Volunteer Blog: Bhavisha’s Year in Zambia
Running the Clinic
“The Children’s Hearing Clinic here in Lusaka has been attracting a lot of attention and this week I completed the hearing assessment of our 50th patient! Since my last blog entry I’ve also been lucky enough to have some very familiar visitors in the clinic (pictured left).
Although my job as an audiologist means I complete the clinical assessments and fit hearing aids, some days are far less glamorous. As any audiologist knows, it’s all about organisation. From labelling storage compartments for otostops and impression materials to organising drawers for hearing aid repair tools and tubing. Without these things II would have become a tangled mess of battery stickers and programming cables. Fortunately, the Round Table Association of Zambia kindly donated a wonderful filing cabinet and it is things like that which really makes the difference. These are the finishing touches to the clinic which really help the smooth running and efficiency of the whole place.
So far, I have fitted 4 patients with hearing aids; three children (including Emmanuel featured in our recent news article) and one adult.
I want to dedicate this blog entry to Ms Esther Mundia who came to the clinic struggling with her hearing. She explained that she is always in group situations and has a busy lifestyle so her hearing ability is very important to her. We spent quite a while chatting about her life and I was immediately inspired. Mrs Mundia is the founder of the MYCEPA organisation, helping families of children with cerebral palsy. She has seen the impact of the lack of services for those persons with disability here in Zambia as she herself has a son with cerebral palsy. She heard about the Children’s Hearing Clinic through other health and disability professionals and came to see it for herself. After her hearing test I explained she did in fact have a unilateral hearing loss which would be contributing to the difficulties she was having during group conversations and big meetings. I was able to fit her with a hearing aid from the Sound Seekers hearing aid refurbishment project (HARP) and I will be reviewing her progress in a few weeks. She was so grateful for the clinic and paid me in kind as her son helped put our new filing cabinet together in our office! Ms Mundia wanted to give a personal account of her experience in the hearing clinic so I put together a video of her thoughts:
As well as my clinical work I have also been teaching students of the Starkey Hearing Institute’s ‘Hearing Instrument Specialist’ course. With our well equipped clinic the students are able to complete practical training of real ear measurements and hearing aid programming. Their final exam is at the end of this week so I am wishing them all lots of luck!”
Teamwork makes the dream work
“The audiology department now has Visual Reinforcement Audiometry! This means we can test the hearing of children from 6 months of age using a behavioural technique that needs quite specific equipment. The brand new equipment has been provided by Sound Seekers with contributions from Otometrics. It was sent to our London office as I travelled back to the UK for a short trip in July to attend my MSc graduation. During my stay I was lucky enough to speak at the British Society of Audiology conference about the establishment of the Children’s Hearing Clinic in Lusaka. The presentation was very well received and many audiologists emailed me for more information about my volunteering experience.
(Note: If any audiologists are reading this blog – I would highly recommend taking some time out from your current role to volunteer and develop audiology services globally if you ever have the chance! As you will notice from this blog, the challenge, variety of work and the job satisfaction is perfect for anyone who is really passionate about developing our field and has the opportunity to commit time and effort towards just that).
During my trip, I caught up with the Sound Seekers team in London as well as my family and friends which was wonderful. I filled my suitcases with all our new equipment ready to take back to Lusaka. Once back, I unpacked and met Heinz, the engineer from Amtronix – South Africa who Otometrics very generously sponsored to come over and help me install the VRA equipment.
Heinz and I spent many hours in the clinic as he rewired the whole room and I tried to be as helpful as possible. One evening we were so determined to get everything finished we got some takeaway dinner and stayed at the clinic until 2am! A very surreal experience. Speakers mounted and wiring complete! We now have VRA testing and the ability to fit digital hearing aids. I sigh. A sigh of relief and joy and tiredness. I realise how emotionally attached someone can get to a project like this!
Teamwork really made the dream work to complete this clinic. A paediatric clinic that matches or surpasses the standard of any paediatric clinic in the UK and we can now provide hearing assessments and hearing aids to patients of all ages. Big thank you to Amtronix, Otometrics and Path Medical for answering all my silly questions and co-ordinating efforts so effectively.
Off to Ndola!
This was my second visit to the Audiology Department at Ndola Teaching Hospital. I met with the audio technicians, Anita and Olipa to provide some hearing aid verification training and it was wonderful to see them using the hearing aid database we created together at my last visit.
I also visited both primary schools where expansion of the current deaf units has started. Foundations have been laid and the plans look very promising. Currently, around 80 deaf students at Chilengwa primary school share three small classrooms. This project can increase the access to education for children with hearing loss. Part of this new project also includes weekly outreach hearing screening clinics for school children. On my last day, I hopped into the HARK vehicle with the outreach team and we managed to screen the hearing of 175 school children in grade 1. The thing I am most passionate about is ensuring there is adequate follow up and necessary onward referral for children identified with hearing loss. It was lovely to know that any child identified with possible hearing loss during outreach events can be referred to an accessible audiology department for advanced testing and hearing aid fitting. I am looking forward to my next visit to see the progress of this exciting project!”
The Children’s Hearing Clinic is now open!
Bhavisha checking one year old Monica’s hearing in the children’s clinic at UTH
Thanks to Darius from APTERS for making the new toys for the clinic
Lone and Trine from Otometrics ready to ship our VRA and hearing aid fitting equipment – thanks so much guys!
Welcome to the UTH Children’s Clinic
“We are open! Since the arrival of our brand new diagnostic auditory brainstem and otoacoustic emissions test equipment we have been able to see our first group of patients.
The clinic is getting a lot of attention from the general public with many people enquiring how to get hearing assessments for their children (and themselves!)
Establishing the hearing clinic has been quite challenging. This is mainly because there has never been an audiology clinic within the government hospital. The priority at the moment is to raise awareness of the importance of audiology services at a government level. We have no concrete data regarding the prevalence of hearing loss in Zambia but some studies have shown it has been as high as 11.5% in school aged children. With that being said, it is vital to ensure there are effective follow up pathways in place so we can support the children we identify with hearing loss.
In a month’s time we will be able to fit digital hearing aids to children with hearing loss and provide the necessary counselling to parents. It is very exciting to see the impact we are able to have in such a short space of time and I am hoping we will be allocated some nurses soon to help in the clinic.
Last week I was lucky enough to attend a course on ‘Public Health Planning for Hearing Impairment’ held at the University of Nairobi in conjunction with the London School of Hygiene and Tropical Medicine. It came just at the right time for me as I was able to take stock of the progress we have made in Lusaka so far and come up with a strategy to move further forward.
Here are some pictures of two patients seen in the clinic this week:
Monica is one years old and has Cerebral Palsy. I performed diagnostic otoacoustic emissions and tympanometry on her and she will be coming for a follow up appointment in a month’s time for behavioural audiometric testing.
Florence is six years old and has had significant hearing loss since birth. She was given analogue hearing aids many years ago but her mother thinks they did not help her. She attends a Deaf Unit in school and she uses sign language. Through play audiometry we found that she did not have usable residual hearing and the hearing aids would not benefit her. Her mother was happy to have an accurate representation of her hearing ability so she did not have to expect Florence to hear from the hearing aids.
A few colourful additions to make the department more child friendly:
New toys for the clinic: ‘Men in the boat’- Such a simple yet effective tool in any Paediatric Audiologist’s toolkit. Here is a photo I took today of Darius, one of the APTERS (Appropriate Paper Technology) employees. I had asked him to make some ‘men in the boat’ type toys for the new paediatric audiology clinic we have set up in the hospital in Lusaka. I was amazed with what he had made and he’s ready to paint and make some more. I asked whether he had enjoyed the project… I think his smile speaks for itself (see picture to the left)
I am looking forward to the audiology department growing and flourishing and have really learnt the importance of lobbying for what you believe in and knocking on as many doors as possible to get the message across. It has been hard work so far but it definitely pays off”
Helping Tulisani hear again
“I met a very shy 12 year old girl called Tulisani recently at Beit Cure hospital. Her aunt told me she was struggling at school and has not been able to follow conversations for the last six years since being given quinine medication to treat malaria.
It took Tulisani quite some time to feel comfortable in the clinic and it was clear she could not hear me when I explained the instructions for the hearing test. We then decided to try conditioning techniques with play audiometry and after a few times using a loudspeaker, and a lot of encouragement; she really got the hang of it. Results revealed a symmetrical severe sensorineural hearing loss bilaterally. Her aunt was not surprised about this but was delighted when we offered the hearing aid fitting on the same day. We took impressions of both ears and within a couple of hours the ear moulds were ready.
Tulisani was fitted with digital super power hearing aids, made possible thanks to Sound Seekers Hearing Aid Refurbishment Programme (HARP). As soon as the hearing aids were programmed and switched on, Tulisani was transformed into a chatty and smiling child. She loved hearing her own voice and repeating what I was saying. Her aunt practiced how to use the hearing aids and Tulisani was keen to try how to put them in herself. At the end of the appointment she didn’t want to take them out! We’ll monitor her progress and see her again in a few weeks’ time”
University Teaching Hospital have also just posted an article about Bhavisha’s work in Zambia. Read the full article here: http://www.uth.gov.zm/?p=1594
A lot of progress in two months
“It seems time really does fly when you are having fun. Since my last post we have made great process with the paediatric audiology testing room. We have fitted new carpets to the floors and walls to ensure it is sound proof, finished the painting and even had to get rid of some very unwelcome rats in the building! Once the renovations were complete we added some lovely tables and chairs which were made by the team at APTERS (Appropriate Paper Technology). APTERS is an organization based in Lusaka, Zambia. It was set up in 1990 to produce mobility aids with recycled paper and cardboard to assist children with physical disabilities while empowering adults with disabilities.
The photos below show the renovated Children’s Hearing Centre:
We are now awaiting audiological testing equipment (for visual reinforcement audiometry and brainstem testing) from Otometrics and Path Medical – Big thank you to both companies, namely Trine Marqvard and Russell Higgs, for all the help, support and donations. Once the equipment is installed the UTH Children’s Hearing Clinic can officially be launched!
Between my work on the project at UTH I was able to spend a week in the Copperbelt city of Ndola with Sanah (Hear the World Volunteer) to provide training and clinic support to Ndola Central Hospital’s audiology department. The department is supported by Sound Seekers and is run by two Audio Technicians and an ENT Specialist Clinical Officer. It was a very busy week which we spent reviewing stock levels and equipment as well as running workshops on hearing aid programming, testing techniques and verification.
Half way through our week 84 year old Mr Chibwe had an appointment in the clinic. Mr Chibwe reported having no hearing in the left ear since childhood and a progressively deteriorating hearing loss in the right ear. It was quite difficult for him to communicate with us due to the severity of his hearing loss but he was very happy to try a hearing aid. We fitted Mr Chibwe with a digital hearing aid, from the hearing aid refurbishment programme (HARP), and verified with real ear measurements. Despite having no hearing in the left ear, his new right sided hearing aid enabled him to take part in conversations without lip reading. He was very happy with his new device!
The busy month got even busier with a welcome visit from from Hear the World volunteer, Tim Ringger as well as Sound Seekers team members Kavita and Tanya. Together we reviewed each project and the work I’ve been doing in the last two months. It was a very productive visit for all involved – even more positive once Kavita got her lost luggage back! They even brought me some lovely goodies from friends and family back home – thanks guys J
In the last few months I have met some amazing people and built good working relationships with hospital staff and those in the Ministry of Health. The thing I enjoy most is teaching and so my next step is to find some enthusiastic staff members to train so they can help with the paediatric clinic once it is up and running. Training and teaching current hospital staff paves the way for this project to transform into a sustainable paediatric audiology service that can be embedded into the University Teaching Hospital structure. So it’s time to get the Ministry of Health and senior hospital staff on board to take the necessary action – wish me luck!
You’ll be glad to know that it is not all work and no play. I was lucky enough to take a short break to attend the Kuomboka Ceremony in Mongu, Western Province of Zambia. The ceremony celebrates the end of the rainy season when the King of the Lozi people moves to higher ground. It was truly spectacular to see the King’s huge barge move along the floodplains.“
Happy International Women’s Day
“Today I have chosen to celebrate four very inspirational and passionate women I have met during my time in Zambia. And I am happy to be in a country that recognises this day enough to grant it as a public holiday! Helen (Hear the World volunteer), Mrs Banda and I are using this day to paint our new clinic room (not quite a full day off for us!)
1) Dr Uta Froeschl – ENT Surgeon, Beit Cure Hospital
I met Dr Uta Froeschl in my first couple of weeks in Lusaka. She is the ENT surgeon at Beit Cure Hospital and has been instrumental in the development of ENT and audiology services in the area. Beit Cure is the home of the Sound Seekers Hearing Aid Refurbishment Programme (HARP) and also houses two audiology testing rooms and hearing aid fitting facilities.
Dr Uta was born in Berlin, Germany and travelled to volunteer in Tanzania in 1989. She was inspired to study medicine and completed her ENT speciality training in Berlin. In 2003 she moved to Botswana to become the only ENT surgeon in the country! She focussed on ear and hearing care and developed ENT courses for nurses as they are the backbone of Botswana’s health system in local hospitals. Dr Uta then moved to Zambia in 2010 to build and develop a comprehensive programme in ear and hearing care in Lusaka (supported by CBM). Her main tasks included equipping the ENT clinic, developing the ear and hearing care service and school screening programmes, training nurses, audio technicians and clinical officers in primary ear care and development of the national strategic ENT plan and to support its implementation.
Dr Uta’s hopes for ENT/Audiology in Zambia: “My vision would be to start more ENT programmes in other districts – just as Beit Cure hospital is doing- for people with ear diseases and hearing loss to be able to access service close to their homes. My hope is that with the new trained personnel and more training to follow at different levels as well as the start of the implementation of the developed national strategic ENT plan, there will be a major change in ENT and Audiology in the country”
2) Dr Racheal Hapunda – ENT Surgeon, University Teaching Hospital
In my first few conversations with Dr Uta she told me about a very passionate new ENT Surgeon at University Teaching Hospital who had completed her postgraduate training with a dissertation about school hearing screening. I, of course, was intrigued and couldn’t wait to meet her…. Dr Racheal Hapunda!
Dr Hapunda qualified as an Ear, Nose and Throat Surgeon in February 2015. She is married with two gorgeous children and told me how that particular month will always be dear to her as she started a new stage in her life -she was officially Zambia’s first indigenous ENT surgeon – an achievement embraced by many. She explained “as a family what started as a dream was achieved by God’s grace after lots of sacrifices made by many”.
Her absence from her family for five and a half years is a testament of her passion towards ENT in Zambia. For a long time the country only had two surgeons catering for a population of 16 million people and this neglected a huge part of the country. Children have to travel miles and miles to Lusaka for procedures like adenotonsillectomies and some just cannot afford to travel. With a hearing loss prevalence of 11.5% in school children as a result of preventable causes, Dr Hapunda feels ENT and audiology in Zambia has its work cut out for itself. The current project is to try and improve ENT and Audiology services at University Teaching Hospital.
Dr Hapunda’s hopes for the future of ENT and Audiology in Zambia: “I hope to see us grow as an ENT and Audiology fraternity with a training programme so that women like me can easily make the choice to specialise in ENT without leaving our families behind. My dream is to see each province in Zambia have its own ENT- Audiology unit so that we can serve our people better”
3) Ms Caity Wessels- Speech and Language Therapist
As a paediatric audiologist I am always looking for the nearest speech therapist to be able offer a multidisciplinary service to the children with hearing loss. I was so happy to meet Caity as she has so much passion and enthusiasm and the biggest smile! She is one of only ten practicing speech therapists in Zambia – a country with a population of around 16 million!
Caity currently works in three different hospitals/clinics in Zambia with patients from all walks of life. Through her work she has met some amazing individuals who are dedicated to making this world a better place for everyone. Her heroes are “the individuals who are working to make society more aware and inclusive for people with disabilities”
Caity’s hopes for speech therapy in Zambia: “I hope that Zambia will be able to educate and nurture its own internationally recognised speech therapists. In addition to this, I would like to see the speech therapists in Zambia being an example of best practice to other developing countries that are implementing this needed service into their health and education sectors. This is because there is a big need for intervention in the area of communication disability the world over and more so in developing countries”
4) Mrs Victoria Mbewe Banda – Senior Teacher for children with hearing loss, Special Needs School, UTH
Mrs Banda is a specialist teacher at the school for children with special needs here at University teaching hospital. She is the teacher in charge of the hearing and speech centre which houses the hearing impaired unit of the school.
She is married with five lovely daughters (six now because I count myself in that list) and she has been my surrogate mum during my process of settling in here! She is one of the most caring people I have ever met and with children travelling from so far away to attend this school she sometimes works over 13 hours a day to ensure they are supervised whilst waiting for parents to collect them. Mrs Banda has been a teacher for 20 years and she has a passion for teaching children with disabilities – particularly children with hearing loss and Autism. She also teaches from home those that cannot travel due to the nature of their disability.
Her hopes for hearing impaired children in Zambia: “I would like to see learners with hearing impairment acquire education for a chance of a better life in society – that is my greatest dream”
And so there you have it. Four fantastic women and four wonderful stories. With a team like that, we can’t go wrong!
Big step forward
“So in my last blog I asked you to watch this space regarding the task of locating a suitable room to perform my diagnostic tests and hearing aid fittings on children identified with hearing impairment.
To my great surprise I came across a fully sound proofed testing booth within the school for the hearing impaired at UTH. The building used to be home to an entire audiology department around 20 years ago! What exactly happened to the clinic is still a mystery but the building was built by the Round Table association and given to UTH. It is now part of the school for children with special needs. Last week I met with Mr Herbert Mwansa, President of the Round Table Zambia group, two Round Table Chairmen and some members of teaching staff from the school itself. They were very keen for me to try and restore the audiology service and this opinion was shared by the teachers of the school and staff at UTH. So this is a big step forward in my journey to setting up audiology services here!
Today we began clearing out the room so I can soon install the new equipment. Stay tuned for updates on this exciting project!
Last week I was also joined by Lisa Rosenfeld (Hear the World Volunteer) and it was great to bounce ideas off each other regarding the TPS, train ENT nurses in performing audiometry with children and make progress with the management of equipment and creation of information leaflets and posters for parents. Thanks Lisa for your support and company!”
The photos below show old equipment being cleared out of the room where the Round Table in Zambia are supporting the creation of an audiology unit by Sound Seekers
“That means ‘good morning’ in the beautiful language of Nyanja! I have just started my second week of work and boy has it been busy. Last week I visited University Teaching hospital (UTH) – the site for our proposed Targeted Paediatric Screening Programme (TPS) and met with various directors of the departments. The hospital is massive with the adult and paediatric departments separated into different buildings – I soon got the hang of navigating around and there’s always a friendly face to ask for directions if I get lost.
The Paediatric Centre of Excellence houses the Developmental Intervention Clinic (DIC). This department cares for children aged 0-5 with varying degrees of developmental delay. I have met the team to observe clinics and gave a refresher course on hearing screening technique. They are confident however conditions are often tricky as we require a quiet environment and the department is very busy. I am currently on the hunt for a quiet room to continue my diagnostic assessments and implementation of hearing aid fittings. I’ve made good progress so watch this space! I have met many doctors and health practitioners in the short time I have been here in Lusaka. There is also a school for children with special needs on site as well as a school for nursing and so this area is extremely busy. From what I have picked up, everyone is very keen on the TPS programme as they see the huge impact hearing loss can have on children. Many parents think their children have ‘tongue tie’ or speech delay due to other conditions and hearing loss is not often thought of as a possibility. With that in mind I plan to run some Deaf Awareness Training workshops with health professionals and hope to also invite parents along to share information about signs of hearing loss in children and the benefit of early intervention. For now, my main priority is getting the TPS up and running so my many other ideas will need to be put on hold…
I have also seen Beit Cure hospital where I am working one day per week. It is home to our HARP (Hearing Aid Refurbishment Project) as well as a busy ENT and audiology department. I spent time in the clinic and observed practice. I feel the main area I can contribute here is by training up existing staff in the art form that is paediatric diagnostic testing – both behavioural and electrophysiological. One little girl presented with delayed speech and testing was almost abandoned as on the surface it seemed she did not understand the testing instructions. However, once we used the conditioning techniques of play audiometry, her shyness disappeared and she engaged fully in testing to enable us to record a full hearing test revealing a severe hearing loss in both ears. With these results we could initiate prompt hearing aid fitting. What I love about paediatric audiology is that it is never monotonous and it challenges a clinician to think outside the box. Each child is different which means every day brings new challenges and I can continue my own learning whilst transferring the skills to those testing around me.
There is a lot of work to do. Raising awareness of hearing loss is key and I will constantly try and raise the profile of audiology here in Zambia as there is a significant need for hearing care services here. Although I love seeing patients here, my mindset is always focused on how this service can grow and continue when I leave Lusaka. I am hoping people see the importance of early intervention and the impact it makes on a child with hearing loss. There are many patient’s stories that I find quite heart breaking. To see very bright, alert and happy children struggle to keep up with their peers and face daily frustrations because of undiagnosed or late detection of hearing loss. But with heart break comes determination and this fuels my passion to try and give these kids a better chance. I have a long way to go but I feel the key skill I need to embrace for the year will be patience. Right now I am filled with gratitude for the opportunity to make a difference and to meet such wonderful and inspiring people.
Zikomo (thank you)”
And so the adventure begins…
“I am currently sitting at the departure gate of Addis Ababa airport, Ethiopia – after a fairly empty flight which was very comfortable as I got all three seats to myself. I am full of thoughts of the year to come and how the project will go. Initial feelings of anxiety and nerves have set in as I really want to be of as much use as possible and there is a lot of work to be done…
That was a short pause in writing as I needed to board the next flight. Interestingly, I was in the queue with a gentleman with hearing loss from Malawi who noticed my Sound Seekers t-shirt and we had a long chat about how his severe hearing loss was only diagnosed in his teens and how he wished it was picked up earlier as he really struggles with his speech and communication. He had a lot of difficulty asking for directions as people would see his hearing aid and proceed to shout very loudly instead of clearly and he hoped one day the general public would become more aware of the impact of hearing impairment and effective communication. All in all a very inspiring conversation given the purpose of my travels and work. Once again I am reminded of how much I love my job!
Another pause… I have arrived at the Starkey Hearing Institute, Lusaka, Zambia! With a very warm welcome and a lovely place to rest my head. Some students of the Hearing Instrument Specialist programme will arrive in the coming days so I’ll make the most of a couple of days to acclimatise to my surroundings and then get to work.
And so the adventure begins… “