Part II: The Logistics of Providing Audiology Outreach in Northern Communities
by Jack Scott, Ph.D.
The only road into Attawapiskat, Canada, is available during the winter months and, even then, it is a precarious drive over a frozen river. At certain times of the year the ice may be thick enough to support standard vehicles, and when it is especially thick (43 inches), it can support commercial loads that contain valuable supplies and resources for the community. Besides the ice road, alternative methods for bringing in supplies are by either barge or plane. These methods of shipping are important to consider when contemplating how to bring in the necessary supplies for audiological assessment in a northern community. Transportation logistics should not be the only consideration when choosing equipment for a placement, because, in the end, every piece of equipment provides additional information for interpretation.
First and foremost, the main purpose of the initial audiological placement in Attawapiskat was to collaborate with the Speech-Language Pathology initiative. During their previous excursions to the north the SLP supervisors were identifying children with language deficits; however, without knowledge of the children’s hearing status, the supervisors were not sure if the deficit was due to language delay or secondary to hearing loss. Clearly, this knowledge would assist with their recommendations and treatment directions. Therefore, it was determined that preschool hearing screening would be the primary goal of the audiology placement; specifically, children between the ages of 4 to 6 years. For the purposes of evaluating children during conditioned play audiometry, the minimum equipment needed is an otoscope, an immittance bridge, and a diagnostic audiometer.
With respect to equipment acquisition, an otoscope could easily be found and borrowed from the in-house audiology clinic at Western University, namely the H.A. Leeper Speech and Hearing Clinic – named in honor of a past faculty member who contributed greatly to the department and the profession. For the immittance bridge, a device was located in the storage unit of the in-house clinic – a Grason-Stadler (GSI) 27 Immittance Bridge. This is an older model, a screener that does not have a digital display and uses proprietary ink pens. Although the machine had its limitations, it was free, and it could be left up north after the trip. The next obstacle was finding an audiometer. Again, the in-house clinic was the savour. The School of Communication Sciences and Disorders at Western had recently purchased a new GSI 61 for the clinic, replacing an older GSI 16 audiometer. Unfortunately, GSI 16 audiometers were being replaced by the 61 and GSI was no longer repairing the older products. That being said, the GSI 16 worked and worked well. Any audiologist who has used a GSI 16 knows that it is/was the workhorse in audiometers: reliable, stable, solid. As part of the audiology initiative, the School of Communication Sciences and Disorders contributed funds to purchase the necessary supplies for the trip, such as otoscope speculum, foam tips, and immittance tips. Finally, a quick email to school where testing would be performed revealed that they had the necessary toys/blocks/balls necessary for conditioned play audiometry.
As mentioned earlier, all of the larger items would have to be sent via air courier. Plus, the older equipment needed to be calibrated prior to being sent. During previous discussions, Julie Purdy, the Director of Education with Starkey Hearing Technologies (Canada), indicated a strong commitment to Starkey’s outreach programs and offered to provide any assistance necessary to ensure the success of the initiative. Dr. Purdy generously coordinated with a lead technician at Starkey Canada to have the pieces of equipment calibrated and then shipped to Attawapiskat. The calibration and shipping of the heavier devices were a huge contribution to the initiative and reduced the overall costs to the School.
In total, the initiative was going to take five days: one day to get there, three days on the ground, and one day to return. Following a discussion with Casey Enright, Special Education Coordinator at J.R. Nakogee Elementary School, it became evident that the preschool screening component would not take the full three days. Therefore, additional areas for assistance were determined while in Attawapiskat. One area were the initiative could assist would be in conducting hearing assessments of adults. These could include teachers and staff of the local schools, adults referred by the hospital, and adults who were self-referred. With this in mind, we set aside two half days for adult assessments.
Finally, another component that had to be considered was hearing aid troubleshooting. As described last week, individuals who needed audiological assistance/intervention had to be flown to a more southern community, because funds were not available to bring an audiologist to the community. The thought was that there must be members in the community who already had hearing aids, but had no access to hearing aid assistance or troubleshooting. During preparation, contact was made with Bernafon Canada for the necessary supplies for hearing aid and earmold troubleshooting. Bernafon Canada supplied several items at no charge. Among them were tubing cement, tubing spreaders, temporary earmolds, a reamer, and a variety of other tools.
With all the necessary items procured and shipping completed where necessary, the actual initiative was ready to begin. In Part III of this series next week, we will learn about the results of Western’s first audiology trip to the north.
This week’s article for Hearing International is the second in a series of postings written by Guest Author Dr. Jack Scott, who is an Assistant Professor/Clinical Supervisor in Audiology at Western University in London, Ontario. Jack received his B.S. and M.A. from The University of Texas at Austin and his Ph.D. from The University of Texas at Dallas. His areas of interest include hearing aid acclimatization, vestibular assessment, and adult and geriatric hearing assessment and hearing loss remediation. He is a member of ASHA, AAA, and a past president of the Scott Haug Audiology Foundation.
Photos were added by Robert Traynor, Editor, Hearing International, Hearing Health and Technology Matters. Watch for Part III of Jack’s article next week at Hearing International!