Newly trained students helping to prevent disabling hearing loss in Zambia

Elfreda Whitty is CBM UK’s Programme Manager for our Ear and Hearing Care programme in Zambia, which is supported by the Scottish Government’s International Development Fund. She recently travelled to Zambia to meet some of the nurses and clinical officers who are being trained as part of the programme, to help prevent disabling hearing loss in the country.

The medic in the clinic told me that the ten-year old boy sitting in front of us, under the canopy to protect from the midday African sun, had been told off by his teacher for being naughty in class because he didn’t seem to be listening. In fact, he had begun to suffer from disabling hearing loss. And following the result of the ear examination at the outreach clinic in Kabwe that day, which his mother had taken him to, he would be referred to Beit Cure Hospital for further tests and the fitting of hearing aids. The nurse told his mother that he would be fast-tracked since he was at school and there would be follow up with his teachers to ensure they were aware of his impairment.

This young boy was one of over 200 patients, of all ages, that the community outreach clinic screened on the day that we visited. Each had their own story and some had travelled from many miles away. I had travelled to Zambia for 5 days to visit CBM’s Scottish Government funded programme and was observing an outreach clinic in Kabwe, 150 km north of the capital city Lusaka. The project is supporting our partner, Beit Cure Hospital, to train health care workers and community health assistants to strengthen community and primary health systems to promote increased accessible quality ear and hearing healthcare to a wider number of vulnerable people.

Disabling hearing loss in Zambia is a cause and consequence of poverty and an under-recognised consequence of major diseases or their treatments, including HIV/AIDS, malaria, tuberculosis, meningitis, maternal complications and childhood illnesses. Hardship and stigma occurs for all ages and genders.

Adults with hearing loss often face unemployment, and communication barriers affect relationships and access to information and services, further risking health and socio-economic problems. In children, it leads to poor language, cognitive and educational performance. According to a recent study, commissioned by CBM, it’s likely that there is a child in every Zambian school class with a progressively disabling, chronic ear infection.

There is a severe lack of formal ear and hearing care services in Central Province of Zambia. In just three of the Province’s 9 districts – Kabwe, Chibombo and Kapiri Mposhi – with a population of 903,023, there are an estimated 45,000 persons (5%) with disabling hearing loss and 72,000 (8%) with ear disease causing or risking hearing loss.

There is only one audiologist in Zambia. Tertiary Ear Nose Throat (ENT) and hearing aid services in Lusaka are costly, and late referrals worsen morbidity outcomes. Studies demonstrate that primary ear care and community hearing aid services are highly cost effective, with 50% of disabling hearing loss being preventable.

In spite of this, among community members and health workers, there is minimal understanding of hearing loss, or basic ear care; with opportunities to promote prevention, rehabilitation and social inclusion being frequently missed.

As a result, this project is training and equipping a total of 105 nurses and clinicians, 12 audiology assistants and 240 community health assistants across Central Province. These health care workers are then equipped to treat and diagnose cases in their health centres. More broadly it ensures that there is greater sensitisation in their communities of the importance of ear and hearing care and to ensure there is awareness of outreach clinics and school-screenings, which allows patients to be screened, treated and where necessary, referred in greater numbers and closer to their homes.

During the visit, I was able to speak to some of the current trainee nurses and clinical officers who used the outreach clinic to put into practice their training over the last 2 weeks at Beit Cure Hospital in Lusaka. Once they completed their two-week training, they returned to their medical centres across Central Province.

One of the students told me that before his training, he had noticed that many people had challenges with ears but he did not have an otoscope to screen or diagnose them and was unsure what to do. They tried to use their phone light, which also wasn’t effective. Following his training, he now felt much more confident to make a diagnosis and crucially treat – for example in the removal of a foreign body or to treat an infection. Another recent graduate said she really appreciated the WhatsApp group that had been set up amongst the graduates as peer support learning and as a forum to allow them to ask direct advice on particular cases from the ENT Surgeon who trained them and who was also on the group chat.

On my last day of the visit, I was privileged to witness 12 trainees graduate at Beit Cure. The group were young, enthusiastic, and proud of their achievement so far. As we took the obligatory selfies with their certificates, they told me they were looking forward to putting all their new knowledge into practice and that they really appreciated the difference the training had made. Their course leader had just told them that they were now on the front line now to help fight disabling hearing loss in their country. At least now they were equipped with the knowledge and tools to fight that battle.

Images: Top – 5-year-old Grace being examined by audio technician Patson at CBM’s partner Beit Cure Hospital in Zambia ©CBM/Hayduk. Bottom – CBM UK’s programme manager Elfreda Whitty and graduate medical students at Beit Cure Hospital.