Ten thousand hearing tests in South Africa – by app

“Can you hear me? Does that sound good? Thumbs up!” A little girl with a head full of tangled curls beams as she raises her thumbs. “Super,” says the woman sitting in front of her. “How about a high five? Ok, you’re done!”

Lindsay Roberts works for Sonova and volunteers for the Hear the World Foundation at the Carel du Toit Centre, a charitable audiology center in South Africa. Children from poor areas with hearing loss come here to learn how to speak and acquire all the skills that they will one day need to take control of their own lives – and to integrate into society like everyone else. Rogers had never imagined that her work could have had such a positive effect. “Giving these children such a gift – knowing that we are enabling them to learn to speak – has turned out to be an unbelievable experience; it means a lot to me.”

Roberts’ job is part of the “HearSouthAfrica” aid project set up to carry out hearing tests for schoolchildren and offer support in fitting disadvantaged people with hearing aids. Stefan Launer, Sonova’s Senior Vice President Science & Technology, has also visited the center to help conduct the tests and get an overview of the project. It was not just the cordial welcome he received that impressed him: “The people there are absolutely determined to help themselves.” While Launer was at the center, the children sang him a song they had written themselves that included the words “I have a right to food, a right to be clean, a right to see a doctor, a right to protection, a right to be heard...” “And we showed them that they also have a right to hear!” adds Launer.

Besides the gigantic gulf between rich and poor, one of South Africa’s biggest challenges is the lack of access to medical care afforded to disadvantaged people. Western Cape province is about the same size as Switzerland, but this enormous area is served by only one hospital. As Stefan Launer explains, “It’s as if you had to travel from Zurich to Munich for a hearing test, in a country where there is no public transport – or money for food.” Such a journey also means missing a day’s work – and thus a significant loss of income.

A screening app to combat poverty

So the children living in the corrugated iron shacks of the slums will now have a chance to benefit from hearing screening tests. To bridge the gap in the provision of audiological care, the Hear the World Foundation has been working closely with the hearX Group, which has developed an app that allows hearing screening tests to be carried out by non-professionals. Although the South African government launched a program of compulsory hearing tests for all children in 2012, it has encountered some practical snags – there is a lack of audiologists and expensive equipment. The hearX Group, whose app can be used by non-professionals, has created a solution to these problems. The project hopes to ensure that hearing loss is identified at an early stage and treated in time, and between 50 and 100 kindergarten-age youngsters in townships around Cape Town and Pretoria are to be screened every day from 2017 to 2019 – a total of 10,000 children.

Since July 2017, the app has been in use in several townships near Johannesburg with a total population of some 1.4 million people and a township near Cape Town that has approximately 2.5 million inhabitants.

Tessie Kirunda from Boots Hearingcare in the UK, Lindsay Roberts and Natalye Faison from Phonak in the USA, and Michael Kremers from Geers in Germany were the team of four Sonova volunteers who worked with the Hear the World Foundation in the summer of 2018 to take care of fitting the hearing instruments. “What I found most moving were the children’s reactions once they had been fitted with hearing aids. They all blossomed and were unbelievably grateful,” remembers Michael Kremers, a Hear the World volunteer who works for Sonova at Geers in Germany.

In preparation for the project, schools and kindergartens had first to be selected to participate, and this proved no simple matter, recalls Stefan Launer, who helped to get the project up and running; there had to be people prepared to get involved at each individual school. Getting parents to submit a written permission slip proved another stumbling block – not every mother or father in the slums can read and write.

App enables non-professionals to test hearing

It is crucial for children’s development that any hearing damage is identified at an early stage; the sooner hearing loss is diagnosed and treated, the greater the children’s chances of developing at a rate appropriate to their age. If problems go undetected, children will struggle to learn to speak – they will not be able to follow lessons properly or may even drop out of school altogether. This can have catastrophic consequences for children from low-income families, and a life of limitations and social isolation may loom.

Although the South African government launched a mandatory hearing test program for schoolchildren in 2012, implementation did not go according to plan – there were not enough experts, as the figures show: in South Africa, there is an average of 2.4 audiologists per 100,000 inhabitants, whereas the UK, for example, has 16.4. The South African state also lacks funding to buy the audiological equipment required – and this is precisely why the hearX Group developed the app described above. “hearScreen” has been designed such that non-professionals with no audiological qualifications can conduct hearing tests; all they need is a special smartphone, headphones, and a short training course. Furthermore, this reduces the cost of hearing tests by 50 to 70%. “Mobile health – in other words, providing support for healthcare with devices such as smartphones and tablets or personal digital assistants – is the way forward,” explains Stefan Launer. “And this app is a perfect example of the opportunities this technology has to offer.”

Better hearing – and creating jobs as well

The crucial factor here is that the tests are being carried out by locals; they know their way around the slums, can spot potentially dangerous situations, and speak African languages. Volunteering for HearSouthAfrica means a lot to such people – they are doing their bit for their community and thereby finding a route out of unemployment. “The screenings create jobs and provide training for people from poor communities, instilling a sense of pride and boosting their confidence,” says Stefan Launer. “It was wonderful to see their enthusiasm and commitment.”

“I had been unemployed for a long time and I’m delighted to be part of this project, as it is changing the lives of the children here,” says social worker Ntombi Ndzunga. A little girl with a long braid is sitting in front of her and counting out loud: “Two, three, four, five, six…” Her mother is sitting nearby in the room. “At first, I cried because I thought my girl was deaf,” she says. “But these are tears of joy today, because she can hear music and speak.”

After-care – a key component

The app is only the first piece of the puzzle. If a child is diagnosed with hearing loss, a second test with the “hearScreen” app will follow to confirm the first results, and children who fail both screenings are referred to a local audiologist. All the results are uploaded to the cloud at the end of the session and parents are sent a summary of the information by SMS. The availability of all the information in the cloud also makes after-care extremely efficient, as the audiologists, too, have access to all the facts and figures via a database. If the state healthcare program is unable to provide the children with hearing aids of their own, they will be lent temporary hearing instruments by the Hear the World Foundation to tide them over.

Most of the children at the Carel du Toit Centre do indeed already wear a hearing aid – the South African government provides a hearing instrument for every disadvantaged six-year-old who requires one. The problem is that “many of these devices are second-rate”, as Susann Ecksteen, the center’s project manager, explains. This means that they are sub-standard for proper hearing and thus not good enough to allow the children to learn to speak clearly. “And that’s also why we’re very grateful for donations,” adds Ecksteen. This ensures that children in need are fitted with hearing aids as soon as possible and their development is not held up by long waiting times. Some 150 new Phonak devices have been provided by the Hear the world Foundation, helping a total of 88 children with single-sided deafness or bilateral hearing loss to hear more clearly and learn to speak.

The work done by Sonova staff for the Hear the World Foundation’s aid project in South Africa has enjoyed celebrity support and recognition thanks to Hear the World’s new ambassador, Gregor Meyle (39), a successful singer-songwriter who has been a fixture on Germany’s concert stages for many years. Putting in about a hundred live performances every year at clubs, town halls, and big open-air events has catapulted his poetic tunes into the top ten of the German album charts. Music means everything to him, which is why good hearing is also so vital. “My hearing is my most important tool; I can’t imagine how I would cope without this sense, and that’s why supporting the work of the Hear the World Foundation is a matter so close to my heart.”

When Meyle began to play his guitar on his first visit to South Africa as a brand ambassador, the children lit up and began to dance. Meyle’s infectious passion and joyful love of music has also enabled him to motivate children with hearing loss to carry on developing their speaking skills – and thus given them hope for the future.

To ensure the long-term success of the project, the team has been working with the University of Pretoria to systematically collect data from the app; they are hoping their research results will convince the South African government of the project’s significance and show them how important it is to enable children to develop at the right pace.