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Imagine a young child suffering through years of relentless pain, fever and headaches. !
This is an agonising reality for many Aboriginal children who, on average, experience middle ear disease for 32 months of their first five years – more than half their lives – compared to three months for non-Aboriginal children.
And the impact is long-lasting; middle ear infection can cause hearing loss, and young children with hearing loss have compromised development.
That’s where the Earbus Foundation comes in.
Earbus Foundation was originally set up to provide health services to hard-to-reach kids in rural Aboriginal communities. The idea was to take healthcare to them, rather than expecting them to negotiate the ‘white fella’ mainstream services.
We recently caught up with Paul Higginbotham, co-founder and CEO of the Earbus Foundation of Western Australia (WA) to find out about this challenging and rewarding project.
Earbus mobile ear health clinics offer primary health-based ear care to Aboriginal children in schools, day care centres, kindergartens and playgroups. Primary healthcare means that GPs treat the kids for a range of conditions including conjunctivitis, head lice, scabies and developmental delays, but the Earbus focus is on middle ear infections.
"Hearing is critical to a child's development in the first three years," says Higginbotham. "It affects balance, sensory processing, play, making friends, and it's particularly difficult in an oral culture when kids can't hear.
"Also a lot of the kids speak English as a second language, and sometimes as a third language, so they have to learn English just to go to school." Higginbotham says that as well as being a health issue, it's a social problem.
"It's a disease of poverty; overcrowded housing, low levels of breastfeeding, low levels of hygiene and poor nutrition.
"We go in once a month, so we need to build community capability for their own self-care. There are lots of things around treatment they need to manage like antibiotics and not to share them, hygiene, how to clean their ears, how not to put things in their ears."
Higginbotham says the service has also developed a powerful model of working directly with the kids as Ear Health Ambassadors.
"We target the older kids who have an interest – the ones who are curious. It gives them a way to learn more," he says. "They go home and show off to their older brothers and sisters and to their parents, and they can tell the younger kids what to do.
"The kids pressure their parents to get their [the kids'] ears fixed, and it's often the kids who make the adults turn up," Higginbotham says. "Also, in these communities there is lot of shared parenting, so you have a stable point of contact if you work with the kids."
Higginbotham remarks that these kids now have health literacy, and some can read the machines the Earbus team uses.
The result is a 95% attendance rate for the surgery list. In the Pilbara, the incidence of middle ear disease is down from 19% to 3.5%.
"It is so rewarding when you go into a community that has been hard-core ear disease territory, and you go back on a visit and, all of a sudden, it has all lifted. Professionally you feel very validated," Higginbotham says.
In a state the size of Western Europe, the service's logistics alone are an enormous challenge. Service capacity is also an issue. Earbus Foundation now employs six full-time people and 15 part time. Contract clinicians including doctors, ear nose and throat (ENT) specialists, audiologists and nurses go along for a week at a time.
"There are 21,000 Aboriginal kids under 18 and we are seeing a couple of thousand," says Higginbotham. "There are a lot more kids we could help, and we could go to more regions."
Continuity of service is difficult when the bus isn't in the vicinity. In between visits they have to make sure treatment continues.
"We build local networks to make sure that happens, but it can take 18 months to two years to build trust with an Aboriginal community," Higginbotham says.
You'd think that Higginbotham had seen it all, but he had an eye-opening moment at the Global Coalition on Hearing Health conference in Manila last year, where most of the attendees were from less developed – or Third World – countries.
"The World Health Organization (WHO) ranks the countries in the world in order of middle ear disease, and they had their own category for Aboriginal kids because they have the worst ear disease in the world," says Higginbotham.
ln Manila, he also saw some of the tech they can look forward to introducing. For example, a standard audiometer – which measures hearing acuteness – is 7 kilos and fills a suitcase, which is difficult when you're mobile. Now the Shoebox audiometer has come out of Canada, and you can get an attachment for your iPhone. There are headphones that allow you to test hearing at the quality you would get in a fully sound-proofed audiology booth.
Higginbotham says Earbus Foundation is no longer a startup and needs stability and longevity.
"It was built in the passion of the people who founded it, but our plan now is to embed that and add other buses to other regions," he says. "We are constantly being shaped by what the data is telling us. We adjust community support to extend our reach and help more kids."
It's no wonder Higginbotham says, "It's the most challenging and exciting thing I have ever done."
The Earbus is proudly supported by nib through nib foundation. Another inspiring Australian, Paralympian Sarah Walsh is helping raise awareness for fellow nib foundation partner, Limbs 4 Life. Check-out our article on her training and exercise regime.