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 CV Lumina Hearing Center, a hearing clinic in Renon, Denpasar.. CV Lumina is a commercial entity which tests hearing and sells Siemens brand hearing equipment. We have selected CV 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 one of two 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 October 2009, 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 CV 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. CV 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 CV Lumina there is a trained Hearing Instrument Specialist, Kadek Yuliarti, who works with Vikki to assess the children. CV 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 CV 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 CV 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 CV Lumina office sends out one of their staff members to do the basic tests and maintenance activities to ensure accuracy.
This project is made possible through funding by:
Greg Evans and family of Australia for their monthly donations to help offset costs in the Guided Study after school program for first graders.
Chris and Mary Hill of Perth, Australia held a joint Garden Party Fundraiser with ABC Radio and raised funds for the hearing programs.
The Fischer family of Switzerland for sponsoring hearing aids for nine children in the SLBB schools
