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A clinic for everyone in Malawi

Edgar is getting his first hearing aids – a big day for the little fellow!

Edgar is getting his first hearing aids – a big day for the little fellow!

The Hear the World Foundation, a Sonova Group initiative, has established a comprehensive aid project in Malawi, one of the world’s poorest countries, that is vital to healthcare provision in the country as a whole.

At first all you hear is a faint noise, but then individual words can be made out amongst the burbling; little Edgar is laughing – loudly, and then with even greater force. He can’t quite believe that he can hear again – finally, after four long years!

That was when he caught malaria, and his treatment with ototoxic quinine proved disastrous. Besides HIV infection, noise-related hearing damage (caused by a lack of ear protection, for example) and chronic (or incorrectly treated) middle ear infection, quinine is one of the principal causes of hearing loss in Malawi.

Edgar has been extremely lucky – and not just because his grandfather, surprised at his grandson’s increasingly poor performance at school, suspected that hearing loss was to blame; his family would never have been able to afford hearing aids for the boy, so it was a double stroke of good fortune that the Hear the World Foundation was able to supply the devices and treat Edgar at its ABC Hearing Clinic.

All this has been enabled by Sonova's initiative, which has been supporting this long-term, sustainable project in furtherance of its vision: to create a world in which everyone can enjoy the delights of hearing and live a life without limitations.

It all began in 2010, when the charity EARS set about establishing a solid basis for audiological care in Malawi: as there were no hearing care professionals in the entire country, their staff would travel the length and breadth of Malawi, visiting schools and treating children who could not afford the trip to the capital, Lilongwe. Their work was made possible by the Hear the World Foundation, which provided an audio trailer equipped with sound booths. Since 2011, the foundation has been supporting their work financially and practically by supplying volunteers and donating new hearing aids.

Helping people throughout Malawi

The milestone that also made it possible for Edgar to receive treatment came in 2013 with the opening of the ABC Hearing Clinic, the first audiological clinic ever built in Malawi. This was followed two years later by a second institution in Blantyre, in the south. Malawi now has two audiological clinics – so the involvement of the Hear the World Foundation has made a crucial difference to audiological care throughout the country.

Once the audiological tests are complete and the otoplastic mold has been made, Edgar receives his first hearing aids at the ABC Hearing Clinic. His joy at this new world of sound spreads even to Tiwa, the audiologist, who completes the fitting despite a temporary (and routine!) power outage. “I’m so glad and grateful that Edgar can hear again! We’re really hoping his school marks will improve again now,” says his grandfather.

As part of his follow-up care plan, the audiologists will use play audiometry to repeatedly test Edgar’s hearing in a soundproofed acoustic booth. Thanks to support from the Hear the World Foundation, the clinic also boasts measuring devices such as OAE monitors (to record otoacoustic emissions) and ABR electrodes (to measure auditory brainstem responses). The foundation has also financed a small laboratory where the earmolds can be produced directly on-site, allowing some 2,000 people to be tested and more than 400 hearing aids fitted annually.

Helping even the remotest areas of the country

Thanks to the Hear the World Foundation, patients in even the furthest-flung corners of Malawi can now count on treatment. The clinic’s team makes regular trips up and down the country with the audio trailer, visiting schools, isolated clinics and even refugee camps. There is a monthly outing to Kasungu, two hours from Lilongwe, for example, where children and relatives can be found patiently sheltering from the sun under the corrugated iron roof of St. Andrew’s Hospital. Most will have heard about the audiological care on offer via word of mouth, and then walked or cycled many miles to be there. With the ABC Clinic covering the northern part of the country, the clinic in Blantyre is responsible for the regions to the south.

The Kasungu team begins its consultations, which often involve removing earwax and prescribing medicine to combat inner ear infections, early in the morning; they break for lunch at 2pm, at which time the hospital also provides food for the people waiting in the queue. Work continues until around 5pm, when the hospital closes. The people who have waited patiently all day will be standing in line again next morning.

A milestone: hearing screening for newborns

One of the audiologists is Chiponde Kamuzu, whose responsibilities include neonatal screening: newborns have been screened in the ABC Community Clinic every day since the end of 2016. Kamuzu works carefully and patiently while also advising parents on general hearing matters. The equipment he requires has been supplied by the Hear the World Foundation and his staff receive appropriate training at the clinic. An agreement has also been made with Kamuzu Central Hospital, the biggest healthcare institution in Lilongwe, for neonatal hearing screening – “a welcome and important step for hearing healthcare in Malawi,” as Elena Torresani, Head of the Hear the World Initiative, says. They hope to gradually expand the services available, ultimately offering neonatal screening at as many maternity clinics as possible, with the option of transferring babies to one of the two audiological clinics if there is any cause for concern.

The foundation has donated an OEA machine to the hospital in Lilongwe for these screenings, and a further two OAE devices have been earmarked to help establish neonatal hearing screening programs in other clinics as well. Thanks to this early identification of hearing loss, pediatric audiological care in Malawi has come on in leaps and bounds: “Our aim is to spot babies with hearing loss as early as possible and to offer them audiological care at the earliest opportunity. That will be a milestone in audiological healthcare in Malawi,” explains Ora Buerkli, who sits on the Hear the World’s foundation’s board. 

A clinic run by Malawians for Malawians

The plan is for the ABC Hearing Clinic team to work even more independently in future. The experts from overseas are due to return home and the Australian management team will be able to step back from day-to-day operations, handing over the clinic to local administrators – but Sonova’s financial, material and technical support will continue.

“Malawi is an excellent example of what can be achieved over the course of a few years. This kind of work requires patience and you can’t expect results overnight. I hope we’ll be able to continue our work as we have done so far – there’s certainly plenty of demand,” says Elena Torresani. And the experts will indeed be coming back – amongst other things, to supervise the next generation of audiologists, who began their training in August. Local expertise is essential to ensure top-quality, sustainable audiological healthcare in Malawi. “We are Malawians, and no one understands Malawians like we do – so we are delighted that we are now able to look after our own people ourselves,” says Fletcher Chisalipo, an audiologist at the ABC Hearing Clinic.

There is no mistaking Fletcher’s enthusiasm for audiology and his work at the ABC Hearing Clinic. He has completed a Master’s degree at Manchester University, funded by the Hear the World Foundation – an investment that is paying off. “With our support, we want to do our bit to ensure audiological expertise stays in the country and bears fruit, securing long-term, quality healthcare for Malawians that is delivered by local experts,” says Elena Torresani. “The creation of promising job opportunities for the local community is a welcome by-product.”


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