Audiology and Humanitarian Initiatives: Interview with Jackie L. Clark, PhD
Douglas L. Beck, AuD, speaks with Dr. Clark about her humanitarian programs in Mozambique, Xanthia, and more.
Academy: Hi, Jackie. Thanks for your time. It’s always a pleasure catching up with you.
Clark: Hi, Doug. Thanks for the kind invitation.
Academy: I know you just got back from another month or so in Africa. Please tell me how you got involved in these amazing projects?
Clark: Great question. Well, it started in 1997 or so. Some women from my church were going to do some charitable and humanitarian work in Mozambique, and they asked me if I’d like to join them. Of course, I thought it would be fabulous and I really did want to help them, but as a state employee, money and time were big issues and I wasn’t sure I could afford either!
Fortunately, that part of Mozambique first got e-mail service in 1997, so I was able to interact with the Mission Hospital charge nurse. After seeking and obtaining donations of equipment, hearing aids, supplies, and successful fund raising, I was able to push forward with the first Mozambique Audiology program in July 1998.
Academy: I know planning a trip like that is nothing short of an epic event—and the details, communication, transportation, and contacts can be overwhelming. What was that like? What were the goals?
Clark: When I arrived in Chicuque, Mozambique, it became obvious they’d never seen hearing aids or audiometers and it took a while to conclusively determine there simply were no audiology services at all in Mozambique. So, the primary goal has always been to leave skills behind by training local individuals and to provide humanitarian services.
In the final analysis, only the local people can provide a sustainable program. In other words, if we diagnose and fit children with hearing aids, we need a trained local person to help maintain the hearing aids and the earmolds, replace the batteries and perhaps do some basic troubleshooting during the lengthy and unpredictable times when there will be no audiologists available.
I should mention that in Mozambique, basic clinical health services are rare, too. Among the major and common problems in the children we see in Mozambique are cerumen impaction and untreated chronic diseases such as unchecked otitis media, as well as HIV/AIDS. As you can imagine, we spend a significant amount of time cleaning ears.
Academy: Unfortunately, all that makes sense. And so early on, the goal was to identify and educate local people to work with you and assist the patients across the year?
Clark: Exactly. In other words, without local support, there wasn’t much we could do that would have a long-lasting impact. So we had to identify and educate local people to identify hearing loss and help those who had received the hearing aids our group dispensed. Fortunately, we had a few medical techs who were very interested in being trained to learn new skills, so we worked with them to get them as far “up to speed” about hearing, hearing loss and hearing aids as possible.
Academy: And stepping back a bit, I seem to recall about 10 years ago you were involved in assembling a humanitarian project through the Academy?
Clark: Yes. Well, I had the good fortune to meet Julia Roskamp. Julia was at that time (1999) with ComCare and she went on to be named “Humanitarian of the Year” from Academy. Anyway, she held a meeting at Academy’s annual convention (1999) for audiologists interested in ComCare programs and I personally believed there was a need to get humanitarians together to share information. As a result, I approached the Academy’s annual convention organizers to allow a group of humanitarians to meet during lunch hour on Friday of the convention in 2000. Since the lecture rooms sit empty over the lunch hour, our hope was to use a room at no charge.
Fortunately, Brisy Northrup (Academy Humanitarian of the Year 2010, who just passed away a few months ago) and Julia notified all of their humanitarian contacts about the Friday Lunch Humanitarian Gathering. It was a small gathering of about 30 or 40 people. Since then, we’ve made it an annual informal meeting held on the Friday of the annual AudiologyNOW! meeting at noon. So this gives us a chance to meet, exchange information and the Academy has consistently agreed to give us room and it’s been very useful for all of us. We have grown to some 120 - 150 individuals attending the gathering and we share information with each other on an annual basis.
Academy: Very good. But then this year (2010), you didn’t return to Mozambique?
Clark: Right. After many successful years and after taking care of hundreds of children, the Minister of Health for Mozambique didn’t give us approval, nor did he disapprove. And so we weren’t very busy during our time there in 2008. Seems to me the communication just fell apart. We’d gone to Mozambique and accomplished some very important, significant and meaningful work—but when the Minister’s office stop “pre-approving” our participation, the local people got scared and wouldn’t allow us to work in the hospital.
We didn’t want to waste our time or money by being “half effective” and so my thought was, if we’re spending our time and money to be there and help, we want to work from sun-up till sun-down (or later!) and do all we can to help. But if we’re going to wind up sitting around looking for things to do—it’s not worth the massive effort and energy it takes to put it all together.
So in September 2008, I formally requested (and also called the Minister of Health) to get clear approval by February (2009) for the group to work in Mozambique. I put in writing that if we didn’t get his approval, we wouldn’t return to Mozambique.
Unfortunately, we didn’t get a response either way, so we turned our efforts elsewhere. And again, to this date, we haven’t heard anything from the Mozambique Minister of Health. I might add that over the years in Mozambique we screened the hearing of over 5,000 school children, worked with almost 600 patients in the hearing clinic in the hospital, dispensed over 200 hearing aids, and trained a number of medical technicians and social action workers.
Academy: What a mess! I can only imagine the frustration of being there and not having patients show up. Sounds like you handled it perfectly. So where’ve you been lately?
Clark: Well, I diverted the 2009 team to South Africa. A dear South African friend, Kathleen Wemmer Stoop, who accompanied me a number of times to Mozambique, was planning the initiation of her Xanthia Program in August 2009!
So, our 2009 team traveled to Bushbuckridge to the Xanthia Clinic to help with the “Shake Down Cruise” for Kathleen’s audiology humanitarian program. We initiated the hearing screening program in many local primary schools and the free hearing clinic next to the Xanthia Medical Clinic. Since I still had not received clearance from the Mozambique Minister of Health by January 2010, I decided the team would spend our entire 2010 work time in South Africa.
So in the summer of 2010, the program was expanded to Parys and Sasolburg (in the Free State Province) along with the existing Xanthia Program in Mpumalanga Province. We’ve continued to include adults and children as well as work with other local professionals and we’ll be going again in 2011. One advantage for us in South Africa is many of the people speak English in addition to their local Afrikaans, Sotho, Zulu, or other tribal languages. In Mozambique, few people speak English and we often needed translators.
Academy: And so you’ve expanded to two provinces in South Africa, and now you’re working with adults and children, and so you’re actually reaching more people than ever?
Clark: Exactly, the project continues to expand. We conducted hearing screenings for children, held hearing clinics, and dispensed hearing aids. In total for the two regions, we saw almost 800 people. Of course, our colleagues in South Africa remain under-resourced—there are very few professionals, very limited access, or no hearing aids, equipment, or supplies and way too many patients to serve. And so they were very grateful for our group working beside them in the various settings.
Acadermy: Is there a difference with regard to South African versus Mozambique populations?
Clark: In general, South Africans in the rural areas appear to be healthier than the people in Mozambique, and it seems to be attributable to a better health-care distribution system—although that’s highly variable. One benefit to the Xanthia project is the hearing clinic is next door to the medical clinic, so sometimes medical care was more attainable.
Unfortunately, the medical care in Xanthia was provided only by nurses who could only dispense antibiotics, but at least some medicines were available. It was frustrating when we were in the Free State Province because medical clinics were much further away and often didn’t have general practitioners, let alone specialists like ENTs. Of course, another problem in Mozambique (and many other parts of Africa) is non-availability of antibiotics and other pharmaceuticals in the hospital or the pharmacy where they’re needed, because very often the medicines are black-marketed. In fact, even hearing aid batteries are black-marketed, so we cannot simply give a one-year supply to the patients as the batteries would often “disappear.” So what we had to do was give the battery stock to the local clinic, and they would have the patients bring in their old and spent batteries from the last month or two or three, and then the clinic trades those in for new batteries.
Academy: I read you now have a university in South Africa getting involved in the Xanthia project, too?
Clark: That’s right. Doug, as you recall, I have a Research Scholar appointment at the University of Witwatersrand in Johannesburg. And so, partly because the Xanthia 2010 “Shake Down Cruise” was so successful, some of the faculty, staff, and students became involved in Xanthia in 2010. In fact, 37 faculty and students from the university got involved with Xanthia. Additionally, the University of Kwa Zulu Natal has gotten involved. So, to have two South African universities who’ve taken notice and gotten involved, is terrifically exciting for all of us.
Academy: Thanks, Jackie. For people who want to learn more about you and audiology-based humanitarian efforts in Africa, what’s the best way to learn more?
Clark: Well, I have a few recommendations. First, I would recommend they seek us out at AudiologyNOW! 2011. And again, that meeting occurs on Friday during lunch time. Check the AAA AudiologyNOW! program for details. I also recommend the Web site for the Coalition for Global Hearing Health and as you might guess, the World Health Organization has great publications and technical information for humanitarian projects. Lastly, the Academy has planned an eAudiology Web seminar in March 2011 called “Humanitarian Audiology Part 2,” which is a follow-up to the seminar that Tomi Browne, Bopanna Ballachanda, and I offered in 2010.
Academy: Jackie, congratulations on your excellent work and thank you so much for your humanitarian efforts and accomplishments.
Clark: Thanks, Doug. It’s an honor to be part of these projects and it’s always very rewarding for me, too!
Jackie L. Clark, PhD, is a clinical associate professor, at the School of Behavioral and Brain Sciences, University of Texas, Dallas/Callier Center. She is also a research scholar with the University of Witwatersrand, Johannesburg, South Africa, and the managing editor of the International Journal of Audiology.
Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology.