Volunteer Blog: Bhavisha Parmar, Sound Seekers Special Advisor in Audiology
Delivering follow up workshops in Malawi
“I arrived in Blantyre, Malawi on Sunday 15th September for my second trip to the QECH audiology department this year. Throughout my previous work in Zambia and Malawi I have noticed that it can be very difficult for patients to access hearing aid follow up care in low resource countries. This is either due to the associated costs of travelling to the clinic (food, travel, accommodation) or a lack of awareness regarding the need for follow up. During my trip to QECH in March of this year the whole audiology team gathered to have a very insightful discussion about their work and ways to improve the services. They had also noticed that once hearing aids were fitted to patients with hearing loss, not all would came back to the clinic, therefore Sound Seekers recognised the need to raise awareness of the importance of returning for follow up appointments.
This week at QECH, thanks to funding to Sound Seekers from Jersey Overseas Aid, we held two hearing aid follow up workshops. The aim of the workshops was to invite children and adults fitted with hearing aids to come into the clinic and discuss their experiences as a group. The team involved in running the workshops included Mwanaisha (Audiologist), Louis (Clinical Audiology Officer), Sam (Audiology technician) and myself.
Workshop for children with hearing aids
During the children’s workshop, parents were able to meet other parents and children with hearing aids met other children with hearing aids. For many this was the first time they have been able to interact in a group setting. We had open discussions about communication tactics and taught patients and parents/guardians how to troubleshoot problems with the hearing aids (retubing, cleaning moulds, battery changing). We gave each attendee a booklet, that had been translated into the local language (Chirchewa) which covered many of the topics we discussed in the workshop.
20 children and their parents attended and during the event the audiology team were on hand to repair hearing aids, change tubing and take new impressions if necessary. 10 children needed significant hearing aid repairs, new moulds or hearing tests.
Main discussion points:
- Some parents told the group how difficult it can be to encourage children to wear the hearing aids. Members shared tips regarding this matter and advice was also in the booklet.
- One mum said she had hoped the hearing aids would help their child speak (alongside learning sign language at school) but now she understands that hearing aids may provide different benefit for those with different levels of hearing loss
- Parents were encouraged to come to the clinic as soon as possible if their child’s hearing aid breaks or it is lost
- Information was provided detailing how wearing hearing aids can help children with speech development, social interaction, education and job prospects.
- Teenagers were taught how to change their own tubing, clean the moulds and check whether the hearing aid is working
- Parents were advised that children should wear their hearing aids for all waking hours not just for school
- We discussed ear protection at length including safe listening levels and how to clean the ears
- We discussed the need for regular visits to the audiology department to get the hearing aids checked and to reassess the hearing.
Teenagers were asked their thoughts about their hearing aids:
“Hearing aid helps me at work and on different occasions. Am able to communicate with anyone around me”
“The hearing aid helps me to understand better when the teacher is teaching in a class”
“Using this hearing aid, I can hear everything surrounding and without this it may be hard for me to hear anything. Am very satisfied with this hearing aid as I do well in class when I understand a particular topic. Communication is also very good with the hearing aid and I am happy”
Workshop for adults with hearing aids
The follow up workshop for adults with hearing aids was a very busy event. We split the group of 22 attendees, aged 22- 84, into three groups. Each led by either myself, Mwanaisha or Louis. Attendees described the experiences they have had whilst wearing the hearing aids as well as the situations where they still struggle. Unfortunately, a few patients had stopped wearing the hearing aids a while ago either because they had stopped working or because they had run out of batteries. The attendees were extremely engaged and involved in the discussion. They were all keen to learn how to clean and fix their hearing aids. One major point of discussion was that the majority of attendees did not realise there were so many other people wearing hearing aids and they said they felt a sense of community today. They shared stories and ideas and it was especially inspiring to see Nelli (aged 84) and her sister Bessi (aged 82), who had both travelled 2 hours to reach the clinic, so proud to wear their hearing aids regularly and fully involved in today’s activities (see photo to the left).
I think the two groups had different, but equally important, take-home messages from these workshops. For the adults it was a far more practical hands on approach but for the parents of children with hearing aids, they seemed to benefit from the support group atmosphere as mothers were able to hear from other mothers dealing with similar issues.
I think these two workshops have been very worthwhile both to the staff within the audiology clinic and to the hearing aid users and their families. The staff were surprised how many people showed up and were delighted to see that they were motivated to wear their hearing aids. They saw the benefit of follow up appointments when it became clear than many of the attendees needed hearing aid repairs, new ear moulds or a new hearing test. The follow up booklet we provided was very useful and can help keep the attendees informed after they leave the clinic. All were encouraged to come back to the clinic if they have any issues with their hearing aids.
There will be two more workshops next month as the team will travel to Mangochi (four hours drive from Blantyre) to provide follow up care to hearing aid users in the area. I hope it will be just as successful as these last two days have been extremely helpful to all those involved!”
Bhavisha reunited with Shine one year on
Seeing Shine one year later
“One of my highlights from this trip was seeing Shine for a review appointment at the Children’s Hearing Clinic at UTH, one year after I fitted her with hearing aids.
I first met Shine in September 2017 and I fitted her with bilateral digital hearing aids (donated by the Hear the World foundation). At the time I remember her mother being quite anxious about Shine having to wear hearing aids but also totally overwhelmed by her fantastic initial reaction to hearing sounds(watch the video of Shine being fitted). In the back of mind I was worried that she wouldn’t encourage Shine to wear the hearing aids due to the associated stigma.
Shine has a severe hearing loss in both ears and delayed speech development. She is a very bright little girl and loves playing with toys and copying the mannerisms of everyone around her. I knew that without hearing aid amplification her speech would not develop and she would not be able to progress in mainstream school. In fact, her family felt she shouldn’t be in school at all due to her speech delay.
Shine returned to the clinic a few weeks ago and her smile once again lit up the whole room. I connected her hearing aids to the computer and was so happy to see that the software stated she had been wearing her hearing aids around 11 hours per day since she was fitted!! Her mother told me that Shine points to her ears every morning to indicate she needs her hearing aids. Shine’s mother had even been repairing the ear moulds at home herself! In the clinic we retested Shine’s hearing, adjusted the hearing aids and made her a new set of custom ear moulds. I also tested her while she wore her hearing aids and found that the amplification was giving her good access to speech sounds.
However, Shine’s speech has not yet improved. I spent a long time with her mother explaining various communication tactics and Richard (sign language teacher at UTH) joined us to teach Shine some simple sign language so she can express her needs. Additionally, Pezo (in house speech and language therapy assistant) will see Shine regularly for additional speech therapy support.
Shine’s story reminds us of how important long term multidisciplinary care is to helping a child with hearing loss. Giving a hearing aid is just one part of the journey.
Knowing that Shine has been regularly wearing her hearing aids for the last year is wonderful but I also noticed her mother’s confidence has increased tenfold. She is aware of Shine’s needs and she is determined for Shine to start school in the New Year. It is very important to help parents like Shine’s mother feel empowered, knowledgeable and supported throughout this journey because they are the key to their child’s development and educational achievements.
I look forward to seeing Shine again soon and the Audiology staff in the clinic will monitor her progress at the next review appointment”.
Watch our new video celebrating one year of the Children’s Hearing Clinic at UTH
One year on: New video showing the impact of the Children’s Hearing Clinic at UTH
To celebrate one year since the opening of the Children’s Hearing Clinic (Audiology Centre of Excellence) watch the video below filmed during my trip to see how the clinic has already helped thousands of children and adults with hearing loss to improve their lives:
Bhavisha reunited with the team at UTH
Returning to Zambia in my new role as Sound Seekers Special Advisor
“It’s been 10 eventful months since my last blog post! I started my PhD in January at University College London to continue research I started during my MSc and Sound Seekers asked me to join the team as the Special Advisor across projects (of course I said yes) to lend my advice and support to the audiology related technical and clinical queries and developments.
My role, so far, has included writing publications for three different Audiology and ENT magazines covering the progress of our clinics in Malawi and Zambia and I have presented at the British Society of Audiology Conference and Global Health Meeting and have been involved in discussions with various different organisations to discuss how countries with limited resources can have access to ear and hearing care.
Right now, I am back in Zambia and have been reunited with the clinic I helped establish last year and I am amazed at how far it has come. What was once an abandoned 1970’s built clinic has been restored to a fully functioning audiology department. We even have on-site speech and language therapy taking place and a working ear mould lab. What surpasses the restoration of a building and the buying of equipment is the development of a team. At the end of my time in Zambia last year, the Ministry of Health had promised some nurses would be allocated to the department to allow for training and capacity building. Unfortunately, I did not have much time left to train the nurses last year but I was lucky enough that my friend and colleague Naomi Elliott was arriving in Zambia just a few months later to volunteer. Naomi has worked hard to raise awareness of the importance of having an audiology department at University Teaching Hospital. She has changed a one-woman-band into a thriving team who see an average of 160 patients per month. There is 1 audio technician, 2 registered nurses, 2 enrolled nurses, one clerk and one speech and language therapy assistant working alongside Naomi in the clinic. Since March, around 700 patients have been assessed with 145 being diagnosed with some form of hearing loss. 71 have been fitted with digital hearing aids (either refurbished within Sound Seekers Hearing Aid Refurbishment Project or new donations from Hear the World Foundation) and custom ear moulds.
What makes a difference, in my opinion, is that the patients know this is the clinic to come to with their hearing needs. If they are fitted with hearing aids they are regularly followed up and counselled on their hearing loss. If there is a patient who has profound hearing loss, unfortunately there is no cochlear implant programme yet in Zambia, but Richard is our on-site clerk and sign language interpreter who is now teaching sign language to children who do not have any residual hearing. Richard is visited in the clinic by deaf children from all over Lusaka!
Yesterday Naomi and I visited Arthur Davidson’s Children Hospital in Ndola to check out the rooms allocated for Sound Seekers latest project setting up a new audiology clinic and planning for sound proofing and equipment purchasing are underway. It will be exciting to follow the developments of the new clinic alongside the progress of this UTH clinic.
I have a few days left in Zambia before I leave for Malawi and then onto Cape Town where I will present at the Coalition for Global Hearing Health and the World Congress of Audiology conferences”.
The Minister of Health at the Children’s Hearing Clinic
New artwork at the Children’s Hearing Clinic
Bhavisha’s farewell do’s with the team in Zambia
The final blog – reflecting on my year in Zambia
“I can’t believe it is my last day in Zambia. This year has definitely been one of the most exciting, eye opening and eventful years of my life.
Since the launch of the Children’s Hearing Clinic I have been meeting the Minister of Health on a regular basis to discuss how audiology can develop and expand throughout the country. I brought up two key areas which need a lot of attention – infrastructure and human resource.
At the beginning of this year I explained that the Speech and Hearing Centre at UTH was actually an audiology clinic around 46 years ago. Over time, the audiology clinic was lost and a school moved into the premises. When I arrived in Zambia there was no other suitable area to set up audiology so we decided to renovate the sound booth to reinstate the testing facility. After recent discussions, the Minister suggested that the rest of the building should be renovated and he would like an Audiology Centre of Excellence to be established! Of course that was quite a tall order but an offer like that cannot be ignored. The Hon. Minister arranged the funds and the renovations started right away. The school has been successfully relocated with agreement from the Ministry of Education.
Expanding the audiology team is quite a challenge because there are no audiologists in the country to work in the government clinic. In the mean time the Ministry of Health has committed to training two nurses at audio technician level and creating a position to employ an audiologist. Now we just need to find a candidate who might want to take up this opportunity. For now, the team consists of one Audio Technician (Sound Seekers sponsored Althea Michelo who has recently graduated), two audiology nurses, 1 lab technician and 1 audiology administrator /sign language interpreter.
It is a very bittersweet time for me as so much has developed since January and I have become so connected to this project but I am confident in the audiology team that is forming here. And I am very glad that my good friend and audiology colleague Naomi will be coming to take my place and guide the team forward.
I was observing the new team in the department this week and I was so pleased to see how motivated they are. The Minister of Health has met with each member to explain how they are officially the first government supported audiology team in Zambian history and they can be pioneers in the field.
If my time here can be summarised in one picture it would be this one:
The picture shows the two audiology nurses and our audiology administrator (Richard) during a paediatric audiology consultation with the patient and her mother in the sound proof booth. The audiology nurses had just recorded the medical history, performed otoscopic examination and assisted in the hearing assessment of the child. The child had profound hearing loss. Usually, we would explain the results and recommend special education and learning sign language. Fortunately this time we could go a few steps further. Richard is a sign language teacher and he immediately grabbed his teaching materials to begin teaching the 10 year old girl some simple signs. Within minutes she had learnt the sign for mother, father and sister. The audiology nurses provided some counselling to the child’s mother and she was booked for a review with Richard to learn more. This appointment was the epitome of multidisciplinary working and shows that audiology is definitely not just about fitting hearing aids. I was so proud of team and I know the department with thrive and continue to develop.
This morning, the Minister of Health came to the clinic to check on the renovations and say goodbye to me before I left for the airport. He left me with these powerful and appreciative words to express his gratitude to Sound Seekers and his commitments to the development of audiology services. I couldn’t have asked for a better way to end my time in Zambia:
Finally, many people have asked me what my biggest challenges and successes have been. I would say that my biggest challenge actually became my biggest success because it is all about awareness. When I arrived no one was thinking about audiology. With persistence, motivation, collaboration, hard work and weekly meetings at the Ministry of Health, the year has ended with the Minister of Health committing to developing audiology services!
My final words to the team:
Thank you Sound Seekers for this amazing opportunity, I will never forget it. Thank you to everyone at University Teaching Hospital and Beit Cure hospital for making me feel so welcome. I hope to be back very soon but for now I am going back to University College London to start my PhD studies.”
Official Launch of the Children’s Hearing Clinic on 27.10.17
The Clinic was opened by the Permanent Secretary of the Ministry of Health, Dr Jabbin Muluwanda, with Bhavisha
Official Launch of the UTH Children’s Hearing Clinic
“I didn’t quite realise what I was getting myself into when I proposed the idea of having a big opening ceremony of the Children’s Hearing Clinic and it took on a whole different life when the Ministry of Health suggested I link it with the launch of the first ever Ear, Nose and Throat Strategic Health Plan.
After designing t-shirts, banners and invitations, I found a cultural dance troupe and Beit Cure Hospital and CBM supported the event with refreshments and a huge marquee. Cooperate sponsorship came from the very generous Stay Easy hotel who helped decorate the venue and printing of the programmes.
The day before the event it was all hands on deck. Dr Hapunda (ENT registrar, UTH) and Emma Judge (CEO of Sound Seekers) helped get things ready and the sign language interpreters practiced the interpretation of our speeches. I was buzzing with excitement.
On the morning of Friday 27th October, Dr Uta (ENT consultant Beit Cure hospital) and I arrived at UTH at 6am to meet with Emma and complete the decorating of the marquee and speakers table. It dawned on me that the preparation and efforts put into this event was becoming somewhat like planning a wedding!
Guests started to arrive including:
- Permanent Secretary (Health Services) of the Ministry of Health Dr Jabbin Muluwanda
- British High Commissioner to Zambia
- CEO of Beit Cure hospital
- Country Director of CBM
- SMS of Adult and Children’s hospital , UTH
- Chief Nursing officer of UTH
- President of Zambia National Association of the Deaf
- Representatives from the Ministry of Education
The dance troupe performed while everyone took their seats, we sang the National Anthem and the ceremony was opened with a prayer.
I was first on the list to make a speech and felt very relieved that the event had come together so well. I took to the podium and spoke of ‘The Need, The Now and The Next’ for Audiology services in Zambia (see video below). I was followed by Emma Judge, Dr Uta and Dr Lukwasa.
The Permanent Secretary of Health Services read the Minister of Health’s speech as the Minister himself was called to Parliament at the last minute. The speech powerfully described the Ministry of Health’s commitment to supporting the growth of audiology services in Zambia and the importance of the ENT strategic plan- a great milestone for ENT, speech therapy and Audiology. From my seat I could see the beaming smiles of those in the audience in response to the Minister’s words, particularly from those who were currently working within ENT and audiology services in Zambia.
Dr Muluwanda cut the ribbon that was placed around a bound copy of the ENT plan to officially mark its launch and then we were led to the new Children’s Hearing Clinic for the unveiling of the ceremonial plaque.
I held the decorated scissors and handed them to Dr Muluwanda for him to perform the ribbon cutting in front of the clinic. A moment that I will never forget. We then led a tour of the clinic and I explained to various officials how to perform hearing assessments for the children and the great need for this service and training in Zambia. After lots of photos in the clinic we were led back to the marquee for closing remarks and a vote of thanks by Dr Hapunda followed by the National Anthem to bring the event to an end.
I was relieved and excited for the future of Zambian audiology and ENT services. The opening ceremony of a clinic is very much just the beginning and commitment is needed at a government level to ensure the continual growth of services with adequate follow up and support for children with hearing loss as well as their families.
The Minister’s speech included this paragraph that was followed by great applause:
“It has come at a great time when we are restructuring the health sector, and I am glad to inform this meeting…that positions for ENT have been established in all our provisional centres. But most importantly, for this gathering, is that audiology positions have also been included in the current structure”
This is Zambia’s first paediatric audiology clinic and to my knowledge this launch was the first time ENT/audiology services were spoken about on this scale, with this level of publicity. Now it’s time to keep moving forward with the momentum and attention created by spectacular events like this one.”
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… “