Audacity Aug14_Layout 1 30/07/2014 10:31 Page 46
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46 received a phone call saying half a dozen people were waiting to be seen at my grandparents’ home. So the work continued throughout the night, with some patients staying over as it was too late for rickshaw services. This seemed daunting, yet the atmosphere was energising.There is no denying that countless challenges were faced: the electricity cutting out, the intense heat, no soundproofing to block the moaning of cows in the fields nearby. However, when conditions weren’t great my cousins and I would visit our local tea garden where I remember playing as a child. The peace and serenity there was breathtaking.
to my eyes. He made me recognise how fortunate we are in the UK to have services that urgently care for children with meningitis. Between seeing patients I began researching audiology in Bangladesh. I visited the Sylhet Women’s Medical College for advice on where to go, and was greeted by Bonnie, a final year medical student. She kindly offered to take me to the Ibn Sina Hospital, the largest public hospital in the city. As we arrived we were introduced to the well-respected ENT specialist, Dr. Sadee. We discussed how audiology is practiced in the county, the prevalence of BPPV in the community and the treatments used. He feels “the support for audiology is very poor in Bangladesh”.There is clearly a need for audiological equipment and support in maintaining existing equipment - audiologists were still using OAE machines past their calibration date. However not only is technology essential, but so is a refreshing knowledge update. It is well known that there are highly effective positioning manoeuvres that have made BPPV the most successfully treatable cause of vertigo. However, perhaps we take this knowledge for granted. A few of the doctors I met would prescribe vestibular suppressants for a classic case of BPPV, and were not confident using the simple, effective treatment of the Epley manoeuvre. Dr. Sadee suggested visiting an organisation called Ear Care. Not knowing what to expect I turned up unannounced in the evening. There were dusty diagrams of the ear arranged on the walls with ageing calendars from hearing aid manufacturers. I enquired about their hearing aids, the cost, the fitting procedure and the experience of the audiologists, and received very confusing responses. One thing that did become clear was that audiologists working there received only a few days of training, and I was astounded by the extortionate prices of their hearing aids. The Rexton Arena 1P hearing aid was being sold for 11,250 taka, equivalent to £88. A lot of money, considering this was one of the poorest parts of the city. On the way back from Ear Care I
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Dr. Sadee, ENT specialist at Ibn Sina Hospital
Audiometer protected from dust
'Echocheck' - OAE Screener
Recording tymps on a young child
At Usmani Hospital I interviewed several ENT doctors who kindly took time out of their busy schedules, with waiting queues so long that security was needed! I spent a day with the team, giving me the opportunity to speak with them about their views on audiology in the country. They each expressed the dire need to have an established audiology service that could benefit all, not just the wealthier minority. They recommended a visit to Dhaka, the capital and largest city, as they felt the services in Sylhet were extremely poor. After a seven hour sleeper cabin ride I reached Dhaka, a compellingly different place to Sylhet. Dhaka is a congested, but thriving and colourful metropolis, home to around 18 million people. It is the most developed part of the country, and suffers from the challenges of poverty, pollution and overpopulation. I headed to the HiCare Centre (the Society for Education and Care of Hearing Impaired Children in Bangladesh), the first facility I visited where there was a recognisable audiology system in place. Before leaving London I was fortunate to liaise with Monica Tomlin
Rexton hearing aid, sold for 7000 taka (=£54)