It has once
been said that the gauge of a country's civilization is the manner by
which it cares for its prisoners and disabled. For two decades,
Filipinos have languished in abject poverty and have inadvertently
neglected the needs of their disabled. This was more as a result of
circumstances rather than by choice. In spite of this, however modest
measures were taken to safeguard the nation's erstwhile healthy ears
from the ominous onslaught of deafness.
Private institutions had earlier taken the initiative to act on the
apparent stoic attitude towards hearing loss. It was not until the early
part of the 90's when the Philippines began to enjoy economic prosperity
did government join the bandwagon. My country was therefore fortunate to
have hosed the 4th Asia Pacific Congress on Deafness in 1994 because it
gave us the opportunity to view the problem of deafness from different
perspectives. In the very words of our President "None is more deaf
than the one who refuse to listen". That interesting convention was
concrete proof that if government and the private sector simply get
their act together, the impossible can be made
Fittingly, in connection with that momentous occasion, the Otological
Center of the Santo Tomas University Hospital was finally inaugurated as
an IFOS-ASA-HI affiliate Center for the Global Prevention of Deafness.
For her part, the government formed the National Advisory Council for
the Prevention of Deafness which was organized by the Department of
Health in 1995. A major concern was to collect data on the prevalence of
hearing impairment in order to convince government of the severity of
the problem and to appropriate budget for the implementation of the
program.
Because of the paucity of audiometers a screening test was devised to
substitute for the latter in its absence. The Ballpen Click Test is a
simple screening test for hearing loss by introducing the sound of a
ballpen click an inch from the ears. When compared to audiometry as the
gold standard, the test had a good batting average, with a sensitivity
of 73%, a specificity of 98.6%, positive predictive value of 95%, a
negative predictive value of 92% and an accuracy of 98.9% when performed
m almost 10,000 ears.
We therefore recommend the ballpen click test as an initial screening
test to be performed in the school as well as the barangay health
centers. In the Philippines, where the barangay is the smallest unit of
government, health workers may be trained to identify hearing loss among
their constituents. This way, hearing loss may be identified without
having to consult an ear specialist or a general physician immediately.
All those who failed the ballpen click test should undergo formal
audiometric studies which will be performed by ENT doctors who will
visit the country's 76 provinces. I believe the training hospitals for
ENT can work on an 'Adopt a Province Scheme' in order to reach out to
the country's 7,107 island of 72 million inhabitants.
A Survey done by IMPACT UK and the Philippines on the hearing status of
elementary school children, a total of 151,185 underwent audiometric and
otoscopic evaluation. 89% were classified as normal and 11% were hearing
impaired of which 87.8% had mild, 9.15% had moderate and 6% had severe
hearing loss, 33.6% were largely due to impacted cerumen, 3% were due to
draining ear, 2% had dry perforation and another 2% with scarred
tympanic membrane.
It is readily apparent that ear hygiene alone can drastically reduce the
number of our hearing impaired children. Primary Ear Care should
definitely be incorporated in the Primary Health Care Program wherein
Thailand sets the standard for other countries to follow.
Unfortunately, 60-70% of births in the Philippines occur outside the
hospital. Traditional birth attendants still handle the bulk of
deliveries in the Philippines. Perinatal factors such as anoxia, trauma
and prematurity are risk factors to consider. Because it would be nearly
impractical and impossible to prevent rural folks from practicing
homegrown obstetric it would seem pragmatic to heed the old adage of
joining them if you cant beat them. In effect, they too should be
educated to identify high risk infants for deafness and to subsequently
refer these patients accordingly.
The Department of Health has an acute respiratory infection program
providing free antibiotics (Co-trimoxazole) which has been tied up with
the otitis media program. Rural health workers have been trained to
recognize a draining ear, provide rural toilette and advise patients as
needed.
Industrial Noise Control is governed by laws although implementation
leaves a lot to be desired. A study was conducted among the employees of
a copper mine wherein 138 of 224 employees were tested. Only 27% had
normal hearing; 48% had noise induced hearing loss while another 25% had
bearing loss which may or may not be due to noise exposure. We should be
vigilant regarding the pervasive effects of noise.
Compensation for the hearing disabled is rather pathetic. Deafness is
not even listed among those causing permanent disability similar to
blindness of both eyes and loss of 2 limbs. It is only listed
compensable as permanent partial disability even when hearing loss of
both ear have been completely lost. Compensation for deafness is equal
to loss of one arm. It's about time that we reassess our employees
compensation act and not take hearing loss for granted. As Aram Glorig
said "Normal hearing can never be restored once it is lost because
of noise. A hearing conservation program is the only ounce of prevention
because there is no cure."
"A small step by man, a giant leap for mankind" uttered
Armstrong as he walked on the moon. Indeed, what we are doing to prevent
deafness in the Philippines is but a small step, hopefully, the giant
leap is not far behind.
