Rhon­da Krys­tal Ram­bal­ly

Hear­ing loss is a preva­lent cause of poor lan­guage de­vel­op­ment and ed­u­ca­tion­al achieve­ments in chil­dren. Neu­ro­tol­o­gist Dr Howard Fran­cis of the Johns Hop­kins Uni­ver­si­ty School of Med­i­cine says one in every 500 chil­dren is born with a "sig­nif­i­cant" hear­ing loss. Fran­cis said if this was not prop­er­ly ad­dressed, then chil­dren can be left in a pre­car­i­ous sit­u­a­tion in so­ci­ety. He said, in ad­di­tion, there were chil­dren who de­vel­oped ear in­fec­tions which were al­so quite preva­lent. Ear in­fec­tions have a sig­nif­i­cant im­pact on chil­dren's be­hav­iour. Fran­cis is an as­so­ciate pro­fes­sor, deputy de­part­ment di­rec­tor and res­i­den­cy pro­gramme di­rec­tor in the de­part­ment of oto­laryn­gol­o­gy–head and neck surgery at the uni­ver­si­ty. He has spe­cial ex­per­tise and in­ter­ests in the di­ag­no­sis and treat­ment of dis­or­ders of the ear and skull base. Fran­cis is al­so the med­ical di­rec­tor of the T&T Health Sci­ences Ini­tia­tive (TTH­SI). He spoke with the Sun­day Guardian last week while on a brief vis­it to Trinidad.

Ear in­fec­tions in chil­dren

"Chil­dren who have flu­id be­hind their eardrums where they've lost a cer­tain per­cent­age of in­flam­ma­tion, we find that their be­hav­iour in class­rooms, their abil­i­ty to fo­cus and to at­tend seems to be im­paired by this," he said. He said their lan­guage im­pact was not as se­vere as a deaf­ness that was found in chil­dren with hear­ing loss. These is­sues have im­pli­ca­tions on the lives of in­di­vid­ual chil­dren but they have ad­di­tive and cu­mu­la­tive im­pli­ca­tions to the so­ci­ety at large as they are re­lat­ed to hu­man cap­i­tal and de­vel­op­ment, Fran­cis said. Trinida­di­an otorhi­no­laryn­gol­o­gist (ear, nose and throat) Dr So­laiman Ju­man is work­ing in col­lab­o­ra­tion with Fran­cis to de­vel­op a new-born screen­ing pro­gramme for hear­ing loss in T&T. Fran­cis said it will al­low doc­tors to de­ter­mine hear­ing loss in the very ear­ly stages of ba­bies' lives. Fran­cis said par­ents were the pri­ma­ry source of knowl­edge for their chil­dren and the ones to pay at­ten­tion to odd be­hav­iour­al pat­terns. He said 90 per cent of chil­dren born deaf were born to deaf par­ents. This is what he said when asked about the im­pact of hear­ing loss/ear in­fec­tions in chil­dren. "The im­pact is that you have a child who has no sys­tem no way of com­mu­ni­ca­tion. "It is not some­thing that we think about, it is not some­thing that we fath­om un­til we meet these chil­dren and what we en­counter then are beau­ti­ful chil­dren who, when you lay out a prob­lem for them they can solve it. "They are smart chil­dren but the con­cept of putting an idea to­geth­er and pre­sent­ing it to them is just not some­thing they can do." He said they were not read­ers and that was an im­me­di­ate road­block to hin­der­ing their op­por­tu­ni­ties for ed­u­ca­tion and em­ploy­ment. He said they can­not ad­vance in a reg­u­lar school en­vi­ron­ment which is the en­try way to jobs and op­por­tu­ni­ties," Fran­cis said. He said there are tiny hair cells in­side the ear which are sup­posed to con­vert me­chan­i­cal vi­bra­tion to elec­tri­cal sig­nals. How­ev­er, hear­ing loss oc­curs when ei­ther those mi­cro­scop­ic cells fail to de­vel­op be­cause the ge­net­ics aren't right, have been de­stroyed in de­liv­ery, preg­nan­cy, vi­ral in­fec­tion or a par­tic­u­lar drug that was ad­min­is­tered.

What are the signs?

Par­ents need to recog­nise whether a child is hav­ing fre­quent ear in­fec­tions or seems not to be hear­ing as well as he/she should be most of the time. He said chil­dren should be tak­en to a doc­tor if hear­ing loss or ear in­fec­tions are sus­pect­ed. He said if a ba­by's bab­bling is not pro­gress­ing then there is a prob­lem. "If a child is not fol­low­ing in­struc­tions by a year to 18 months then there is some­thing wrong," Fran­cis said. Fran­cis said the lack of bab­bling should raise red flags that a child is not hear­ing. He said an acute in­fec­tion would be as­so­ci­at­ed with fever and pain but even af­ter that has passed, there is flu­id left in the ear which hadn't been drained. Chil­dren who have mild to mod­er­ate hear­ing loss usu­al­ly use a hear­ing aid, while those who suf­fer with more se­vere to pro­found hear­ing loss can start with hear­ing aids but grow up with a lan­guage deficit.

Cochlear im­plant

A cochlear im­plant is a sur­gi­cal­ly im­plant­ed elec­tron­ic de­vice that pro­vides a sense of sound to a per­son who is pro­found­ly deaf or se­vere­ly hard of hear­ing. Cochlear im­plants may help pro­vide hear­ing in pa­tients that are deaf due to dam­age to sen­so­ry hair cells in their cochlea. In those pa­tients, they can of­ten en­able suf­fi­cient hear­ing to al­low bet­ter un­der­stand­ing of speech. The qual­i­ty of sound is dif­fer­ent from nat­ur­al hear­ing, with less sound in­for­ma­tion be­ing re­ceived and processed by the brain. As of De­cem­ber 2010, ap­prox­i­mate­ly 219,000 peo­ple world-wide have re­ceived Cochlear im­plants. (Wikipedia) Fran­cis said one of the more re­cent de­vel­op­ments is the Cochlear im­plant. He said cost de­pend­ed on where a pa­tient was hav­ing it done. Three have been done in T&T–one on a child who was deaf by menin­gi­tis and one who was born deaf. Fran­cis said there have been dra­mat­ic dif­fer­ences in chil­dren in the Unit­ed States who have been im­plant­ed by age one. Fran­cis said the TTH­SI was fo­cus­ing on three key ar­eas to ad­vance the de­liv­ery of health­care, name­ly car­dio­vas­cu­lar dis­ease, di­a­betes and a sys­tem based on best prac­tices and man­age­ment skills. He said car­dio­vas­cu­lar dis­ease and di­a­betes ac­count­ed for close to 50 per cent of T&T's mor­tal­i­ty rate.

Fran­cis said, "That does not ac­count for the many peo­ple who are dis­abled by those dis­eases. "The amount of cost in lives and pro­duc­tiv­i­ty is al­so sig­nif­i­cant and we have been asked to help out col­leagues here in ad­vanc­ing a sys­tem. "The build­ing blocks are here but we are try­ing to build more blocks and we are try­ing to put them to­geth­er in a way that al­lows Trinidad and To­ba­go to ad­vance to a first rate kind of de­liv­ery sys­tem for those kinds of prob­lems." He said it re­quired a three-pronged ap­proach–ed­u­ca­tion­al pro­gramme, de­vel­op in­fra­struc­ture that pro­motes team­work and re­search team to keep ad­vanc­ing health­care. "Just be­cause we know how to treat these prob­lems in Bal­ti­more doesn't mean that it is right for Trinidad and so we are try­ing to come up with a sys­tem that is re­al­ly care­ful­ly thought through and strate­gic." He said it should first be trans­par­ent, based on da­ta and fact, not hope and ex­pec­ta­tion.

What has TTH­SI been do­ing?

Fran­cis said so far there has been 115,000 hours of in­struc­tion across the spec­trum of health­care, which brought on "a new breed" of lo­cal spe­cial­i­ty car­di­ol­o­gists af­ter two years of con­cen­trat­ed train­ing. He said the TTH­SI was "charged" with the re­spon­si­bil­i­ty of ad­vanc­ing car­di­o­log­i­cal and di­a­bet­ic health­care in T&T. He said there was a lot of con­sul­ta­tions and part­ner­ship-build­ing that had to be done to un­der­stand the sys­tem as it re­lat­ed to car­di­ol­o­gy and di­a­betes. He said three were prac­tis­ing af­ter the train­ing and oth­ers were in the pipeline. The doc­tors who were in the lo­cal health sys­tem were trained by pro­fes­sion­als from Johns Hop­kins. "We have had our peo­ple com­ing out here, con­stant­ly train­ing them and they have the same lev­el of train­ing that we give our folks back home. "We feel very strong­ly that they would pro­vide qual­i­ty health­care." Tech­ni­cians, nurs­es, pri­ma­ry care physi­cians in dif­fer­ent fields are al­so be­ing trained. He said di­a­bet­ic care was based on ed­u­cat­ing pa­tients and providers for suc­cess­ful care be­cause there were ma­jor prob­lems as­so­ci­at­ed with it such as blind­ness, re­nal fail­ure and am­pu­ta­tion.

About the TTH­SI

It is an um­brel­la pro­gramme im­ple­ment­ed by the pre­vi­ous ad­min­is­tra­tion in 2006 and rep­re­sents a col­lab­o­ra­tion among the Min­istry of Health, the Min­istry of Sci­ence, Tech­nol­o­gy and Ter­tiary Ed­u­ca­tion, the Uni­ver­si­ty of Trinidad and To­ba­go and Johns Hop­kins Med­i­cine In­ter­na­tion­al, aimed at ad­vanc­ing med­i­cine and health sci­ences in T&T and the wider Caribbean.