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The Pleasant Point reservation, home to part of the Passamaquoddy Tribe, is remote, located in far northeast Maine in one of the poorest counties in the United States. But as with any population, it contains those with hearing loss and communication difficulties in need of diagnosis.
Enter audiologists Gary Schwartzberg, AuD, and James Dean, AuD, who were looking for a service opportunity in the community.
"We feel very fortunate to be where we are and doing the work we're doing, and it's been quite successful," Dr. Dean says. "But as time has gone on over the past years, we realized more and more people are being left out of the loop" and not being served.
Dr. Dean says both he and Dr. Schwartzberg were involved in charitable efforts independently before working together at their offices in Rockport and Waterville, ME, and they continue to be active in the Starkey Hearing Foundation's "Hear Now" program, as well as AUDIENT.
"We're always looking for ways to make sure people who have hearing loss and resultant communication difficulties have some way of obtaining hearing aids," Dr. Dean says, adding that he and Dr. Schwartzberg wanted to specifically look to their own Maine community.
"There are parts of Maine that are truly underserved," Dr. Dean says. "So we were thinking, 'How could we reach out to populations that are remote and in need?'"
Reaching Out
Knowing there were few existing services for American Indian populations in the remote northeast and northwest sections of the state, the doctors approached the Maine Department of Minority Health in February 2008, Dr. Dean says.
Proposing to initiate an outreach program, the doctors found that department director Lisa Sockabasin was "very receptive" of the idea. Sockabasin, herself an American Indian, lent her expertise as to what was needed and how to best deal with concerns and suspicions that might arise with outsiders starting any program on a reservation, Dr. Dean says.
They collectively decided it would be best to acquire basic audiology equipment. The doctors could then train those who live and work at the reservations to use the equipment effectively and make appropriate referrals.
The doctors' goal was to get to the respective tribes in Maine, learn about their culture, work with the people already in leadership roles in the community and health centers, and establish audiology screening programs. They decided the Pleasant Point reservation would be a good starting place since the site's health center was set to host an annual health fair in August 2008.
In planning the program, Dr. Dean says he and Dr. Schwartzberg worked in accordance with the World Health Organization Guidelines for Hearing Aids and Services in developing countries.
He also credits the Special Olympics Healthy Hearing initiative, which he has been involved with for several years, for guidance on how to effectively arrange for hearing tests on location in order to get the "best bang for our buck."
Pleasant Point
As part of their visit to the Pleasant Point reservation, the doctors trained medical staff at the site to use an audiometer and a portable tympanometer, which they then left behind. Other equipment donated to the health center included otoscopes, ear phone covers for infection control, disinfectant for ear tips, a sonic ear cleaner, and more. Equipment was purchased with funding acquired by Sockabasin.
While set up at the health fair, "the reception was excellent," for two reasons, Dr. Dean says. First, they had the credibility of Sockabasin's support. Second, they waited for people to come to them. Word spread, and they were busy right through closing. In fact, after the fair closed they were still serving people.
Beyond the fair, there are now people on site who can continue middle ear screenings and air conduction hearing tests, Dr. Dean says.
Extending the Outreach
Dr. Dean and Dr. Schwartzberg have continued their outreach at two other Maine reservations--another Passamaquoddy center in Indian Township and one serving the Penobscot in Old Town.
Dr. Dean says he and Dr. Schwartzberg were not teaching health center staffers to be audiologists. Training was intended to develop appreciation for how the ear works and for the abilities and limitations of the equipment staffers would be using, as well as to instill in them the idea that you are not diagnosing but simply identifying people who are at risk for either otologic hearing disease or hearing loss.
They emphasized to health center staffers that "their scope was to scan for problems in the outer ear and the middle ear to get some estimate of hearing sensitivity," and then make sure patients in need are referred to the appropriate medical provider, Dr. Dean says.
"We left skills and equipment behind so that this can be perpetuated, and we don't have to be on site," Dr. Dean says, adding he and Dr. Schwartzberg remain available by e-mail and telephone, and that they also created a small training booklet that stays behind as well.
"We went up there and we got started. But is this a done deal? No," Dr. Dean says.
Values and Inspiration
For Dr. Dean, the inspiration for what he calls "humanitarian audiology" stems from the same values comprising everyday audiology.
Promoting hearing healthcare in the community and increasing communication access for individuals with hearing problems are key values for all audiologists, but there's also a "patient-centered value" that involves going out and working with people who are underserved or may not be served at all, he says.
"Sometimes, in order to reach these goals of service, patient advocacy and cultural sensitivity, you have to go out there and be receptive," Dr. Dean says, before adding that all audiologists have something to offer.
"The great thing about humanitarian audiology and the reward that we've gotten is that we realize that people generally, when it comes to hearing loss and communication, have the same concerns," Dr. Dean says. For everyone seeking care, it comes down to being independent, able to communicate with your family or to be successful academically-regardless of their location or economic status.
Advice
For audiologists interested in initiating their own humanitarian efforts, Dr. Dean suggests opportunities will typically "pop up" on their own, and frequently in their own backyards. The key is committing to getting out of the office once an opportunity presents itself.
"If you wait for everybody to come to you, that's not going to happen," Dr. Dean says. "You need to reach out and go out."
If an opportunity is not jumping out at you, Dr. Dean suggests audiologists consider what they can do to insure their services are provided for people not coming through their office door by recognize what areas/people are not getting served.
"Go out and understand what's happening in that community, figure out who the players are-who is respected, who do people go to when there are healthcare needs?" Dr. Dean says. "Just plan on becoming a part of that community as someone who is providing service just for the pride and joy of being able to do so."
While feeling good about partaking in humanitarian projects is definitely a motivator to seek them out, the actual work should not be taken lightly.
"I think everyone who works in the area of humanitarian audiology understands that going in, and doing something once makes you feel good, but once you've left, if you haven't left something behind like skills and equipment that can be used continually, then you haven't really impacted the situation," Dr. Dean says.
Rewards
Of course, taking the planning and work seriously, and committing to long-term projects does not mean there are not additional benefits.
Thinking back to the Pleasant Point Health Fair, Dr. Dean says, "We walked away from there thinking, not only did we do something good today, but we really started something that's going to carry on, and that was very satisfying. We also walked away thinking that these people we saw today represent a very small portion of the number of people who are out there who need similar access."
And so the work continues.
Due to the isolation of the sites the doctors visited and the lack of audiology service providers in those areas-Dr. Dean's offices are about 200 miles from Pleasant Point-it will be a slow process in determining the success of the program.
But Dr. Dean says he and Dr. Schwartzberg are following up with Sockabasin to determine what went well, where the needs are and how to take the next step.
"As we look down the road we realize that identifying people with hearing loss is important, but that's only part of the job, which in the long term is getting the appropriate amplification on them," Dr. Dean says. "And our current concern right now is how are we going to manage that?"
In the meantime Drs. Dean and Schwartzberg, along with Sockabasin and other allies, are helping create a better community experience for everyone.
"We're part of the Maine community at large, we've been fortunate. and thought we should give something back," Dr. Dean says.
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