Half a billion people have trouble with regular conversation due to disabling hearing loss, and 80% of them live in the developing world. For people in this situation, it means a lower income, poor educational achievement and a cycle of poverty. However, some groups like World Wide Hearing (WWH) and SHOEBOX are on a mission to provide access to affordable hearing healthcare – from testing to diagnosis to rehabilitation. I joined them for a hearing health mission in Peru last November for a transformational 8-day medical mission along with volunteers from the Children’s Hospital of Eastern Ontario (CHEO), The University of Ottawa, VIBES and Hear the World Foundation.

WWH has set a goal to provide 30,000 hearing tests for children who otherwise wouldn’t have access.  Peru is in particular need due. They have a shortage of audiology services, with only 10 audiologists in a country of almost 32 million people. They also suffer limited access to hearing aids due to a low average monthly income of around $600. Interestingly, while hearing loss remains an underserved area in healthcare, the Peruvian government has committed to developing a universal hearing screening program. When fully implemented, all babies would be tested at birth. At present, only 20% of children are screened, so there remains a huge gap in services, resources, and programming for children with hearing loss.

One key piece in solving the global hearing healthcare crisis is the ability to improve access to simple, inexpensive, and reliable testing. As an ENT physician at CHEO, I see the same problems in Canada’s North and rural areas. It is clear that a better understanding of the causes, types, and locations of people with hearing loss is needed to advocate for the resources required for hearing rehabilitation. One of the exciting aspects of this Peru project is that it will be the first time that data from Peru will be collected in a single large database that can be used to help us understand hearing loss.

SHOEBOX worked with WWH by providing mobile audiometers, support, software, and access to a global medical database. The CHEO team provided medical support, nursing, volunteer training, and documentation. Together with the other volunteers, there were about 20 people participating in the mission. The entire team worked with 3 local coordinators to visit clinics, schools, and orphanages, providing hearing screening and medical services followed by rehabilitation where needed.

Some of the time was also spent on educational work. Lectures were given to students, speech pathologists, community physicians, technicians, and ENT residents on various ear-related pathologies and skills. At the end of the trip, 40 new technicians were trained and left behind to continue the work.

Hearing loss is an invisible disability, and as such, it is hard to recognize without proper screening. However, the improvements made by treatment are so dramatic that it is well worth the effort to identify appropriate patients. Out of the 2,100 children screened over 10 days on this mission, 34 were identified with hearing loss, and 12 were candidates for further hearing rehabilitation. There is no question that their lives have been positively altered as a result.

While the outcomes are clearly desirable, the provision of care in low and middle-income countries is fraught with difficulty. Local engagement, longitudinal care, and sustainable solutions are three important aspects of the success of outreach programs. Through WWH, local employees worked with governments, school boards, teachers, and healthcare to develop a screening program that was both acceptable to the population and also well-understood and efficient. The inclusion of local assistants, trainees, and volunteers was essential. However, screening for disease is only as good as the proposed treatment. Hence, being part of a longitudinal program that provides follow-up is essential. Finally, the solutions proposed must be sustainable in the local environment. This means that mechanisms for equipment repair, services, and the provision of batteries must be considered.

We encountered additional challenges when moderately quiet environments for hearing screening weren’t available. However, with the use of noise-occluding headphones and noise monitoring software, we were able to manage most cases. Ideally, rooms far away from regular school activity can be secured, and lines of waiting children can be kept away from testing areas. The most efficient day of screening was achieved by those who facilitated the easy flow of children in and out of the screening area. Furthermore, knowing the timing of each activity allowed us to apply the appropriate number of people to each station. For example, we had 8 screening units, 2 otoscopy stations, 2 secondary testing stations and 1 medical ENT. This ratio proved to be the most efficient.

In North America, hearing loss is the most common workplace injury that many of us will encounter.  Similarly, age-related loss is also likely to affect most of us at some point. While the impact of hearing loss is important in adults, it is even more critical to the normal social development of children. The 10-day mission in Peru was a small step toward delivering on our promise of providing healthcare for everyone.

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