew.

One of the center's founders, William T. Hunter, Jr., was a missionary from Arizona who moved to the Dominican Republic in 1971 to join short-term medical missions with other North American volunteers. He saw a need for a permanent health care facility for the locals with limited resources. In the early 1980s, he teamed up with Juan F. Batlle, MD, a Dominican ophthalmologist, and built CCSM to provide eye care and training for young doctors interested in ophthalmology. CCSM rapidly became a household name in Latin America, as its residency, fellowship, and technician training programs are among the largest and most well-known in the world of ophthalmology.

Over the years a variety of specialties have been added, including orthopedics, otolaryngology, cardiology, OB/GYN, gastroenterology, endocrinology, plastic surgery, general surgery, urology, and general medicine. Establishing services in these areas was a priority, as these are usually expensive or only offered by a few doctors.

CCSM has one large tertiary center and four sub-centers, two in the capital city of Santo Domingo, one in the eastern region, and another in the southwest region of the island. People from all over the country and even neighboring Haiti go to these locations for affordable health care. Cognizant of these patients’ travel expenses, CCSM provides all support services on site to prevent patients from incurring further expenses.

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CCSM's audiology services are the fruits of several partnerships. In 2001, the center partnered with the Australian foundation Ears, Inc., led by audiologist David Pither, to train two professionals in basic audiometry and fit solar-powered body-worn hearing aids. Later in 2005, pediatric audiologist Donna Carkeet, AuD, also from Ears, Inc., moved to the Dominican Republic to establish a two-year audiology technical program that produced the first nine audiology technicians in the country. Through Carkeet, Joanne Travers of Partners for A Great Voice got on board and helped establish CCSM's auditory and verbal therapy department.

CCSM also received a five-year grant from the Hear the World Foundation under the close guidance of Richard Seewald, PhD. This gave birth to the only newborn hearing screening program in the Dominican Republic that now operates in two of the largest maternity hospitals in the country. This special partnership provided CCSM with a state-of-the-art pediatric sound booth and diagnostic equipment, allowing the staff to do more tests if needed after the initial screening.

CCSM's Audiology Center operates in a recently remodeled tertiary center to provide world-class and evidence-based care, such as audiometry, tympanometry, OAEs, evoked potentials, hearing aid fittings, and cerumen removal. The center has the only lab in the country where ear molds can be made—a service that is also extended to other hearing centers. All hearing aid repairs are done on site. Two of CCSM's four sub-centers also provide audiology services, while the third sub-center will be expanded to include this service within the next two years. In 2017, the Audiology Center served close to 3,600 patients and screened more than 720 newborns. This year, the center aims to double these numbers and expand the availability of audiology services to all five sub-centers.

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One of CCSM's top challenges is the socioeconomic status of our patients. Since most are low-income, travel expense plays a big factor in early detection. So we made it our priority to organize regular outreach projects to reach patients in schools, churches, and communities throughout the country. This way, only patients who need follow-up are referred for further testing. Community-based work is also very much a part of the center's mission. Every year, the center provides children from low-income families with donated hearing aids.

As its newborn screening program grows, CCSM aims to share important data with the country's ministry of health to promote the importance of early detection and management of hearing loss, which will hopefully lead to mandatory newborn hearing tests and better health coverage for hearing loss and rehabilitation.

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