HEALTH / Feb ‘2020
Hearing Impairment in Indigenous Children; a Third World Problem in a First World Country?
Aboriginal people are 10 times more likely to suffer from ear diseases than non-indigenous people, and only seven per cent of Aboriginal children in remote communities have healthy ears.
Australian Ear Nose and Throat Specialist, Dr Kelvin Kong recalls a remarkable encounter; “In a community in central Australia I visited, the health worker was baffled by a patient, a little girl. She called me over to have a look and it was a normal healthy eardrum. She’d never seen one before.”
What is otitis media?
The Department of Health defines otitis media, as the term used to describe all forms of inflammation and infection of the middle ear. Infections can present with middle ear fluid or persistent discharge, and can be chronic or acute. Unless corrected by surgery, chronic infections can lead to long term, and in some cases, permanent hearing loss.
The report published by the Australian Institute of Health and Welfare, highlights otitis media as the key condition contributing to hearing loss among Indigenous children. A condition that is treatable and preventable.
There are generally two ways to treat otitis media; one is through an operation called Myringotomy, whereby surgeons make an incision in the eardrum to relieve pressure caused by excessive build-up. Alternatively, surgeons perform a Tympanoplasty, which is reconstructive surgery used to treat a perforated eardrum.
What causes otitis media?
Data from the Aboriginal and Torres Strait Islander Social Survey of 2014-15, highlights how poor socio-economic factors may contribute to an increase in ear infections. Over nine per cent of Indigenous children living in the most socioeconomically disadvantaged households had hearing problems, compared with just over six per cent of Indigenous children living in the least disadvantaged homes. Poor hygiene, overcrowded housing and inadequate access to clean running water and functioning sewerage, can all increase the risk of developing ear infections.
Many Indigenous families live in remote areas; this is associated with decreased access to key health services. A lack of coordinated, accessible and culturally sensitive health care services in remote areas can lead to delayed diagnosis and treatment for ear infections.
Research shows one in five indigenous children in rural and remote areas wait longer than the recommended period of three months for audiology testing.
Reduced awareness of essential health information has led to higher numbers of premature births, low breastfeeding rates and nutritional deficiencies, all of which increase the risk of otitis media in children.
Why should we be concerned?
The National Aboriginal Community Controlled Health Organisation (NACCHO) explains that 0-4 years is the critical age range for laying down neural pathways relating to language and speech, it is therefore imperative children’s hearing during this period, is properly functioning.
Sadly, statistics show on average, Indigenous children having to wait until the ages of five and six, before having their first hearing aid fitted.
Hearing problems at such a young age can lead to poorer outcomes in areas of expressive language; vocabulary; language memory and speech intelligibility. Poor development in these key areas can increase the risk of behavioural problems such as irritability, disobedience and poor school attendance.
Beyond the education system, these problems are closely associated with higher rates of social isolation, limited employment options, low income and increased contact with the criminal justice system.
The final report from the Royal Commission into Aboriginal Deaths in Custody (1991) was the first to comment on the relationship between childhood ear disease, poor school performance and their connection to involvement in the criminal justice system. An alarming 90% of Aboriginal prisoners at Darwin Correctional Centre showed signs of hearing loss, while this figure increased to 95% in Alice Springs.
On a spiritual level, the art of story telling within Indigenous families forms a crucial part of their cultural identity. If children are unable to hear stories of their family history, they will not be able to share these with future family members, causing far-reaching inter-generational difficulties. A crisis of personal identity is strongly correlated with reduced self-esteem and an exacerbation of mental health problems.
How can improvements be made?
The key is prevention and early intervention. NACCHO suggests increased awareness of the importance of basic hygiene skills such as washing hands and faces can help reduce the risk of ear infections, along with timely immunisations and healthy food choices.
The Department of Health put forward recommendations to improve the training of health care practitioners to ensure Indigenous children who attend primary health care are appropriately screened or treated for otitis media and hearing loss.
Greater coordination of research and collaborative health and housing initiatives, developed with Aboriginal and Torres Strait Islander bodies is recommended to address the barriers and exclusion many Indigenous families encounter.
The Department of Health are also calling for education strategies to improve outcomes for Aboriginal and Torres Strait Islander children. Such an initiative has been trialled in remote parts of Western Australia, whereby teachers are using microphones and speakers in classrooms to create a more inclusive learning environment. The teachers have reported increased attentiveness, reduced frustration and report that students appear much happier and confident in themselves.
What does the future look like?
Data shows that the proportion of Indigenous children with poor ear health has fallen in the last 15 years thanks to the introduction of a range of Government prevention programs such as The National Healthy Ears, Better Hearing, Better Listening program, which offers diagnosis, treatment and management of ear and hearing health for Indigenous Children and young people aged 0 to 21 years.
Outreach programs; such as the Northern Territory Remote Aboriginal Investment Hearing Health Program (NTRAI HHP) have also shown promising results. The results, following their delivery of specialist ear and hearing services to high risk Indigenous children and young people in remote parts of the Northern Territory have shown so far, of the children who moved through the NTRAI HHP, 51% had improved hearing loss and 62% had improved hearing impairment over time.
There is hope that improvements can be made, however there needs to be continued awareness, understanding and support if there is to be success in improving the health and social outcomes of Indigenous children across Australia.
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