Advancing Communication

by Mandi Kimball

In November 2002, a BYU audiology team of four professors and four graduate students traveled to Hanoi, Vietnam. The eighteen-day medical mission was headed by Dr. David McPherson, chair of the Audiology and Speech Language Pathology Department. The BYU team was part of a larger medical mission called Project Vietnam— a humanitarian aid organization that brings medical assistance to rural areas of Vietnam. The larger sixty-nine member team consisted of volunteer pediatricians, plastic surgeons, ophthalmologists, nurses, and physical therapists from all over the United States. The purpose of the trip was to provide medical aid to those who could not otherwise afford the treatment. Funding for the BYU participants was provided through many sources, including the David O. McKay Department of Education and Division Four of the American Academy of Pediatrics.

Avoiding Trauma Through Early Testing

McPherson and Richard Harris, audiologists at BYU, trained Vietnamese physicians, nurses, and other medical staff about the repercussions of hearing loss and taught the medical personnel how to fit people with hearing aids. McPherson and Harris also brought materials to help the Vietnamese establish a self-sustaining program so more people could receive the help they need to hear properly. One of their patients, a twenty-one-year-old Vietnamese girl, was fitted with hearing aids and could hear for the first time. She hadn’t had money or access to equipment to properly test and fit hearing aids, and she hadn’t been able to communicate verbally with her family. The hearing aids will change her life. She had been dismissed from school due to her hearing loss and will now be able to obtain an education. Her father feels that now she will be more socially accepted in their small, traditional village.

Children born with a hearing loss and not fit with hearing devices at a young age not only experience difficulties communicating verbally but are also at risk for academic, social, and emotional problems. In the United States, these children are usually at least one to two grades behind. Socially, they are left out because they cannot understand the communication going on around them. For children in Vietnam, these repercussions may be worse because they may never have the opportunity to receive hearing aids.

In most of the United States, babies are screened for hearing loss before they leave the hospital. If they fail the screening, they are rescreened a few days later. More advanced testing is used if they fail the screening the second time. If a baby continues to fail the hearing tests, he will be fitted with hearing aids when he is three months old. If children are properly fitted at a young age, the risk of later academic, social, and emotional problems is dramatically reduced. Hearing screening is often a low priority in developing countries, such as Vietnam, because of the limited funding for the equipment and medical training.

While McPherson and Harris were training medical personnel, the other six members of the audiology team worked in hospitals, small clinics, and birthing houses. In hospital rooms just feet from the noise of the honking horns of mopeds, busses, and cars, two women and their newborn babies would share a bed. Nancy Blair, director of clinical audiology at BYU, supervised the four graduate students as they used otoacoustic emission equipment to screen the babies’ hearing. The babies were quickly screened at a very soft sound level using the techniques of otoacoustic emissions and the automatic brain-stem response. The screening instruments were very sensitive to background noise, so when traffic was heavy outside the open windows or when visiting hours started, it was almost impossible to test the babies accurately.

Otoacoustic emissions testing is done by a small device resembling an ear plug that is placed into the ear. A portable screening machine is connected to the plug and a soft buzzing or clicking noise is presented to the ear. The echo the ear produces in response to the sound is measured. If the machine did not detect an echo, the baby fails the screening. Upon failing, the baby is tested again with otoacoustic emissions by a different machine that would measure specific frequencies and report on which frequencies the baby failed the test. The baby would also be screened using a technique called automatic brainstem response. When a person hears a sound, the brain responds, producing very predictable brain waves. These waves can be measured to approximate a person’s hearing level.

One of the major obstacles the audiology team faced was not being able to communicate with the mothers. We tried, in very rudimentary ways, to tell the mothers or other family members that their baby had passed the screening. When the babies did not pass, we were not able to tell them why their child did not pass the screening. We were dependent upon the translators to convey messages to the families.

Repairing Congenital Defects

While there, Lee Robinson, director of BYU’s clinical speech and language services, gave two lectures to Vietnamese speech and language therapists on the effects of cleft lips and cleft palates on the development of speech and language and the proper treatment for the condition. In the U.S., the deficits in speech and language caused by these anomalies are not as prevalent, due to surgical repair at a very early age.

In Vietnam, it is not safe to operate on infants because of vitamin deficiency, so cleft lips and cleft palates are often repaired late or not at all. Project Vietnam’s plastic surgery team worked at a rural hospital in Hoa Binh and was able to perform forty-four reconstructive face and jaw surgeries, including cleft lip and cleft palate repair.

Student Rewards

Working and learning in Vietnam provided not only an academic experience but a valuable life experience as well. There were tremendous opportunities for service in this country, where poverty abounds. April Benson, a second-year speech language pathology graduate student and member of the audiology team, said, “Being part of the whole team and doing something important for the people of Vietnam was the best part of the experience.” BYU students saw firsthand that working in audiology and speech language pathology can truly help people with a variety of impairments. “We are in one of the most rewarding professions because we get to help people who have problems with communication, and communication is such an important part of life,” Benson observed.

The trip also allowed the graduate students to apply the information from their undergraduate training. Lee Robinson stated, “I believe that the trip was a valuable learning experience for our students because they had the chance to apply their skills and knowledge in helping people in extreme need in a very unique environment. The point in pursuing an audiology or speech language pathology degree is to provide real and significant help to people.”

Reasons to Give

Not only did the medical mission provide practical experience in the field, but it was also a lesson in history. Many of the interpreters and physicians grew up in Vietnam but now live in California. During the Vietnam War, many of them fled with their families from Saigon and Southern Vietnam to the U.S., New Zealand, and Australia. They shared their experiences of escaping just days or weeks before the U.S. military left Vietnam. One of the interpreters was nine when she and twelve other family members escaped Saigon the day the United States left. Two sisters also recounted their escape with their family; one sister was twelve and has very little memory of her life in Vietnam. Her older sister was in her late teens and is now torn between two countries—her original and adopted homelands. There was a stark difference between the lives of these individuals currently living outside of Vietnam and the lives of poverty they would have faced had they not fled.

I am incredibly grateful for the freedoms that we enjoy here and for the price that was paid for those freedoms. Other students and faculty members also expressed their gratitude for the opportunities and benefits they experience in the United States. We felt the desire to share those benefits through our service. The memories and impressions of the fifteen days the faculty and students spent in Vietnam will have a lasting effect, both personally and professionally, as each member of the audiology team strives to provide services to enrich other people’s lives.

McPherson returned to Vietnam in March to present the research on the incidence of hearing loss in newborns in Hanoi and the surrounding areas to government officials. He hoped to convince government officials that the benefits of instituting a universal infant screening program for newborns would be worth the cost. During his trip, he also hoped to help establish a one-year project in which all babies born in Hanoi will have their hearing screened. The data will be used to establish whether infant screening will be established on a routine basis. Otoacoustic emissions and tympanometry will be used for the screening during the year-long project. However, due to cost considerations, it is necessary to begin at basic levels, which may include high-risk registers (a checklist of risk factors associated with hearing loss) and behavioral audiometry (watching to see if an infant reacts by widening his eyes or turning his head in response to sounds). These screening procedures are far less accurate than screening by otoacoustic emissions or tympanometry, but are also less costly.

McPherson stated that his long-term goal is to “assist the government of Vietnam in establishing a ‘hearing screening’ program in the public schools as a means of reducing the number of children whose educational future is limited by the problems associated with undetected and untreated hearing loss.”