On a trip to Northern Thailand in July my husband and I were taken on a visit to a school. The tour guide knew that I was a pediatric audiologist and that I was in Thailand to do some lecturing about managing hearing loss in children. The school staff asked me what I was interested in seeing. I said I wanted to see the little kids.
As we walked to the room with little kids they pointed out one little girl (age 5 years but looking younger) who did not speak. I, of course, went into audiologist mode. I started asking what she understood, etc. They said she could follow some directions and said a few words. They had been told that she could not speak because her tongue could not move enough. I put my tongue flat on the bottom of my mouth and showed them that, although I did not speak well that way, I still could certainly speak. I asked if she could eat and chew food. They said that eating was no problem. I explained that if she could move her tongue enough so that she could eat there should be no problem with speaking.
Could she get services?
It seemed the first thing this little girl needed was a hearing test. I discussed with the school staff how to get a hearing test. I knew that services were available in Bangkok where I would be speaking, but I knew little else. I had heard that there was a school for the deaf in Chang Mei, which was much closer than Bangkok but still too far for the family. The father had moved to another city to find work and the mother worked in the local area but they did not have the money to go to Chang Mei, much less to go to Bangkok. In addition, I did not know if the school for the deaf a few hours away performed hearing testing. From my experience in Vietnam doing volunteer work with the Global Foundation for Children with Hearing Loss I know that there are many schools for the deaf in this part of the world that do not have any audiology services in the school.
Could I help?
There was obviously no audiometer available, but I thought it was worth a try without one. I started off trying to get this little girl to imitate sounds, but she was not really interested. I asked her teacher to try and saw immediately that her teacher communicated by getting the little girl to look and using vision. It was becoming increasingly clear that we needed to find out if she could hear.
I asked the staff what sort of things they had that made noise. I found a tambourine and a drum. Since the little girl was clearly hesitant to work with me (not a surprise), I took one of the other kids and taught him conditioned play. He learned the task quickly while the little girl watched. I then taught her the task with my husband helping by making noise with the drum and tambourine. We accomplished this quickly by starting with loud sounds and letting her watch where the sound was coming from. Then by making the sounds softly when she could not see them, we were able to get some information. I tried some Ling sounds next. It was hardly a complete hearing test, but it provided enough information that I felt comfortable saying that she had enough hearing that she should have some language. ( I also recommended that they still try and arrange for a complete hearing test.)
I talked to the school staff about some things they might try. I suggested the kind of things we do when working with young children. First, work on building receptive language and when you know she understands a word, expect her to use it. Pretend you do not know what she wants unless she asks for it. We talked about teaching her to imitate sounds, and then building into words (not typical of language learning, but considering her age, it might be worth a try.) I strongly encouraged them to try and arrange for this little girl to be evaluated by an audiologist and speech pathologist who might be able to help develop a plan to help this little girl learn to talk. The principal and I exchanged email addresses so we could follow-up.
Connecting the little girl with an audiologist
When I got to Bangkok to do my workshops, I told everyone the story about the little girl. I found an audiologist who lived in Chaing Mai and worked in the hospital there. She was delighted to help. I emailed the principal at the school and the audiologist and exchanged their information. I have not heard if they have worked anything out, but I also spoke to the tour guide who had brought me to the school and he will also try and help get the little girl to Chaing Mai for testing.
We are fortunate in the US
Sometimes, those of us trying to arrange services for children with hearing loss are frustrated by the difficulties we have getting everything we think the kids need. But my experiences in Vietnam and Thailand make me grateful for the services we have. Most kids in the US are capable of getting at least basic services. These are not always available worldwide. (When I talk with families of children in this part of the world I have to decide whether to discuss cochlear implants when I know the family cannot afford to purchase them, and decide which should get donated hearing aids.)
Should we be satisfied with what we have in the US? Absolutely not, we need to work to improve all services for kids who need them. Kids are our future and we need to provide them with everything they need so they can be the best they can be. I will also try and figure out how to help this little girl in Thailand and worry about children in poorer countries than ours.