Apunipima's Audiologist Kristen Wallin presented at the World Congress of Audiology held in Brisbane in May 2014. Kristen holds a Masters in Audiology and has been an Audiologist for over 10 years. She has worked with Apunipima Cape York Health Council since 2010 and has worked closely with colleagues and other health providers to increase the number of children receiving hearing checks and to improve hygiene and nutrition for kids on Cape - both key factors in poor hearing health.
Tell me about the Conference
This is the 32nd World Congress of Audiology, held in Brisbane from May 3-7, hosted by Audiology Australia on behalf of the International Society of Audiology. An enormous number of research papers were presented on topics including Medical Audiology, Paediatric Audiology, Implantable technology, Hearing Loss Prevention, and Audiology with Disadvantaged Populations.
Have you been before?
This is only the second time the international conference has been held in Australia – the first before I qualified – so this is my first World Conference. I have previously attended Audiology Australia professional conferences.
Tell me about your presentations
I presented several papers at the Conference including one looking at the results of the hearing component of the school screening in various Cape communities. My other presentations address the way we screen for hearing problems in children in community.
For many years, my industry has attempted to implement hearing health screening programs in communities, and they have been largely unsuccessful as the operational requirements are not sustainable, or do not adequately fit in with existing responsibilities of staff on the ground.
At Apunipima, we are instead focusing on the schedule of Medicare Health Checks, and the opportunities these checks allow for us to examine kid’s ears (even when the health check does not require it).
This means older children can have an ear check once a year during their health check, and children under the age of three (who are much more susceptible to middle ear infections) can be checked on several occasions through the year while staff are performing health checks to assess the child’s development.
This plan is a much more efficient use of staff time and resources than attempting to run a separate program, and also allows for much easier tracking of test results over time, as the health check paperwork is easy to find in the patient chart, so it is a quick task to compare today’s results with previous results.
Tell me about yourself and your role at Apunipima Cape York Health Council
In Australia, audiologists are trained at university level, with a Masters Degree as the requirement to enter the profession. I have been an audiologist since 2001; I moved to Cairns in 2002 and worked for many years at Australian Hearing, including outreach visits to Cape York communities and the Torres Strait Islands.
In late 2009 I moved to Cooktown, and began working with Apunipima early in 2010. My previous work at Australian Hearing involved fitting hearing aids to people with hearing loss, a job that relied on Primary Health Staff to determine which of the clients in their community are in need of these specialist services.
It was readily apparent in many locations that this was no easy task. During my time at Apunipima, I have worked to begin improving these processes. This has included working with Primary Health clinic staff to improve their skills and confidence in assessing ear health; educating nurses and doctors on how to confidently diagnose the different types of middle ear infections and to know the different treatments that are recommended; working with schools to support teachers in managing children with ear infections in the classroom; as well as working with clinics to ensure that visiting Ear Nose and Throat doctors or hearing aid specialists are spending their time with the clients that need it most.
Paint me a picture of ear health on Cape York
Cape York has similar problems to wider Australia, with people over the age of 50 showing increased levels of hearing loss due to ageing as well as the build-up effects of exposure to harmful levels of noise over a person’s working life. Of more concern, however, Aboriginal and Torres Strait Islander children show much higher rates of middle ear infections, called Otitis Media, compared with non-indigenous children.
Otitis Media is linked to the same bacteria that cause colds and chest infections, as these bacteria access the middle ear from where they live, in the back of the throat. In non-Indigenous children, Otitis Media often improves/resolves after the age of three, as the respiratory system improves with growth. In Aboriginal and Torres Strait Islander children, this is often not the case.
There are many reasons for this, including poorer access to healthy food in community, so immune systems are not as strong; higher rates of crowded housing, so the bacteria are passed around more readily; and higher rates of smoking, so the membranes that line the nose, throat, lungs and middle ears are more often inflamed and producing mucus. So Aboriginal and Torres Strait Islander children are more likely to have stubborn hearing losses that persist into their schooling years – well after the hearing should have returned to normal levels. And this is certainly the case on Cape York.
The research that I presented at the World Congress shows that Cape York has been making very positive changes that are reducing the rates of chronic Otitis Media and hearing loss in school aged children. Together with our partner organisations, Apunipima has been working hard to educate people about nutrition, and making sure that shops in communities offer some healthy choices that people can afford. We work hard to teach kids about good hygiene, the importance of blowing your nose rather than wiping it with your hands, the importance of washing your hands after using the bathroom and before eating so that bacteria can’t catch a ride. The rates of hearing problems that I presented at the World Congress compared well with the rates that others presented from different parts of Australia. But we are not satisfied yet – there is still a lot of work to be done.
What are the implications of compromised hearing for the people of Cape York?
The main problem is that if children can’t hear, they can’t learn – and over time, the problems with learning grow like a snowball. Small children learn to speak by listening to others around them talking. When children have ongoing Otitis Media, they can’t hear all the different speech sounds, so they become delayed in learning language. While many of them eventually catch up, the rules of language and the way to speak and write properly never come easily for these kids. In addition, hearing is a natural skill that we have – but listening is something we learn to do.
Children with ongoing Otitis Media don’t learn to pay attention the way other kids do, so they have a lot more behaviour problems, they get bored or distracted more easily, and some of them withdraw into their own world rather than playing well with other kids. You can tell that these problems will become a disaster once they are in school. They don’t have the skills to listen to the teacher, they have trouble sitting still for very long and they sometimes don’t hear the instructions so frequently get in trouble for not doing the right thing.
As time goes on, they fall further behind the other kids and can’t catch up. School is hard and boring, so truancy increases. As their skills in reading and maths fall further and further behind, teenagers become ashamed of “being dumb” and tend to drop out of school early. Low levels of education means there are much fewer opportunities to find a job, and it is very hard to find a job that pays well. This produces more shame, and reduces a person’s pride in themselves.
Because it is hard to find a good job, some people turn to welfare – and the cycle of low income, poor living conditions is passed down to the next generation to start all over again. Others choose instead to become involved in illegal activities. Those who take this path frequently have trouble hearing police, the lawyers and judges, and are often treated more harshly in the Justice system.
So when we don’t act to help kids with ongoing Otitis Media, the long term affects are a disaster for families and communities and eventually for the whole economy of our nation. The good news is that there are lots of things that we can do to improve the opportunities for these kids if we catch onto it early!
Are you the only audiologist working on Cape York?
There are lots of visiting audiologists to Cape York who are there to work with specialist services to help kids with ongoing Otitis Media. Some of them come with the Ear Nose and Throat doctors, who are looking for kids who might benefit from some surgery to help their ears. Other audiologists work with Australian Hearing to offer hearing aids and other devices to help kids of all ages improve their hearing while they have Otitis Media.
I am the only one who lives on Cape York and whose primary goal is to work out which kids are ok, and which kids need help to listen and learn. So there is only one of me – and Cape York is a really big place!
But there are lots of things that families can do to help their children. Any time you take your kids to your health clinic, ask the staff to check their ears. Any time your kids are given medicine or antibiotics, make sure you follow the instructions and use them for all the days that have been recommended. But the best way to have healthy ears is to have a healthy body. Make healthy choices at the shop –remember that we need two fruits and five serves of vegies every day to be at our best health. Drink lots of water instead of juice or coke – just like a shower washes our outside, drinking water cleans our insides too. Kids need lots more sleep than adults, as we do a lot of healing and growing while we sleep. Plan for 10 hours a night – that means if they need to be up for school, they must be in bed by 8 or 9 o’clock at night. Teach your kids to wash their hands – don’t let germs catch a ride! And finally, if you choose to smoke, don’t do it near your kids. Your smoke is really bad for their health.