Developing a Comprehensive Hearing Health Plan for Nicaragua. Karen Mojica, MD Nicaraguan Medical Director Mayflower Medical Outreach.

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1 Developing a Comprehensive Hearing Health Plan for Nicaragua Karen Mojica, MD Nicaraguan Medical Director Mayflower Medical Outreach.

2 Status of Nicaragua Hearing Health Second poorest country in Western Hemisphere 6 million people ~30 otolaryngologist (most in Managua) 2 audiologist / 1 speech therapist 3 audiometric technicians No public programs for: otology training temporal bone lab audiology training / certificate newborn screening school hearing screening

3 MMO Hearing Health Projects Mayflower Medical Outreach (founded 1999) Establish otolaryngology / audiology clinic in Jinotega Provide surgical and medical services on outreach trips Provide and distribute subsidized hearing aids Equip and train Nicaraguan otolaryngologists US based training Residency training / temporal bone labs Albergue / school for rural deaf children Economic sustainability projects (Bakery, Internet Café) Transitional home for teenagers Vocational training Support research projects on causes of hearing loss Hearing screening in Jinotega public schools

4 Mayflower Medical Outreach School screening, Jinotega ENT / Audio, Jinotega Deaf Albergue, Jinotega Teaching Surgery Lenin Fonseca Hospital, Managua

5 Summit Meeting on National Hearing Health Plan May 2012 Attendees WHO / PAHO MINSA health workers CBM Los Pipitos Mayflower Medical Outreach Otolaryngologist, audiologist and speech therapist Prompted by WHO support for National Hearing Programs Petition of hearing health professionals Ministry of Health (MINSA) survey of disabilities (Todos con Voz)

6 Todos con Voz Program. Surveys of 179,113 homes with reported disabilities 126,316 disabled individuals (2.43% of population) Most common - intelectual disability (32,741) 12,780* with (self-reported) hearing impairment 10.12% of disabilities Most are severe to profound Regions with high rates were: Managua Esteli and N. Segovia Matagalpa and Jinotega Chontales * Recent estimates 500,000 hearing impaired in Nicaragua

7 Age Distribution of Hearing Loss Age Groups People with Hearing Loss Percentage 0-4 AÑOS % 5-14 AÑOS 2, % AÑOS 1,151 9 % AÑOS 1, % AÑOS 1, % AÑOS 2, % 60 Y MAS 4, % TOTAL 12, %

8 Proposed Regional Hearing Centers Esteli Juigalpa Correspond to highest prevalence of Hearing Loss

9 Dificulties found on Todos con Voz survey Lack of hearing health promotion and prevention of hearing loss Lack of human resources (ENT and audio tech) No surgical equipment in ENT clinics. Not enough audiometers or audio boothes Lack of access to hearing aids

10 Strategy for National Hearing Health Plan Primary Ear and Hearing Care WHO PEHC Manuals / Certification Secondary level of care Audiometric technician training MINSA certified SILAIS positions for audiometric technicians Build and equip regional centers Esteli Juigalpa Managua children s hospital (La Mascota) Strengthen tertiary care Surgical training / equipment

11 Primary Ear & Hearing Care Training MMO Training in Jinotega (March 2012) 25 health workers Basic and Intermediate (combined) Diego Santana Advanced Course MINSA Oct attendees Train the trainers Attendees train in regional SILIAS

12 Primary Ear and Hearing Care Training (312 total) MINSA Health Workers (98): Advanced training 59 Basic and Intermediate - 39 SILAIS Regional Basic and Intermediate Training (214) : Rivas: 30 Nueva Segovia: 36 Boaco: 18 Carazo: 24 Chontales: 20 Masaya: 30 Zelaya Central: 8 Estelí: 18 Chinandega: 30 Boaco: 18

13 Primary Hearing Loss Prevention- Ototoxicity Educational Campaign Public Awareness Posters & Physician Education Developed by Afton Chavez (Dartmouth Giesel MSII)

14 Primary Intervention: Remote School Screening with Cell Phones?

15 Secondary Hearing Care Audiometric Technicians First class of 12 audiometric technicians Current MINSA health workers Juigalpa, Managua, Esteli Certificates Positions for audiometric tech Hands on / classroom sessions Feb & Fall 2013 Mark Sanders, AuD Website training in future?

16 Secondary Hearing Care Regional Centers Esteli: Completion of audio booth / clinic First MMO clinic in Esteli Surgical equipment (microscope) Juigalpa private partnership? Managua SILAIS not supportive of audio clinic at Children s Alternate site in Managua planned for 2013 Possible joint venture with other NGO Container with requested equipment held in Nicaraguan Customs for 3 months

17 Tertiary Care Surgical Training and Equipment Lenin Fonseca Hospital: 3 additional microscopes Provide audiometric support Temporal Bone Lab (trouble finding cadaver specimens) La Mascota Children s Hospital Donation of microscope Other hospitals: Cochlear implants? Surgical Equipment Bank 3 complete ear sets

18 Endless bureaucracy Approval form both MINSA and SILIAS Customs delays Biggest Challenge

19 Lessons Learned Comprehensive ear and hearing plan is possible Participation of ALL stakeholders Professional Public / government NGO s Families / communities Interventions at primary, secondary and tertiary levels Challenges lack of resources and bureaucracy

20 Thank you to my colleagues James E. Saunders, MD Mark Falk Debra Fried, MA Joaquin Escoto, MD Shelly Chadha, MD Diego Santana, MD Jose Gomez, MD Leonor Morin, MD Daysi Enriquez, MD

21 Albergue Mayflower: Casa de Sordo