22/10/2016

Outline Audiology for : Creating a sustainable audiology • Sound Seekers • History of audiology in Malawi department in a developing • Sound Seekers’ Malawi project country’s healthcare system • Building infrastructure • Training local staff • Creating standards and protocols • Education Courtney Caron, Au.D, CCC-A • Outreach Renee Garuccio • Building funding sources for self sustainability BSc, DipAudSc, MClinAud, MAudSA, CCP • Advantages/Disadvantages of working within an established healthcare system • Improving access to quality service

Sound Seekers History of Audiology in Malawi • Population of Malawi: 17.2 million • Established in 1959 • Prior to 2010: no audiology professionals, extremely limited audiology • UK registered charity services • 2010: Peter & Rebecca Bartlett (EARS, Inc.) established the first • Previously called the Commonwealth Society for the audiology clinic in on the campus of African Bible College in Deaf Lilongwe, ABC Hearing Clinic & Training Centre (ABC HCTC) • Currently work in 5 countries in Africa • Established at a private hospital that serves both private and community patients • • Helped to pave the way for the Sound Seekers project in Blantyre • • Malawi • • • Project in Malawi is the largest in the charity’s history

Sound Seekers in Malawi: A history Sound Seekers and Malawi healthcare

• 2007: Malawi’s first ENT Dr Wakisa Mulwafu negotiated to have Sound • External NGO establishing an Seekers’ original HARK vehicle moved from Cape Town to Blantyre as it was audiology department within no longer being used in South Africa Queen Elizabeth Central • 2010: Dr Mulwafu meets Sound Seekers’ CEO in London. Hospital, Malawi’s largest public • Sound Seekers assist in funding refurbishing of old HARK hospital • 2011: Sound Seekers funded the first Malawian Audiology Officer to attend • Partnering with the Malawi a one-year training course in Nairobi, Ministry of Health to work directly within the existing • 2012: First Malawian Audiology Officer returned to Malawi. Another healthcare system Malawian funded by Sound Seekers to attend same course. • A first for Malawi audiology • Sound Seekers team comes to Malawi to begin discussions with Dr Mulwafu, • Memorandum of Understanding Queen Elizabeth Central Hospital administration and Ministry of Health for large in place between MOH and audiology project. Correspondence continues virtually. Sound Seekers • 2013: Sound Seekers team returns to Malawi finalize discussions and • Increasing the level of create a partnership accountability of both parties • July 2014: International audiologist moves to Malawi to begin 4-year project

1 22/10/2016

Building infrastructure: comprehensive QECH Audiology Clinic Comprehensive list of services offered

• 3 consultation rooms • Cerumen management • Vestibular screening • Manual extraction, irrigation, • Bedside testing • Adults, Paeds, Auditory suction (January 2017) • Treatment for BPPV (Epley Evoked Potentials • Tympanometry (226 + 1000Hz) maneuverer) • Hearing aid fittings can • Otoacoustic emissions (TE + DP) • Tinnitus assessment/counselling be conducted in any • Comprehensive hearing • Hearing aid fittings with verification assessments and validation measures consultation room as • Conventional, Visual Reinforcement • Traditional and non-surgical bone equipment is portable Audiometry, Conditioned Play conduction hearing aids Audiometry • On-site earmould making • Earmould Laboratory • Auditory evoked potentials • Targeted newborn hearing • Auditory brainstem response screening • Training Room (screening + diagnostic) • Auditory steady state response • Outreach services to southern (sleep-deprived and sedated) region of Malawi • Cochlear Implant evaluation and mapping

QECH Audiology Staff Creating standards and protocols for the practice of audiology with the country

• Paediatric Diagnostic Audiology protocols • Vestibular protocols • Hearing Aid fitting protocols • Auditory Evoked Potential (AEP) Protocols • Development of Database for data collection • Targeted newborn hearing screening • Sedated AEP testing

Planning, implementation, review Moving towards standardization of protocols with only other audiology clinic in the country in Lilongwe (ABC HCTC)

Outreach Outreach

• Currently partnering with • Audiology services from local NGOs and other otoscopy through hearing organizations such as aid fittings with verification MACHOA (local disability and instant earmoulds to association) who already follow-up services have well established connections in the more rural parts of the southern region. • Future outreaches within the Ministry of Health System (district • Currently approximately 3-5 outreach days a month hospitals, health centres, etc.) • Audio-trailer houses two sound booths for accurate diagnostic assessments in the field. • Runs entirely from a small generator

2 22/10/2016

Building a funding sources for self Working within an established healthcare sustainability system: Disadvantages

• • Supplementing services for community patients with funds Bureaucracy received from private patients • Slow moving • Memorandum of Understanding helps to reduce time • Partnering with organizations within and outside Malawi to • Hierarchical structure and protocols, which can be obtain donated supplies, services and professional expertise unclear • Less flexibility in systems and practices • Future development of industrial screenings for large companies and private school screenings to assist with the financial sustainability of the program

Working within an established healthcare Working within an established healthcare system: Advantages system: Advantages • Established name • Some costs covered by Ministry of Health • Everyone recognises where you are from • Staff salaries, electricity, water, internet, some consumables • Working within a hospital with many specialties • Established connections • Particularly working closely with ENT and Paediatric departments • Dr Wakisa Mulwafu, Malawi’s first ENT surgeon • Referral hospital for the entire southern region of Malawi • Access to a pool of healthcare professionals for • Better integration of international audiologist. Viewed as further training “one of us” – the Audiology expert in Malawi's Ministry of • Our audiology officers were all nurses except one who Health was an ENT clinical officer • Easier transition for future local audiologists to become the • Already have a medical background and have other skill Audiology experts within MOH sets such as the ability to prescribe medication • Long term sustainability

Improving access to quality service The future of QECH Audiology

June 2014 January 2016 • October 2016- Malawian Audiologists returned to To 2015 To QECH from University of Manchester December September • 2014 2016 Volunteer audiologist will supervise newly trained audiologists Total number of patients 299 751 1379 • Business management, human resources Clinic patients 299 751 992 responsibilities, financial management, etc. slowly Audiology Outreach patients N/A N/A *387 handed over to office manager and new Children (17 years & under) 96 194 576 audiologists Women 95 219 368 • By July 2018, the Audiology clinic will be run and Infection(s) 11 74 203 supported by local Malawians Patients fit with hearing aid(s) 48 158 191

*Audiology outreach began in June 2016

3 22/10/2016

All of this would not have been possible without….

• The generous support of:

Zikomo

4