 Worldwide an average of three percent of all children are born with some type of hearing disorder. In Bali the figures are from 1 – 3%. The reason we don’t know the exact figures is that there is not universal screening at birth. There are many hearing impaired children in Bali who could benefit from hearing aids. Children who do not hear well enough to develop language before the age of 6 or 7, will probably never be able to do so. The area of the brain responsible for language development will not respond after that. Even if diagnosed and fitted at age 4 or 5, a child will probably never catch up.
We are looking for donors to either fund the purchase of new hearing aids or pay for the maintenance costs for used ones; for needed testing equipment and for furniture and supplies for the Schools for the Hearing Impaired.
FIRST EVER PRESCHOOL FOR THE HEARING IMPAIRED IN BALI
Click here for details.
Background to Hearing Loss in Bali
Hearing loss for children presents a physical, emotional and social challenge that is difficult to describe. For the children affected in Bali, this challenge is compounded by a lack of resources and an inability to access hearing aids, receive corrective medical treatment, or even achieve an education. Assessing children for hearing loss in Bali has up until very recently been almost impossible due to a lack of facilities and trained personnel.
 Another part of the problem is that many hearing impaired children are kept at home because there are no special schools for the hearing impaired (called SLBB or Sekolah Luar Biasa, Section B) in their neighborhood. Often, hearing impaired children get streamlined into "normal" schools and are labeled as "stupid" because their hearing loss has gone unnoticed or untreated.
The main school for the hearing impaired is the government school in Jimbaran, South Bali. There are three other SLBB throughout the island and ten other schools for the disabled that have mixed enrollments (physically and mentally challenged). Few of these schools have proper testing equipment, hearing aids for the children or enough specially trained teachers to provide such fundamental things as speech therapy or sign language.
We are working in conjunction with the Lumina Hearing Center, a hearing clinic in Renon, Denpasar.. Lumina is a commercial entity which tests hearing and sells Siemens brand hearing equipment. We have selected Lumina as our partner as their staff have offered to work with us on a volunteer basis as well as help train those who work in schools for the hearing impaired. This clinic is also the only one of its kind on the island at the moment. The Bali Rotary Club of Nusa Dua has donated immense amounts of time and money to the Jimbaran School for the Hearing Impaired and we will ensure that we do not duplicate their efforts. Our goals are to:
- Test all the children at all the SLBB schools and outfit those children who would benefit from hearing aids. As of January 2008, all the current enrollments at the Tabanan, Sidhakarya, Jimbaran and Singaraja SLBB have been tested.
- Work out a maintenance program for those children with hearing aids (see below)
- Upgrade audiometers at the Jimbaran school and if funding permits, install audiometers at all the other SLBB in Bali.
 This may seem like a simple task, however, testing and prescribing hearing aids for the children necessitates several involved sessions for specific audiometric testing. It also involves several trips to the Lumina clinic in Renon, one hour away, to the only pediatric testing facility on Bali. Children who require medical treatment or surgeries will require extra time and attention extending the process!
Once a hearing aid is prescribed, custom ear molds must be made for each child and these may have to be replaced up to three times a year due to the quick growth spurts in a child's development. The hearing aids use batteries that must be replaced every two weeks. The children and their teachers must be trained in how to keep their hearing aids maintained and clean.
 The main obstacle to this project is, of course, funding. New hearing aids can cost anywhere from Rp 2,000,000 - 7,000,000 (US $222 - $775); batteries are Rp 60,000 ($7) for a month's supply and maintenance will vary according to the age and development of the child. Lumina Hearing Center provides free consultation by Canadian Vikki Mackay who has helped in similar projects in Uganda and Zimbabwe. This hearing center has already provided donated audiometric testing equipment and donated used hearing aids to the program. At Lumina there is a trained Hearing Instrument Specialist, Kadek Yuliarti, who works with Vikki to assess the children. Lumina works closely with physicians at Sanglah Hospital in Denpasar to facilitate the treatment of any children identified with medically treatable problems. Children need to be fitted with the appropriate hearing aid.
The fitting of the hearing aid involves:
- The making of a custom fitted earmold
- The diagnostic fitting of the hearing aid which may involve computer programming, real ear measurements, sound field evaluation, and other
- Counseling of child, parents, teachers, and others regarding: hearing aid use and care, maintenance, realistic expectations, etc.
- Follow-up sessions (usually at least 2) to monitor progress and make any programming adjustments that may be necessary in order to make the sound produced by the hearing aid optimal for the child.
- Ongoing support for teachers, families and others concerned with the child to help them to manage the hearing aids and understand how to best help the child wear them
As one can see, the fitting of hearing aids on children tends to be quite a bit more complicated than fitting them on adults. It is also quite a bit more important, which is why so much care must be taken. Not enough amplification, and the child will not benefit properly, and too much and the child may incur a noise-induced hearing loss which will worsen their condition!! Children must hear well in order to develop language.
 Giving a child the use of whatever level of hearing they may have - even if that hearing is severely damaged, is a wonderful gift. It will enable them to understand that sound exists, and that it has meaning. It will allow them to realize the function of their own voice and let them use it - even if just to learn the names of their families, or to call for items of basic need. It will greatly enhance their ability to interact with the normal hearing world!
As indicated, testing and fitting the hearing aids will most certainly take several visits per child. In addition to these initial visits, children will need to have their hearing monitored every 6 months and their hearing aids readjusted if their hearing levels change. Transporting children back and forth to the Lumina clinic proved both costly and challenging. It is more cost effective and ultimately a better service to construct a suitable testing facility within the school itself. That way, rather than bringing the children to the clinic, the staff can visit them. This can save a lot of time, and if a child becomes tired or uncooperative, testing can simply stop and begin for the next child. In 2007, Nick Liem, an Indonesian engineer currently living in Canada, constructed with the LUMINA staff, three soundbooths which have been set up at the SLBBs in Tabanan, Sidhakarya and Singaraja (the one at Jimbaran was repaired by the LUMINA staff and is now up and running).
The beneficial spin-off of this would be that the entire area near the school gains the benefit of a properly constructed hearing testing facility. The Lumina office sends out one of their staff members to do the basic tests and maintenance activities to ensure accuracy.
Personnel involved:
Volunteer Consultants:
- Vikki MacKay B.G.S.: Hearing Instrument Specialist licensed with the Board of Hearing Aid Dealers and Consultants of British Columbia, Canada
- Nick H.L. Liem: P. Eng.: Mechanical Engineer, Canada
- Jim Renshaw: Biomedical Technician and Audiometric Equipment Specialist, Canada
Lumina Employees
- Ni Kadek Yuliarti: Hearing Instrument Specialist, apprenticed in Indonesia
- Alex Susanto: Technician
- Ni Komang Kumala:
Budget
Per Child Cost Breakdown
A. USED HEARING AIDS
| Item |
One time cost IDR |
Annual Cost IDR |
Amount US$ |
| Testing |
40,000 |
|
5.00 |
| Fitting of used hearing aids |
250,000 |
|
29.40 |
| Hearing assessment |
|
300,000 |
35.20 |
| Earmold1 |
|
60,000 |
7.00 |
| Batteries2 |
|
600,000 |
70.00 |
| TOTAL |
290 |
960,000 |
|
| TOTAL PER YEAR IN US$ |
|
|
$ 146,60 |
B. NEW HEARING AIDS
| Item |
One time cost IDR |
Annual Cost IDR |
Amount US$ |
| Testing |
40,000 |
|
5.00 |
| Fitting of hearing aids (fee is waived for new hearing aids) |
|
|
|
| Hearing assessment |
|
300,000 |
35.20 |
| Earmold1 |
|
60,000 |
7.00 |
| Batteries2 |
|
600,000 |
70.00 |
| Hearing Aids3 |
7,200,000 |
|
847.00 |
| TOTAL |
7,249,000 |
960,000 |
|
| TOTAL PER YEAR IN US$ |
|
|
$ 966,60 |
| 1Earmolds |
: |
Rp 60,000 (per year or up to 3x a year depending on age of child and growth of ear) |
| 2Batteries |
: |
Rp 50,000/month or Rp 600,000/year |
| 3Hearing Aids |
: |
Rp 2,000,000 - Rp 8.000,000 PER AID (Rp 3,600,000 is the price for the medium quality one, which is what is being used for costing here) |
Maintenance costs for both used and new hearing aids is approximately US
$115/year (IDR 960,000).
DEVELOPMENTS
Thanks to generous donations from the Annika Linden Foundation, we are able to continue to expand our services to the hearing impaired community.
We are now working with all four SLBB on the island assisting 110 children in these schools.
It is wonderful to see the progress that many of these children are making. All are becoming aware of sounds and their meanings and many are learning to speak
 Lumina Hearing Center is also pleased to announcethat they have received a very generous
donation of a critical piece of hearing testing equipment that will enable the accurate diagnosis of hearing disability in infants and young children. This unit – a GSI Audera ABR/OAE (BERA) System was donated by VIASYS Heathcare of the United States. Lumina is very excited to have this very advanced piece of equipment – the first of its kind in the island of Bali (and one of two in all of Indonesia) – because it means that we can now identify and provide hearing aids for hearing loss in babies and toddlers. This will greatly increase their speech and language development potential.
NEW PROGRAM IN 2008: NEO NATAL SCREENING
As part of a pilot project funded by the ALF, we will be working with three hospitals: Sanglah Government Hospital, Gianyar Government Hospital and Surya Husada Private Hospital in a new, first of its’ kind Neo Natal Screening. Every child born in these hospitals will have their hearing tested and those who are found to have problems will then have further tests done either at LUMINA or at one of the other private practices in Denpasar. If a child can have his/her hearing improved by the use of aids or cochlear implants, the chances of a more normal childhood are greatly enhanced. The LUMINA staff shall work with the staff of these three hospitals in both the testing as well as the counseling for the families. Once this project gets off the ground, then we shall move into more remote areas as the equipment is portable.
We currently have three portable and one stationary unit and are in need of at least three more (they cost US $10,000 each).
 Volunteer Jocelyn Duncan's visit at the SLBB. CLICK HERE
Volunteer Adrienne Oberoi, a hearing adult born to two deaf parents, held sign language classes for the parents of the children at SLBB Jimbaran.
CLICK HERE
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