On her recent mission to Cambodia, La Trobe’s Dr Chyrisse Heine was part of a team that helped 46 people to hear for the very first time. As an accomplished academic, speech pathologist and audiologist, nothing in her professional experience prepared her to witness young Cambodians listening to music they’d truly never heard.
“It’s unbelievable,” says Dr Heine. “I feel very lucky to have a profession that can be translated into such good work.”
In this conversation, she describes what audiology and speech pathology are, and how she embraced the rewards and challenges of delivering clinical services in Cambodia’s rural provinces.
You’re an audiologist and a speech pathologist. What’s the difference?
Audiologists evaluate and rehabilitate patients with varying degrees of hearing loss. Once a diagnosis has been made, the audiologist is the primary person involved in identifying a solution, and that may be anything from fitting a listening device to cochlear implantation.
Speech pathologists help people with communication and swallowing problems. Some of my patients include children with autism or Central Auditory Processing Disorder (CAPD), and older adults who have dementia or Dual Sensory Loss.
I’m very interested in CAPD, a condition that causes a breakdown in the listening process. It’s a rich area where speech pathologists and audiologists work together to achieve a good outcome for the patient. People with CAPD usually have normal peripheral hearing, but have difficulty processing auditory information, particularly in situations where there is background noise. Both children and adults can have CAPD, and there is no one cause.
How did you begin volunteering in Cambodia?
Almost five years ago, I decided I wanted to volunteer my time and services. For months I tried to find an appropriate position, but I hit dead end after dead end. As a professional speech pathologist, you can apply for a job, but professional volunteer opportunities are almost non-existent.
A colleague sent me an email about an organisation in Cambodia called Capacity Building of People with Disability in the Community (CABDICO), who were looking for a speech pathologist. I sent them my CV and, before I knew it, I had agreed to present at their upcoming workshop.
But the excitement about being asked to volunteer soon gave way to panic. Everything was unknown to me, on so many levels. I had never been to Cambodia before, I didn’t know anyone associated with CABDICO, I couldn’t speak Khmer, and suddenly I was beside myself.
I drove my poor travel agent mad with questions. It really stretched my comfort zone. I look back on it now, though, and it must have been fate. It wasn’t me who chose Cambodia, it chose me.
It turned out that the workshop was sponsored by the Australian Government Department of Foreign Affairs and my presentation went well. I have worked with several organisations since then, including CABDICO, Speech Therapy Cambodia and Cambodia Vision.
What’s the situation in Cambodia in terms of hearing and speech?
For a start, speech pathology is not a tertiary level degree in Cambodia. So there are no qualified professionals coming through Cambodian universities in a country where there is real need. A large percentage of the population have hearing loss, speaking problems and communication difficulties. Many children are born with hearing loss, or have had repeated infections, and accumulate some damage along the way. Farmers often end up with hearing loss from working with noisy machinery. Cambodia is a country that has been at war, so there is some noise-induced hearing loss as a result of that.
There are also logistical issues to overcome. Most people have to travel several hours to get access to basic health care. And even if you make a diagnosis, that person is going back to their village, often without the education and resources to manage their condition.
So, what’s being done to build capacity among health professionals?
I’ve been working with various organisations to establish and teach into a short course on speech pathology. It gives students and health professionals in Cambodia the opportunity to receive some development with a speech pathology flavour.
And each year, Cambodia Vision organises a mission to a rural province to conduct vision surgery and provide general healthcare. I asked if an audiologist went with them. They said no, but they would love one, and I volunteered to go.
In 2016, two colleagues accompanied me and I also took four La Trobe speech pathology students as part of an overseas clinical placement. We were stationed in Pursat province, in the western part of the country, with 60 other volunteers for two weeks. We repeated the work in 2017, with a different team.
What was your first Cambodian clinical mission like?
We worked out of the local hospital, but it was a self-sufficient mission. We took all our own equipment with us and set up the clinic from scratch. With the help of translators, our team conducted hearing testing and fitted listening systems, as well as some speech therapy work.
When you close the clinic door at night, you don’t want a single person waiting there who is not able to come back the next day. And when you shut the door on the final day, you know you are not going back. We all dig our heels in and do as much as we can.
It became a collaboration for the better good. We worked as a team, where the students were equal partners in the effort. On the two missions, we completed around 1,000 assessments and therapies. Each time, it’s an unbelievable learning experience, but also a lot of hard work.
What logistical and practical challenges do you face in the field?
There was one case that absolutely broke my heart. We saw a young adult male who did not have an outer ear, and the listening system we had couldn’t be fitted. The following year, I ordered a special system for him, but he lived in a very remote village, and we were unsuccessful in notifying him when it arrived.
In the end, I left the device at a monastery in Pursat. I showed the monks what to do and they promised to follow up and get a message to the boy’s village. I don’t know if they were able to contact him or not.
On my last mission, I met a mother who wanted to continue to work with her hearing impaired child. I kept in contact with her for about eight months. I provided her with instruction and exercises that improved her son’s skills so much that he was able to enrol in school. Children with disabilities are kept at home in Cambodia, so this was absolutely amazing. He could also say ‘Mae’, which is mother in Khmer. She loved that, for her it was very special.
After four years volunteering for a host of different organisations, what has Cambodia taught you?
I have greater resilience, independence, and know how to work as part of a team. I have more empathy after seeing the difficulties that Cambodian people face as part of their everyday lives. It’s exciting to be able to identify a need and know that you are able help.
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