Amyn Amlani 0:10
Welcome to This Week in Hearing. I am extremely excited to have our next guest on, I had the pleasure of meeting Antonio at the recent Academy of Doctors of Audiology meeting in Dallas. And Antonio is a hearing care provider in the Dominican Republic. And we had such a great conversation that we had to get him on one of our podcasts here to share the work that he’s doing in the Dominican to help individuals with hearing loss. So Antonio, thank you for agreeing to be on the show. And I’m really, really looking forward to this conversation.
Antonio Esteban 0:51
me too, I’m at the beach right now. So I’m very, very happy.
Amyn Amlani 0:56
You had to rub it in, right? The rest of us are either in snow or rain, and you have to be so in addition to the exciting discussion we’re going to have, you know, hopefully, you’ll be able to send me some warm weather as we move into the winter months here.
Antonio Esteban 1:15
Of course, all right.
Amyn Amlani 1:17
Okay. So let’s start out because I don’t think many of us understand or realize what the hearing care market is in the Dominican Republic. So can you enlighten us on that aspect, please?
Antonio Esteban 1:32
Sure. First of all, we are in the Dominican Republic, we are in the Caribbean. We are a developing nation. We have no winter. So it’s always warm here. And we will share the island with Haiti, which is in the news often in case you want to look us up in the map. And there is no audiology career in the universities. So I cannot go to university in the Dominican Republic and sign up for an audiology as to become an audiologist. So when the reason I became a hearing professional is because of my firstborn son. He’s he was born profoundly deaf. And I think there was only one Hearing Center in the Dominican Republic, back then, obviously, about 100 ENTs. And that’s the first thing we did, we ran to an end, we ran to the his pediatrician. And, you know, is that I think our son cannot hear mother’s always realize it first. My wife called me and he says, I think David cannot hear me. Are you kidding? I sing to him, and he’s laughing out loud, is of course, how do you sing to our baby. And we got to the pediatrician, and he goes like that. And, of course my son is following the hands oh this baby can hear you. You’re wrong. So then we went to an ENT, and he did. What I now know is n otoacoustic emissions test. This was 23 years ago. And this is interesting, because he tests my son and he starts, you know, like, what’s wrong? I don’t think the machine is working, because I have never seen here zero. Wow. So he tested himself and now it’s working. So he goes back to David and this is, you know, this is serious hearing loss. So, we go back to our doctor, and he goes, you know, why don’t you go to the States. And we call, we made an appointment with an ENT doctor in the States. And as soon as we saw him, he says, you know, you have a profoundly deaf child. So yeah, what can we do is- he did say, learn sign language. He did you know. I said, I said there must be something else. So he said, Yeah, go to our audiologist, we have an audiologist on staff. Go talk to her. So now I’m just going to start the story and the reason why I became a hearing professional, this lady was an angle. I mean, I mean an angel, I will tell I will tell you which you probably know her beautiful face. You can see the empathy. She could see the anxietiy in our faces. She says you know, the test is a very, very profound hearing loss. We should try very powerful hearing aids and see if you respond, but I think he’s a candidate for a cochlear implant, I had no idea what that was back then. So David wore hearing aids for two years. No response, nada. He would not even respond to really loud sounds, he did not say mom or his name or milk or anything. So we decided to go ahead with the cochlear implants. He, he had his first implant when he was two years and eight months old. And a second implant. My wife is gonna kill me, but I don’t remember if he was eight or nine years old. Anyways, with the second implant, he did a lot better. Yeah, might have been that he’s, that was a better ear or better technology more advanced. But if he runs out of battery on the left side, which he was the first one, he would probably stay like that. Not David he’s 23 now in university, and, but if he runs out of battery on the right one, or you know, he’s, he’s gonna run to, for batteries. Anyways, we, we come back to the Dominican Republic, and, and my wife tells me, you know, what are other families going to do? I mean, this is not easy. There’s so much information. I mean, some people say learn sign language, hearing aids cochlear implant, how do you navigate through all that? So she said, why don’t we start a foundation to help people and we started basically just helping people cope. You know, you get a diagnosis, you, you have to cry a lot. First, you know, there is a process of coping with it. And, and we can tell you, our experience is not, may not work for you, but we can tell you what we went through and what worked for us and, and we can help you and Family is very important. Family is very important. I remember when I told my father in law, Samantha’s father, I think David is deaf, but we’re gonna, you know, we’re going to do the best for him. Because, you know, the saying- two heads, think better than one. And his response was, and we are 26. The whole family came together. So this is a family project, the whole family, my son is the reason for the foundation to exist. I do all the fun work. As I said, my wife runs the foundation. My daughter, Sophia, an amazing volunteer, she started volunteer when she was seven years old.
Amyn Amlani 7:52
Antonio Esteban 7:54
She’s now 21. And Tani Austin says she’s better than most of my staff, as a volunteer, and of course, we started the foundation, raising money to buy hearing aids so we can donate them. And then I see in the newspaper, Starkey Hearing Foundation donates 800 hearing aids, I think I was up to like 10 hearing aids that I had donated then. So I said, I have to be getting contact with them. And so what I did is I waited for them to come. They come, they used to come every year. So this was 2005 -2006. I was a volunteer, I was already a trained hearing professional. And I was a volunteer at the mission at the second mission in the Dominican Republic, and I was the first one in last one out, and I could figure out most and fix most problems and I think Mr. Austin saw that and at the end of the mission he told me he said hey would you like to work for me. I said ya. And of course, and he says, No, I cannot hire you. But I can help you start your own Hearing Center. And that’s how the AudioNet Hearing Center started. For we first were our foundation we first donate hearing aids. So the reason for for us is to help people. And the way we we can help people is we have a hearing center that provides hearing aids for paying customers. And actually some of my customers say that I am like type of Robin Hood I sell hearing aids to the paying customers and then I donate hearing aids to the customers who cannot afford it. And we have donated close to 50,000 hearing aids in the Dominican Republic – 100% donated by the Starkey Hearing Foundation. Mr. Bill and Mrs. Tani Austin donated all the hearing aids, and they used to come every year with a big entourage. And it will take me all year to evaluate every patient one by one will take their we test them their ear impression. And then of course, prepare, huge event where all the patients will come in and get fitted. And one year, I think we did close to 7000 hearing aids in a week.
Amyn Amlani 10:20
Wow. Wow. Wow.
So this is just an incredible story of philanthropic work that, you know, you on behalf of your son’s disability, you’ve taken it, and now giving back to your community, which, you know, we had this conversation in Dallas, and I just thought it was such a heartwarming story. And it’s also one of great philanthropy. And you’ve, you’ve given so much and you know, it’s it’s, it’s a great alliance that you’ve created with the Starkey Foundation. But you also have other alliances, right? You have one word Salesforce, can you talk a little bit about that?
Antonio Esteban 11:02
Yes, yes. But I have to, I have to tell you the story, because I didn’t finish it. Sure. When we were in the hospital, after that, we saw the ENT, and we went to the audiologist, I’m going to I’m going to tell you what happened. We get out with hearing aids I go to cashier and of course there is a bill for the ENT consult. And, and I’m gonna pay and I said no, there must be a bill for the audiology department also, and cashier says its not in the system. So we sat and we waited. After a while waiting. My wife says, Oh, we tired we we landed and we went straight to the hospital. That’s how anxious we were. And we so I go back to the department and I say please, can you help me hurry up with the bill so I can go pay? We… And she was oh, I forgot to tell you. There is no bill. I’m like what?
why she didn’t know us. We are from another country. I may never come back. I don’t I don’t know if I’ll be able to repay you. She said no. pay it forward. What about the hearing aids, I know that they are expensive? ah, those are demos. You know, when when you’re done with them, you can donate them. And that was the first pair of hearing aids that we ever donated, and we’re still in contact with the girl that we donated those hearing aids to.
Amyn Amlani 12:43
Amazing story. It’s an amazing story. Yeah, that’s an amazing story. But these alliances in these, these, these contacts in these relationships that you’ve created are so powerful. It Again, going back to the question, you also have this relationship with Salesforce. So you have the hearing aids that have helped you but then you also have to take manage the patients. And you’re now using Salesforce through, you know, you’re on your own good luck and good well and good fortune as well. To help you with this.
Antonio Esteban 13:18
Yes, this isn’t this is an amazing company. And I’ll try to keep it simple, but they have to donate 1% of their time 1% of their software. So they they have to look for pro bono. They are in court and they have to and they have what they call paid voluntary time off. And they someone looked us up and said, you know, we want to come and help you. And this is actually a high ranking person in Salesforce. That happens to be from the Dominican Republic. It was there is a Dominican high ranking person insofar as I you know, of course, I’m going to look for a pro bono in the Dominican Republic and one of his co workers had two sons with hearing loss and he said why don’t we look for something with hearing loss. So they found us and they said, you know, the end of the year as we need a lot of help, we have 1000 At that time we had close to over 15,000 patients and we first started with written paper then we were working with Excel. Then we had a very basic database in the in the cloud provided by Starkey Hearing Foundation and then the Starkey Hearing Foundation because of the pandemic closed. So they stopped supporting the database So I said wait… I have all these patients that I’m going to keep seeing. Because we basically say we keep seeing you for life. I will see these patients. Even if I’m in a wheelchair, I will see them. It’s free, free aftercare service for life anyways. So they said, sure we can, we can give you the software, that’s very easy for us. So they actually came. And the funny thing is that they came from different parts of the world because they have this chat, internal chat and say, Oh, we want to help admission in the Dominican Republic who wants to come? So we had people coming from France, from the states from different parts of the States, from Spain. Really, really interesting group. And they came and they said, you know, what do you need? And I said, Well, we have all these database, I say, yeah, we can upload it to recruit, they created an app for us a dashboard. And they uploaded all our patients. And it’s amazing. And this is a funny story. I don’t know if you’ve seen a Starkey Hearing Foundation mission, or video, but what we the first thing we tell a patient when we fit them is pa pa pa. You never, you never seen it, they look, ah, you can you can hear me and then you know, that’s that’s the first sound they hear. So the app is called Pa Pa Pop.
Amyn Amlani 16:29
Oh, that’s That’s funny.
Antonio Esteban 16:31
We have pa pa from Salesforce, and we are, you know, uploading the follow up aftercare services on it every day, we are providing between 350 and 500 follow up services for free every month.
Amyn Amlani 16:54
That’s incredible. And in we were talking offline just a minute ago that, you know, one of the most important aspects about philanthropic work in general, is not just the initial engagement, but it’s the follow up care that takes place afterwards. And you were telling us that you’re telling me a story of how you know, in in the Dominican because of the humidity because you’re in the Caribbean That aftercare is a really important component, particularly given the humidity. Can you share a little bit about that aftercare for us?
Antonio Esteban 17:30
Yes. Well, all the all the touching images and videos of hearing missions in in that you can find in YouTube or Instagram is about the first moment when they get the hearing. And it’s an aha moment, and it’s really, really touching. It’s really beautiful. But the real magic happens in the aftercare when they come and tell us all the stories of their new life with hearing their new hearing life. And it’s really touching and interesting because they never forget you. They say you are part of our lives forever. I had a patient tell my wife that she felt that the hard of hearing community lives on one side of the street and the hearing community lives on another side of the street. And we cross the street to service and to help them and it was it was very touching and really interesting is what I always ask them what what are you happy to hear? Can you imagine someone telling you I can hear the noise of the cars. No one is going to be happy. That’s what such a powerful thing about hearing because you don’t we take it for granted. It’s an unique gift people who cannot hear are happy to hear noise that you hate. You’re always coming oh man, this the noise of the cars. They are happy that they can hear noise. So the interesting story I think you were asking me sorry is that we were told by the Starkey Hearing Foundation that we break more hearing than any other country in the world. We are repairing between 100-200 Hearing is every month and when they when they reopen and they are beat to a pupl they say what are you doing with this hearing aids they say. We are using them. and you know as they say why do you say were the worst country in the world breaking hearing aids they says because you have the most repairs. And you know statistics are funny in a way that you know if you go we were talking about if you go to you say Papua New Guinea and you do a hearing mission and you donate, hearing aids, they will break down, but you may never see them. So we keep track because of the database. We keep track of all our patients. And so every hearing aid almost every hearing aid that breaks, we will, it will come back to us. So imagine if you have 50,000 hearing aids, I think, you know, between 100-200 a month, it might be a little a small number, you know, I don’t know, what percentage is that. But it might be a small number, but it’s it looks like a huge number. So basically, they tell us in Starkey, that it may be something in our diet, our sweat is so corrosive, the hearing aid is all corroded inside, and you can see the green corrosion coming out of the hearing it anyways, some most of the times they just give up, they just give us another one. You know, we’ll just send you a new hearing aid. So yes, we go through a lot of hearing aids in the Dominican Republic.
Amyn Amlani 21:12
And again, the atmosphere, as you pointed out is so critical. It’s so important. And I’m glad that you touched on it that that’s the place that the magic happens. Is that Is there a story that you have of a patient that you fit? And you’ve seen multiple times? Is there. Is there one that stands out for you, I outside of, outside of yourself?
Antonio Esteban 21:34
Yes, of course. I’ll tell you. One is a girl that I saw when she was eight years old, and she was so happy, she gave me a kiss on the cheek. And of course, I looked a lot younger, I had no, no beard. And so the photographer took a picture. And it was it somehow it became a popular picture. And then I keep I keep seeing her. So now she’s 20 years old. And I showed her the picture. And she says, you know, we should do another one. So we have a picture now where she’s gave me this, you know, the same same picture 12 years later. So, you know, that’s, that’s too, that’s proof right there, that you can see that follow up is happening, and it works. And another one is, is it’s it’s very touching, you know, hearing loss has a lot of comorbidities, or other disabilities that that have comorbidities that one of those commodities can be hearing loss. So we have patients with multiple disabilities. And I remember it’s hard for me to describe, this woman carrying a child that was bigger than her. And this child had probably severe cerebral palsy, and he could not move and she, this is a 20 year old man being carried by a small woman who then and shes’ carrying and she’s coming towards the mission and I get up and we all get up and we start running to her to help her carry and she goes No No
she says ‘I’ve been carrying him for 20 years 50 more meters, 50 more meters is nothing’. So you know of course I got on the phone. We got to get a wheelchair man. So I got in touch with another foundation. We are as good as our alliances. I got in touch with another foundation and and that donate hearing that donate sorry, crutches and wheelchairs and of course we got her a wheelchair. And I was so excited about it. I said I’m going to be a volunteer. It’s gonna be a lot of fun. I’m gonna we’re gonna donate wheelchairs and crutches. And I have to tell you, man, I thought I’m gonna see people that broke their knee and so they’re stuck in a wheelchair in the nation now people that live in a wheelchair. That’s a whole nother story. I mean, it was it was very, very, very tough. It’s a lot tougher than hearing loss. Let me tell you. It’s a lot tougher than hearing loss people that live in a wheelchair. It was a very tough experience. Sorry, I got off on on the side, but there is a lot of help needed. And there are many amazing organizations that you can be part of and You don’t need to start your own, you can just find, like the Salesforce they found an already ongoing thing. And they just, you just help in any way you can.
Amyn Amlani 25:16
No, I, you know, I got chills from the stories that you’re telling and you make me want to go out and offer my services. And so, you know, again, the conversations that we’re having now and that we’ve had previously are just so so touching and you know, are really, really important to the overall quality of life that we as humans and professionals are able to give back to our peers.
Antonio Esteban 25:46
Have you met Bill Austin? Do you know him?
Amyn Amlani 25:49
I have. I’ve met I’ve met Bill, it’s been a number of years since I’ve seen him, but I met Bill when I was practicing. And as an academic, it’s, it’s probably been at least 15 years since I was up in Minneapolis actually was there for the event and we ended up at his home. And was, you know, he was just a very gracious host when we were there.
Antonio Esteban 26:12
He’s amazing. I mean, I am very proud to, to be to call him my friend and to be I don’t know how to say it in English, English is my second language, but that he calls me his friend. And I don’t know, you know, for people I know him. He calls me every once in a while. And, you know, I see. Because from his wife’s phone, so I see Tani Austin and I pick up and say “Hey, Tani, no, it’s Bill how are you doing?” You know, how come you break? You know, so many hearing aids? Not it’s to me. I have, of course many stories about about my, my relationship with him. To me, he’s just an amazing person. And I want to tell you that 100% of the hearing aids that are donated by the Starkey Hearing Foundation are donated by him. And it’s they’re up there in the 3 million, 3 million hearing aids donated. And I think it’s, to me, it’s a win win win win win. Relationship, all I have to do is provide my services with these two hands. And the little knowledge I have in here and he will send me all the hearing aids that I asked no limit. If I ask for more hearing aids he will always send me all the hearing is that I need so it’s a matter of how much time I have to see patients and 100% of the patients that I see that it hearing aids. If I call him up and ask for hearing aids, I get them.
Amyn Amlani 28:00
In just for our audience. You’re the only provider in this clinic. Is that correct?
Antonio Esteban 28:06
We are a one man show. We are actually not out not not anymore. I have a hearing professional from Switzerland, who came as an intern. This is a really interesting story because I already was contacted by some students that were in the ADA that they want to come and serve as interns in the foundation. And they are going to have a lot of hands on experience because we see a lot of patients. So they it’s probably going to be a life changing experience for them. But this guy came this kid came well he’s 23. Now he came from Switzerland and he does not want to go back to Switzerland. So I hired him. So he’s full time working with me that’s how I can be now here at the beach, I’m actually doing a 10 day international certification on safety in kiting. And he’s back at the clinic working so we are right now building a second office we are a one office center with one booth and a waiting area and and we took because we had a huge waiting area because before the the pandemic we could see I think our record was 110 patients in one day in one office. And so a huge waiting area now we have half the waiting area is going to be his office. And we are right now in the process of finishing touches of building that because now we we only see patients one by one was golf course we still see you know, over 20 patients a day. But they don’t come in before like before you know anybody who needs a service anytime they have this now they have to call and they have To make an appointment, so So we keep social distancing and safe, you know, safety protocols.
Amyn Amlani 30:10
Yeah, this is the one unfortunate part about COVID. Right? It’s changed how we get to, to see our patients and, and so forth and so on. But you’re at their, you know, safety has to come first. Absolutely. You’re talking about being at the beach. And I think one of the other interesting stories that we talked about at ADA was the fact that you are a surfer and a parasailing er and you’ve, you’ve done some things at a more professional level. Can you share that with us?
Antonio Esteban 30:38
Well, let me clarify, clarify. I think parasailing is not the correct term. I think parasailing is when you’re dragged in a parachute by a boat, boat, right but yeah, that’s not a sport. That’s a touristic sightseeing. Basically, I mean, you do nothing is hang and you you know you, you get pulled by a boat, towed by boat and you can get pretty high as long
Amyn Amlani 31:07
as you will -do I actually get a score for my landing?
Antonio Esteban 31:11
No. You have nothing to do with the boat slows down until you land. Softly hopefully softly Anyways, now I am a windsurfer. Sailor, sailor and wind surfer. I’m called. Now there is a new term is that a waterman. Because I surf I wind surf, I do stand up paddle. And I kite, and now there’s a new sport called called wing. And I also do that wing and now we have foils underneath our boards. So now I windsurf foil I kite foil, I wing foil, it’s a hydrofoil. So actually the board comes off the water and you have a wing under the water that is actually flying through the water and you are above the water. So you can be a lot more efficient because there is no friction the board is not touching the water. And that’s how the America’s Cup is being run for a few years now. All the boats are on hydrofoils. So they can speed they get up and they accelerate. Because the you know it’s just a wing under the water the acceleration is is immense. They’re going over 100 kilometres an hour. To me, the exciting thing about it is that I can go four times 3, 3-4 times the speed of the wind. So it’s a lot more efficient. Even with very, very light breeze. I can go very fast. And the angles, of course, are a lot more extreme. I can go almost straight into the wind and scurried off the wind very fast. And I don’t know why. I was good at it. Really. I guess. There was some talent in there. But I made it to the Olympics. I was a competitor in the 1984 Summer Olympics in LA, in Los Angeles in windsurfing. And it was the first time when surfing was introduced as Olympic sport. I kept racing after that I did manage to win World Cup, windsurfing in 1990. And then I retired from competing regularly in 91. But I never, I was always either studying, working and competing at the same time. So I never had a time where I was only competing. So and then of course after I graduated from university I was working on competing so I’m what we call weekend warrior. Yes, and I’ve never stopped sailing. I’m always sailing on the weekends whenever I can. And I also fly paragliding paragliding is yeah, basically, I don’t need to describe paragliding but I’m not flying as much as I used to. Paragliding I’m mostly windsurfing and kiting. And it’s going to be almost 40 years since I went to the Olympics. And we have a competitor right now Sammy go. rooting for him, too. That is going to be a break that I don’t, dry forty years no competitor from the Dominican Republic in the Olympics as a wind surfer. I was the first one and I’ve been the only one for 38 years and in two years, he might think he has a good shot of making it. So right now we’re all rooting for Sammy to to qualify for the for the Olympics in 2024 in France.
Amyn Amlani 34:55
That’s amazing. That’s amazing. You’ve lived an amazing life. You’re doing amazing things, Antonio, I just, I’m so grateful that we were able to meet and we got Thanksgiving coming up. All right, thanks. It’s the week of Thanksgiving here in the US. Yeah. And, you know, we’re gonna have turkey here in a couple of days. How is what are you going to do for Thanksgiving? Back back on the island
Antonio Esteban 35:19
Well, yeah, we we always, my family, always, we do a Thanksgiving is slightly different. Because we, if times, we don’t have the same history, but it’s a good opportunity to say thank you for everything. So we basically all get together. And we sometimes each bring a list of all the things that we are thankful for. And it’s a really nice experience. But this year, we’re gonna postpone it. In my family, we get together when we can to celebrate birthdays, we hardly ever get together on the actual day of the holiday, or the birthday, or the, or the celebration or the anniversary, it’s going to be 25 years, married to my wonderful wife, Samantha, who is always supporting me in everything that I do when she runs the foundation. She does all the hard work, by the way, and so we’re going to postpone it. My mom has COVID now. Oh, boy, my mom has COVID right now. So we are going to do it next week. But we still have the Turkey
Amyn Amlani 36:26
Well, you know, I’m married to a Mexican. So it’s I understand your culture, it’s very similar. And it’s the same thing we’re always getting together, we’ll have, we’ll have most of her family or at our place, except for her sister who’s going to see her in laws. In Yeah, it doesn’t matter when the birthday is it doesn’t matter when the engagement is it doesn’t matter what the anniversary is, you just get together. And it’s always it’s always great. And then of course, I grew up in the Indian culture, it’s the same thing family means everything. But Antonio, we’re wishing you all a very, very happy Thanksgiving in conclusion to this to this year, best readings for that for the upcoming year. And again, you have been such a tremendous asset to your country, to the people who are hearing impaired, and to the sports that you know, you continue to, to entertain yourself in in provide. So I hope to see you at ADA next year it’s going to be in in Florida. And when we when we get together, I will certainly find a time to grab a coffee or a beverage and I look forward to keeping in touch with you and having more discussions.
**I wanted to share a quick update on the interview that HHTM was able to have with Antonio Esteban out of the Dominican Republic, we’re pleased to announce that Redux has generously donated to Antonio Esteban’s clinic, one of their units, given the fact that so many of the repairs that they encounter our humidity and moisture based and this is a win win for Antonio and patients that he services. And a huge shout out to Redux for stepping up to the plate and helping not only Antonio but to the individuals who benefit from free technology and services that are provided in that country. So again, just a quick update and a huge thanks to to Redux for their philanthropic efforts. And Antonio, keep seeing those patients and hopefully with the Redux product. You’ll have less repairs to send over to Starkey. Thank you
HHTM would like to offer a special thank you to Redux, who stepped up after this interview to donate one of their professional hearing aid dryers to Antonio’s clinic.
Due to the high humidity in the Dominican Republic, hearing aids are much more susceptible to breakdown. Redux’s unique moisture removal process can help prevent moisture-related repairs and keep patient’s hearing aids working longer. Learn more about Redux here.
About the Panel
Antonio Esteban Molinari is a hearing instrument specialist and president of AudioNet, a hearing care clinic located in Santo Domingo, Dominican Republic.
Amyn M. Amlani, PhD, is President of Otolithic, LLC, a consulting firm that provides competitive market analysis and support strategy, economic and financial assessments, segment targeting strategies and tactics, professional development, and consumer insights. Dr. Amlani has been in hearing care for 25+ years, with extensive professional experience in the independent and medical audiology practice channels, as an academic and scholar, and in industry. Dr. Amlani also serves as section editor of Hearing Economics for Hearing Health Technology Matters (HHTM).