Challenges of screening for deafness in a developing country

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Challenges of screening for deafness in a
developing country

• 1. HYPOTHESIS The earlier the deaf child
  receives the necessary intervention the better
  his or her prognosis will be in learning speech
  and language.

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2. Where did it all start?

• 1996 Community Outreach Programme (COP)

• Workshop

• Focus on one clinic

• Combine outreach with research

• Donation

• Challenges we face

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3. Challenges of Screening in Khayelitsha

• Age of first immunisation
• - Protocol
• - Lack of communication

• Chronic middle ear problems
• - Huge problem
• - Refer again and again
• - Lost paediatrician
• - Otitis media protocol

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3. Challenges of Screening in Khayelitsha
(continued)

• Follow-up appointments
• - Leaving for the Eastern Cape
• - Addresses hard to find
• - Cell phones

Population of Khayelitsha in 2003 407 050 (City
of Cape Town 2001 2006)
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3. Challenges of Screening in Khayelitsha
(continued)

• Young mothers
• - 17 years old
• - Not concerned about hearing
• - Scared of hearing-aids
• - English illiterate

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3. Challenges of Screening in Khayelitsha
(continued)

• Challenges with clinic staff
• - Biggest problem over 5 years
• - Waiting for files
• - New clinic with Day Hospital
• - After immunisation
• - Positive relationship
• - Motivate
• - Sisters in charge

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3. Challenges of Screening in Khayelitsha
(continued)

• Facilities
• - Back of a Venture
• - Room share with adult TB-clinic
• - Different room
• - Social worker kitchen

• Accessibility of ABR-testing
• - Administrative and practical
• problems

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3. Challenges of Screening in Khayelitsha
(continued)

• Cultural differences
• - older people vs. younger generation

• Infra-structure within the health
  sector of the Western Cape
• - Confusing story
• - Department of Health
• - City of Cape Town

• We did not stop here!

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4. Addressing the Challenges
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4.1 Age of First Immunization

• Daily newborn information session

• Intervals of immunization clinics of
• the Western Cape
• 6, 10, 14 weeks Immunization
• 6 months Vitamin A (every 6 months)
• 9 months Measles
• 12 months Deworm, Vit A, supplements
• 18 months Boosters
• 5 years Immunization

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4.2 Chronic Middle Ear Problems

• Universal challenge
• Park, Warner Sturgill (2005)

• Protocols procedure at Nolungile Clinic
• - Screening tympanometer
• - High frequency (1000Hz) tympanometry
• neonates aged 0-7 months
• Kei, Allison-Levick, Dockray, Harrys,
  Kirkgard, et al. (2003)
• - Referral system

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4.2 Chronic Middle Ear Problems (continued)

• Importance of an infrastructure system
• - Nurses at Nolungile clinic
• - ENT clinic
• - Tygerberg/Red Cross Childrens Hospital

• In-service training for nurses

• Xhosa pamphlet healthy eating plan

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4.3 Follow-up Appointments

• Importance of support from ENT
• specialists and nurses

• Protocols at Nolungile Clinic
• Oosthuysen (2003)
• - 2 week follow-up appointment
• - High-risk infants (6 month f/u)
• - Diagnostic testing
• - Middle ear pathologies
• - Reminder cards and text messages

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4.4 Young Mothers

• Protocol diagnostic testing at The
• Carel du Toit Centre

• Nurses role referral to the social worker

• Education awareness
• - Xhosa presentation and pamphlets
• - Xhosa English video

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4.5 Challenges with Clinic Staff

• Focus building a professional relationship
• - Identifying nurse of influence
• - Meetings information sessions with nurses
• - In-service training
• - Communication consistency
• If something is not communicated it doesnt
  exist

• New approach
• - Attitude
• - Building interpersonal relationships
  nursing
• staff as colleagues

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4.6 Facilities

• Two-room detached prefab structure

• Top level management

• Posters

• Create warm natural environment

• Launch
• - Create a stir
• - Community awareness positioning
• - Networking

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4.7 Accessibility of ABR-testing

• Diagnostic testing collaboration between
• The Carel du Toit Centre Tygerberg Hospital
• Oosthuysen (2003)
• - ABR machine
• - Steady State machine
• - AABR machine for high-risk infants

• Pilot study screening ABR project at a
• KMC unit

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4.8 Cultural Differences

• Attitude

• Keep learning understand adjust

• Relevance

• Language

• Going beyond the line of duty
• People dont care how much you know until
• they know how much you care

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4.9 Infrastructure within the Health Sector of
the Western Cape

• Despondency who is in charge of the clinic?
• - City of Cape Town
• - Mayor Helen Zille

• City of Cape Town 8 sub divisions
• - September Deaf Awareness month

• Vision Without a vision the people perish
• - Modeling in other communities

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4.10 The X-factor

• Professional approach

• Business-minded

• Confidence

• First world service in a third world
• setting

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References

• Park, A.H., Warner, J., Sturgill, N. (2005). A
  survey of parental views regarding their childs
  sensorineural hearing loss. In J.L. Danhauer et.
  al. (2006). A national survey of pediatric
  otolaryngologists and early hearing detection and
  intervention programs. Journal of the American
  Academy of Audiology, 17(10)708-721.
• Kei, J., Allison-Levick, J., Dockray, J., Harrys,
  R., Kirkgard, C., Wong, J., et al. (2003).
  High-frequency (1000Hz) tympanometry in normal
  neonates, Journal of the American Academy of
  Audiology, 14, 21-28.
• Oosthuysen, H.L. (2003). The effect of early
  diagnosis and treatment of hearing loss on speech
  development in babies from Nolungile clinic.
  Research Proposal

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Contact details
Dr. Erika Oosthuysen [phone] eoost_at_pgwc.gov
.za

• The Carel du Toit Centre
• Niki Friderichs Where deaf children learn to
  speak
• [phone]
• sarpark_at_pgwc.gov.za