By King Chung, PhD, CCC-A, and the Heart of Hearing Team
War, a word that evokes so many memories of destruction and grief, has been a staple in the news since February 2022 when Russia invaded Ukraine. Russia has since carried out numerous air strikes destroying civilian buildings, infrastructure, and power grids in Ukraine. These conditions have left many Ukrainians internally displaced, while many women and children have fled the country. Millions of Ukrainians have sought shelter and safety in Poland.
Poland is located on the west side of Ukraine, and the two countries share a long border. As of December 2022, Poland has recorded more than 8.4 million Ukrainian refugees since February 2022. While many refugees have subsequently traveled to other countries or returned to Ukraine, approximately 1.4 million refugees registered for Temporary Protection in Poland as of August of 2022.1
During the Thanksgiving break, a group of students and faculty from Northern Illinois University and Federal University of Rio Grande do Norte in Brazil embarked on a humanitarian trip to Kraków, Poland. During the trip, we collaborated with professors at Jagiellonian University in Kraków and the staff at Jewish Community Centre (JCC) of Kraków to provide free hearing services for school children and Ukrainian refugees. The services were much welcomed by the parents of the school children and our experiences with the Ukrainian refugees left us forever changed.
HEARING HEALTH CARE CRISIS
JCC is a nonreligious, nonprofit organization located in the Jewish part of Kraków. It connects visitors to modern Jewish life and provides community services to Jewish descendants and surrounding people. Since Russia invaded Ukraine, JCC has also extended its services to care for Ukrainian refugees.
Our initial intention was to examine the hearing status and the hearing health care needs of the refugees. After unsuccessful attempts to obtain rechargeable hearing aids from manufacturers, we brought four pairs of older lab hearing aids with us and planned to fit them to refugees with hearing loss.
During the trip, we conducted otoscope exams, tympanometry, distortion product otoacoustic emissions, and pure-tone audiometry. Among the estimated 150 refugees we tested, approximately 70 of them need hearing aids and some of them needed cerumen management in one or both ears. After testing, the JCC team provided translations so we could talk with the refugees to let them know about their hearing status and to counsel them for the next step. During the process, we got to know some of their stories.
STORIES OF HEARING LOSS AND SURVIVAL
A 20-year-old woman with intellectual disability had hearing aids in Ukraine that were accidentally left behind while she and her family fled the country. She had severe to profound hearing loss in both ear and did not have verbal language. Although the Polish government gave all the Ukrainian refugees two years of access to the Polish health system, which provides free hearing tests but hearing aids are not covered. As refugees, her family cannot afford to buy hearing aids. Now she is living without hearing aids, and communication with family has been very difficult.
Several women and older men were found to have perforated ear drums or have the look of a perforated ear drum during otoscopy, and many had sloping hearing loss in both ears. The patients with perforated ear drums were confirmed by Type B tympanograms, and some of the ear drums were healed as indicated by Type A tympanograms. One patient still had a blood rim on one ear drum. When we talked to them, they said their hearing was damaged by the shockwaves of the bombings. Some of them reported to have lingering tinnitus, and all had hearing loss in both ears. We referred the ones with perforated ear drums to otolaryngologists. When we advised them to seek hearing aids, they said they did not have the money to do so.
A father we tested had asymmetric hearing loss with mild-to-severe hearing loss in the left ear and mild-to-profound hearing loss in the right ear. When we inquired about possible reasons for having better hearing in one ear than the other, he said he and his son were both in a missile attack. He fell on his left side, leaving the right ear more exposed. Now he has tinnitus in the right ear. He said it was too painful to think about the event. We wondered what happened to his son, but the JCC staff said they didn't dare ask him in fear of triggering deep grief.
Two of the older women we tested sobbed constantly during their time at the testing sites. They said they missed their homes and their family members. The mere thought of the war elicited sorrow. They had aidable hearing loss, but they did not have money to buy hearing aids.
RAISING AWARENESS
As we were overwhelmed by the number of people with hearing loss, the testing process took much longer than anticipated. We did not have time to fit the hearing aids. Instead, we left the devices with the staff at JCC and are now in the process of seeking hearing health professionals in Kraków who can help us fit the hearing aids. The problem is that the need is so great that four pairs of hearing aids were not nearly enough to meet their needs.
While the impact of the war is often expressed the number of casualties in the media, the damage to people's hearing is not mentioned. Ukrainian refugees are not only displaced by the war, but many are also left with a permanent disability that can negatively affect their communication abilities and cause long-term disability. Studies have shown that adults with hearing loss are more likely to have communication difficulties, lower employment rates, and lower income. A report published in The Lancet also stated that hearing loss in mid-life would increase the risk of cognitive decline by 9% later in life.2 As a recent publication indicated that hearing aids can slow down the cognitive decline among people with hearing loss3, we hope these stories raise the awareness of the great hearing care needs of the Ukrainian refugees. We also hope to obtain enough rechargeable hearing aids so that we can return to Kraków to provide the much-needed amplification services.
Hearing loss will likely to be one of the most prevalent noncommunicable disabilities among the people who stayed in Ukraine, because of the continuous and relentless missile attacks. We strive to raise awareness of the great hearing health care needs among the people in Ukraine and hope to reduce the negative impact of untreated hearing loss on their cognitive and communication abilities and their quality of lives. We also hope more people will join our cause to provide hearing and amplification services and devices to the Ukrainian people.
For monetary donation to support students traveling to Poland to provide services, please:
1. Use the Northern Illinois University donation website: https://foundation.myniu.com/give.php and choose "Audiology General".
Then (very important!)
2. Send an email to NIU Foundation at [email protected] to specify your name and donation amount for
Heart of Hearing for Ukrainian Refugees.
For hearing aid donation, please contact:
Dr. King Chung @ [email protected]
Dr. King Chung is a professor of audiology and the program director of Northern Illinois University's Audiology program. She is the Best Practice Director at the Coalition for Global Hearing Health, a Fulbright Scholar, and the recipient of the 2020 AAA Humanitarian Award and the 2020 NIU College of Human and Health Sciences Service Award. The Heart of Hearing team is a group of faculty and students from Northern Illinois University and other universities led by Dr. Chung to provide humanitarian services. They have traveled to eight different countries and served more than 3,000 unserved and underserved people in the past 12 years.
References:
1. Statista. Estimated number of refugees from Ukraine recorded in Europe and Asia since February 2022 as of December 6, 2022, by selected country. Retrieved from: https://www.statista.com/statistics/1312584/ukrainian-refugees-by-country/
2. GDB 2019 Hearing Loss Collaborators. (2021). Hearing loss prevalence and years lived with disability, 1990–2019: findings from the Global Burden of Disease Study 2019. The Lancet, 397:996-1009. https://doi.org/10.1016/S0140-6736(21)00516-X
3. Yeo, B.S.Y., Song, H.J.J.M.D., Toh, M.S. (2022). Association of Hearing Aids and Cochlear Implants with Cognitive Decline and Dementia: a systematic review and meta-analysis. JAMA Neurology. https://www.doi.org/10.1001/jamaneurol.2022.4427
