Missed opportunities: Kenyans are becoming deaf to expensive health services

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Missed opportunities: Kenyans are becoming deaf to expensive health services


Richard Mwangi, an audiologist assists a patient during a test on January 18 at the IncusEar Hearing and ENT Center in Nairobi. PICTURES | DIANA NGILA | NMG

Summary

  • Children with mild, moderate or severe hearing loss are considered hard of hearing.
  • Hearing aids cost around 50,000 shillings while surgical cochlea implantation procedures cost around 2,500,000 shillings to 3,000,000 shillings.
  • Health experts have recommended medical examinations before, during and after pregnancies to help in the early detection and management of these risk factors to avoid their harmful effects.

When Mary gave birth to her now 10-year-old son in 2011, she was overjoyed. His wish was for him to enjoy optimal development so that he could thrive and be able to participate in the normal activities of life like other children.

Everything seemed to be fine until six months later when the family noticed that the child seemed oblivious to the sounds being made around him.

“He smiled and laughed whenever someone played with him or held him. But gradually we started noticing that he didn’t respond to sounds directed at him. You could walk into a room and call his name or clap and he would stay still until you moved somewhere he could see your face,” Mary said.

“At first we didn’t take it seriously as we thought it was something he would overcome as he got older. But when he was around one year and three months old, we decided to consult a doctor because nothing seemed to be changing.”

It was the start of a long journey which saw the family contact different ear specialists as they all seemed to be giving conflicting diagnoses.

“We tried many things, including an operation, but our son’s condition did not improve. Eventually we were told by the last specialist we visited that our child had permanent hearing loss and that nothing could be done to reverse the situation,” says Mary.

She is not alone. Such stories have been shared by families who have had similar experiences after giving birth to hearing-impaired children.

Health experts note that these uncertainties and delays in diagnosing children with hearing problems caused by birth or birth defects are a major cause of preventable deafness in early childhood.

“Most cases of deafness or profound deafness can be avoided if affected children are identified early enough, when it is still possible to intervene and save them from the disability”, explains Dr. Njoroge Muhuhu, ENT doctor. based in Nairobi.

It is for this reason that newborn hearing screening tests are recommended for all babies born before they leave the hospital or within the first month after birth.

While such assessments are common practice in most developed countries, they are not routinely carried out in the country.

“These are missed opportunities, because by the time parents notice something is wrong with their child, it may be too late to change the situation,” notes Richard Mwangi, audiologist at Doctors of Hearing, who looks after many children affected.

A child’s ability to hear is very important. Hearing is essential for the development of speech, which lays the foundation for a child’s learning experience, interaction with others, academic performance and ability to earn a living in the future. .

“If you can’t hear sounds at all, you won’t be able to learn a language in any way. Also, children who can’t hear well will have delays and speech difficulties,” observes Mr Mwangi.

Hearing screening in newborns is usually done by audiologists.

Using a myriad of tests – such as Automated Auditory Brainstem Response (AABR) and Otoacoustic Emissions (OAE) – these specialists can determine if a baby has hearing loss, the degree of the loss and what type it is. acts.

Children with mild, moderate or severe hearing loss are considered hard of hearing. On the other hand, people with profound hearing loss are considered deaf and need support to communicate using sign language.

window of opportunity

According to Mwangi, children classified as hearing impaired usually have a window of opportunity for interventions that can prevent their condition from progressing to deafness.

With prompt support (ideally within six months and no later than a year and a half), these children can benefit from treatment or interventions such as hearing aids, cochlear implants, among other assistive devices. which usually go a long way in improving their hearing ability.

This gives them the best chance to grasp languages ​​and develop speech optimally. Some of these children may also need speech therapists to help speed up this process.

Unfortunately, these essential services remain largely out of reach for many children who need them due to myriad health infrastructure, human resource and funding challenges.

For example, audiologists who perform hearing tests have long been hard to find. But great strides have been made in closing this gap with the introduction of an audiology training program at the Kenya Medical Training College (KMTC).

“This is a great achievement that will increase the pool of audiologists in the country, enabling many needy children to be served,” Mwangi said.

The number of ENT specialists spread over the territory is also insufficient, with the majority concentrated in urban areas.

Worse still, the cost of the interventions used to address hearing problems remain unaffordable for most affected Kenyans.

Cost Barriers

For example, hearing aids cost around 50,000 shillings while cochlea implantation surgical procedures cost around 2,500,000 shillings to 3,000,000 shillings.

Also, speech therapy sessions cost around 3,500 shillings per session. They are often offered three times a week and can last over two years, depending on the age of the child before they are enrolled in these sessions.

“When parents cannot afford care, they lose hope. And their affected children end up struggling with the problem throughout their lives,” says Mr Mwangi.

He notes that hearing impairments seem to be forgotten conditions in Kenya, as they are not given much prominence compared to other disabilities.

“We need a structured way to deal with this issue through raising awareness about prevention measures and available solutions that can be accessed or within reach for anyone who needs them,” says Mwangi.

These efforts will also involve addressing harmful myths or traditional beliefs such as the perception of hearing impairment as a curse on families.

Such beliefs prevent affected families from seeking medical care for their children or accepting help from hearing specialists.

Risk factors

Some of the risk factors that predispose children to hearing loss at birth are: genetics or family history of the disease, certain infections that affect pregnant women such as rubella or cytomegalovirus, babies who suffer from a prolonged lack of oxygen (asphixia) around the time of birth, as well as those born with low birth weight.

Meningitis and frequent ear infections can also cause hearing problems in affected children.

Health experts have recommended medical examinations before, during and after pregnancies to help in the early detection and management of these risk factors to avoid their harmful effects.

Indeed, the World Health Organization (WHO) indicates that 60% of hearing loss in children can be prevented through measures such as vaccination against rubella and meningitis, improved maternal and newborn care as well as as the early detection and management of inflammatory diseases of the middle ear. .

In addition to children, the WHO warns that more and more adults are also increasingly developing hearing problems due to their lifestyle or behaviors.

Growing problem

According to statistics from the health body, almost 2.5 billion people worldwide – or one in four people – are expected to have hearing problems by 2020.

The WHO further notes that major contributors to acquired hearing loss in adults include loud noises or sounds, impacted earwax, ear or head injuries, ototoxic medications and old age.

To highlight the growing problem of exposure to loud noises, the WHO theme for this year’s World Hearing Day (today) is: To hear for life, listen carefully.

“This is very important because what many people don’t know is that noise-induced hearing loss is permanent and irreversible,” warns Mr Mwangi.

Some of the safe listening practices that can protect against hearing loss include setting the volume of devices to no more than 60% of maximum, keeping sound sources away from loudspeakers or noisy machinery, wearing ear protectors such as earplugs in noisy places, as well as the use of well-fitting, noise-canceling headphones to reduce the need to turn up the volume in noisy situations.

Regarding earwax buildup in the ears, Dr. Muhuhu notes that people should refrain from using headphones to clean their ears as they end up pushing the earwax inward causing a blockage. .

“The ear cleans itself naturally and pushes the wax out where it can simply be wiped off or cleaned off. Therefore, you don’t have to worry about cleaning the inside of your ears,” he notes. .

rule of thumb

In addition to causing earwax buildup, earphones can also cause accidents during use that can tear the eardrum, leading to more hearing complications.

“The general rule is that you should put nothing smaller than your elbow in your ears,” says Dr. Muhuhu.

According to the WHO, ototoxic drugs that cause hearing loss should be closely monitored and prescribed cautiously or cautiously.

They include aspirin; Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibrufen or naproxen; certain antibiotics; certain medicines that treat cardiovascular diseases as well as certain anti-cancer medicines.

Hearing loss caused by these drugs tends to develop quickly, and the first symptoms are usually ringing in the ears.

Hearing usually returns to normal after people stop taking the drug. However, some medications can cause permanent damage.

Although it can be difficult to predict when accidents will occur, safety measures such as the use of seat belts in vehicles and helmets on bicycles or motorcycles can prevent head or ear injuries that lead to hearing loss problems.

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