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Hark Western Cape
Progress Report - December 1999
ESTABLISHMENT OF SITES
CAPE METROPOLE REGION
CAPE METROPOLE REGION
OBJECTIVES AND PRIMARY HEALTH CARE
SOME EMERGING ISSUES
ENT (UCT) EAR CAMPS
DATA COLLECTION/ STORAGE/ ANALYSIS
The progress report of July 1999 reflected on the planning stages and the formulation of
operational plans for the HARK Project - Western Cape. In this progress report the
establishment of the project including quantitative and qualitative information will be
documented. Furthermore an attempt will be made to evaluate the progress of the project
according to its primary objectives and the five core principles of the Primary Health
2. ESTABLISHMENT OF SITES
2.1 Cape Metropole Region
The project has been established in four of the six districts/substructures of the Cape
Metropole Region. The project has not been established in the Tygerberg or South Peninsula
districts as an audiology service is provided by the Carel Du Toit Centre/Tygerberg
Hospital and the Deaf Child Centre in each of these areas, respectively.
The project has been established in the following districts and sites:
City of Cape Town: Brown's
Farm Day Hospital
Municipal Clinic and Wesfleur Day Hospital
Helderberg: Somerset West
Centre (Day Hospital) and Kleinvlei Centre (Day
2.2 Boland/Overberg Region
Following the working group committee meeting, the establishment of the project at the
following sites was recommended:
Worcester: Eben Donges
Ceres: Ceres Municipal
Ashton: Zolani Municipal
Grabouw: Grabouw Municipal
As can be seen above, the service is provided at ten sites throughout the Cape Metropole
and the Boland/Overberg Regions. The sites are visited once per month, except for Eben
Donges, which is visited on a weekly basis. A timetable for 1999 (see Appendix A) was
agreed upon by all parties. The frequency of visits to each site is proving to be
sufficient in terms of providing effective rehabilitation and the present demands of the
number of children referred for assessment or rehabilitation.
In Tables 1 and 2 below quantitative information regarding the service, which has been
provided over the past 4 months, is presented
METROPOLE REGION: SUMMARY OF STATISTICS
||No. of children tested
||Hearing status of pts
||No. h/aid fittings
||Source of referral
Referral out/further contact
|Blaauwberg: Tableview Clinic/ Wesfleur Hospital
||Health nurses, RXH Audio
Town: Browns Farm Day Hospital
||Health care workers, DCC, School clinic
Somerset West Clinic
BOLAND/ OVERBERG: SUMMARY
status of pts
4 SNHL: 3
self, health nurses
6 SNHL: 5
nurses, ear camp, DCC, creches, pre- & primary schools
12 SNHL: 4
camp, school, health nurses
9 SNHL: 6
LaBat & Nuwe Hoop, EDH
Paediatric Clinic, Speech
38 SNHL: 19
As can be seen in Table
1, the number of children having received hearing aids is lower than the number of
children diagnosed with a hearing impairment. This figure reflects the procedure required
in which a diagnostic hearing assessment is conducted and an ear mould impression is taken
on the first visit, followed by a hearing aid fitting on the second visit. Hence, at the
next follow up visit the children diagnosed with hearing impairments will be fitted with
To date, the service has not been provided at Oostenberg. However meetings have been held
in which discussions concerning where the site should be based within this region was
undertaken. The need to provide services to both the Municipal Local Councils Services and
the Community Health Centres Organisations was recognised and will be implemented in 2000.
As is illustrated in Table 1, to date, 79 children have been diagnosed with a hearing
loss, 28 children with a sensori-neural hearing loss and 51 children with a conductive
hearing loss. These figures clearly reflect the need for the audiology service provided by
the HARK Project.
4. QUALITATIVE INFORMATION
In this section qualitative information concerning each site is presented.
4.1 Cape Metropole Region
Blaauwberg: Tableview Municipal Clinic
This site is proving to be
an extremely successful site. The nursing staff are
highly involved in referring patients and undertaking all bookings for
Project. Much team- work between the audiologists and the nurses is
undertaken. The nurses are involved in research and further studies and
clearly indicated that they would like to acquire additional
knowledge in the field of deafness.
Blaauwberg: Wesfleur Day Hospital
This is a large day
hospital, which is staffed by numerous medical personnel. The
need for audiology services at Wesfleur Day hospital has been clearly
It is felt that further
awareness of the project among the medical personnel is
required. Meetings with medical personnel and awareness campaigns will
established in 2000.
Numerous referrals have
been made from the Deaf Child Centre and Red Cross
Hospital to the HARK Project at this site. The referrals back from a
secondary/tertiary health care level to a primary health care level
appears to be
most effective in that patients have expressed that the accessibility
of the HARK
Project at this site has allowed them to make repeated visits for
City of Cape Town: Brown's Farm Day Hospital
At this site the Health
Care Workers play an integral role in the project. As a
result of their regular home and pre-school visits, the Health Care
critical in the referral of children with possible hearing impairment.
Care Workers are very happy to assist the project and the audiologists
provide the Health Care Workers with further training in the field of
deafness in the
This location of this
site is accessible to a large population from the surrounding
areas of Phillipi, Guguletu, Cross Roads, Nyanga and Langa. A meeting
scheduled with the nurses from the Day Hospitals and Municipal Clinics
these surrounding areas so as to inform them of the HARK project and
of referring patients. However this meeting had to be cancelled as a
result of a
local strike. The meeting will be re-scheduled early in 2000.
Hearing screening in the
local creches and pre-schools has been initiated and will
be continued in the following year.
Due to a shortage of
accommodation at the site, the audiologists utilise the
HARK vehicle for assessments and rehabilitation. Although this is
proving to be
satisfactory, it limits the number of children that can be seen.
Helderberg: Somerset West Municipal Clinic
The nursing staff have
been highly supportive and involved in the HARK Project.
They have been responsible for all referrals and bookings of patients.
providing information about the HARK Project with nursing staff from
clinics in the
surrounding areas have been undertaken.
This clinic was chosen due
to its central location in the district and it was
reported that transport for patients in surrounding areas was
the audiologists are of concern that the clinic may not be accessible
populations from surrounding areas. This will be more fully explored
early in 2000.
4.2 Boland/Overberg Region
Ceres: Ceres Municipal Clinic
It is felt that increased
contact and collaboration is required with other medical
and paramedical professionals in the area. Furthermore closer liaison
mobile health clinic which services the area will be undertaken in
Ashton: Zolani Municipal Clinic
Many children referred to
the HARK Project are from schools in the surrounding
area. The nursing staff at the clinic have made contact with the
the HARK Project.
There is concern as to the
clinics accessibility to populations in other local areas
and the possibility of sharing the service between two clinics is
Hermanus: Hermanus Municipal Clinic
The nursing staff has been
highly supportive and involved in the project. This has
resulted in many referrals being made to the HARK Project and 67
already been seen in three visits. The nursing staff
are enthusiastic to acquire
more knowledge in the field of deafness and training will be undertaken
Swellendam: Swellendam Municipal Clinic
The nursing staff have
been highly supportive and much team work between the
audiologists and nursing staff has been carried out.
Numerous referrals have
been made from the UCT ENT ear camps held in this
There has been concern
regarding the accessibility of patients from surrounding
towns, therefore Caledon is being examined as an alternate or
additional site for
Parent training programmes
are required and will commence in the new year.
This site is visited every
fifth Wednesday of a month. This is proving to be
satisfactory as patients requiring more regular service are able to
sites in Somerset West or Hermanus. Further dates will be scheduled for
should the need arise.
Worcester: Eben Donges Hospital
Much collaboration between
the HARK Project, based at the hospital, and the
local schools for the deaf has been established. This collaboration has
referrals, assessment and rehabilitation.
In the initial stages of
establishing the HARK service at Eben Donges Hospital,
numerous meetings with medical and paramedical personnel were held.
Awareness of the project and the services it offers was well carried
out. This has
resulted in many referrals being made and much multi-disciplinary work
undertaken. This in turn has resulted in a highly comprehensive service
offered to hearing impaired children.
The audiologists are
involved in hearing screening in the neonatal unit at Eben
Donges and all patients are followed up on a regular basis.
5. OBJECTIVES AND PRIMARY HEALTH CARE (PHC) PRINCIPLES
Evaluation of the project in terms of its objectives and PHC principles:
Vision and Objectives
The project has continued to focus its service on early identification and intervention.
Initial attempts to apply the service at sites in which the Developmental Screening Tool
is being administered, has not yet proved to be successful as few children under the age
of 18 months are being identified as having possible hearing impairments and then being
referred to the project. However further support for the Developmental Screening Tool will
be undertaken in 2000 and research concerning the hearing component of the tool will be
The project continues to move towards sustainability by implementing the project within
existing infrastructure, using current resources and working in close collaboration with
various departments and sectors. Furthermore, the collection of epidemiological data
hopefully will highlight the need for the continuation of such services. The development
of a sustainable service delivery model for hearing assessment and rehabilitation is being
developed on an ongoing basis.
The objectives (see Appendix B) for the HARK Project are being met in terms of the
audiology service provided, liaison with DEAFSA and DCCT, and empowerment of families of
hearing impaired children.
and intersectoral collaboration
Much intersectoral collaboration has been undertaken at the levels of the advisory
committee and working groups. Representatives from various departments from
the University of Cape Town, the Department of Health, the Western Cape
Education Department and DCCT have jointly determined the vision and
objectives of the project as well as monitored its progress (See Appendix C -
Minutes from the Second Advisory Committee Meeting). Collaboration across
sectors and across levels and division of services within the Department of Health
has been achieved at a working group committee level (See Appendices D and E
- Minutes of the Second Working Group Committee Meetings). This
collaboration has resulted in joint decisions being made with regard to the location,
nature of the service and implementation of the HARK Project in the Cape Metropole and the
In addition, collaboration with other professionals within the health and educational
sectors has been conducted at the primary and secondary health care sites.
participation in health and health care
Integral to this project has been the involvement of professionals already
operating within the health and educational services within the various
communities. This has involved health care workers, nursing staff, school health
nurses, school clinics, primary health care practitioners, medical health
officers, and other paramedical personnel. In addition school principals, teachers
and therapists have participated in the project.
Initial attempts have been made to identify deaf adults within the various communities.
The parents will be integrally involved in the project with the commencing of the parent
training programmes early in 2000.
accessibility to health and health services
As has been mentioned previously, the working group committees recommended the selected
sites. The majority of the sites are at a primary health care level and are accessible to
the local population. Concern regarding accessibility for all local population groups at
the Somerset West Clinic and the Zolani Clinic in Ashton has arisen and the possibility of
establishing an additional site in both of these areas will be addressed early in 2000.
The project is conducted at two sites at a secondary health care level, namely Eben Donges
Hospital (Boland Overberg Region) and Deaf Child Centre (Cape Metropole).
Appropriate use of
technologies such as resources and strategies
The adoption of otoacoustic emissions (OAE) as the preferred screening tool is based on
the advantages of OAE's being simple, fast, non-invasive, objective, sensitive, reliable
and valid. Screening of hearing is undertaken in conjunction with the primary health care
clinics and the school health clinics. The future provision of solar powered hearing aids
will alleviate the difficulties experienced concerning the financial cost of the
purchasing of batteries.
Protocols concerning referrals for screening, diagnostic audiological evaluations and
rehabilitation have been compiled jointly by the various professionals involved in the
health and educational services within the regions. Referrals made by the audiologists to
other health professionals support existing referral pathways.
Close liaison with schools for hearing impaired children within the regions is carried out
and existing resources offered by the schools are utilised. In turn referrals, support and
training is offered to educators and other professionals within the schools for hearing
impaired children and in the mainstream schools attended by hearing impaired children.
Existing channels for the dissemination of information is utilised at all sites. The
dissemination of information regarding the HARK Project and hearing impairment will be
undertaken through existing channels at a regional and district level. Public awareness of
hearing impairment and the services offered by the HARK Project has been undertaken using
community based radio stations.
and prevention of illness and disability
The importance of public awareness of hearing impairment and its effect on the acquisition
of speech and language is well recognised by the HARK Project. Posters and pamphlets are
currently being designed and will be disseminated through existing channels. An objective
of increasing the awareness among other health professionals is undertaken on a regular
basis at the various sites.
6. SOME EMERGING ISSUES
Over the past six months limited screening of hearing has been undertaken in creches and
pre-schools in the areas serviced by HARK. However the need for hearing screening of
children between the ages of 2-6 years is well recognised. As from January 2000 a
screening programme will be implemented in the immediate areas serviced by HARK. This will
entail working closely with the creches and pre-schools in the area.
involvement of school clinics and school health nurses
Following the working group committee meetings, held in November 1999, it was acknowledged
that to date that although the HARK Project had been working in very close collaboration
with the Municipal Local Clinics (MLC's ), additional collaborative work was required with
the school clinics and school health nurses. This will be undertaken in 2000.
It is clear that there is much need within the communities and the health professions for
increased awareness of hearing impairment, the psycho-social and educational implications
of a hearing impairment and the need for early intervention. A primary objective of the
HARK Project is to disseminate this information. Use of existing channels for the
dissemination of information within the health system will be undertaken. An attempt to
disseminate this information in the education system will be explored in 2000. Workshops
and training sessions for other professionals will be undertaken on a regular basis. Much
information is imparted to parents of hearing impaired children obtaining a service from
HARK during counselling and within the parent training programmes.
and training of University of Cape Town and University of
Stellenbosch Speech Pathology/Audiology students
As from January 2000, the HARK Project in the Cape Metropole Region and Eben Donges in
Worcester will become clinical practicum sites for students from the Department of
Logopaedics, UCT and the students from the University of Stellenbosch, respectively. This
hopefully will provide the students with much training in aural assessment and
rehabilitation at a community level as well as provide the HARK project with support,
allowing for increased numbers of children to be seen.
7. ENT (UCT) EAR CAMPS
The HARK Project and the Department of Otolarngology, UCT, have worked in close
collaboration over the past six months concerning the ear camps. The ear camps have been
conducted in the sites adopted by the HARK Project. This has allowed for additional
medical support at these sites. The ear camps provide ear care to persons of all ages,
however as the focus of the HARK Project is on early identification and intervention,
discussions regarding HARK's involvement in the ear camps being restricted strictly for
children are currently being held.
Research currently being undertaken involves measuring the efficacy of the use of solar
powered hearing aids in a developing country (See Appendix F - research proposal). Two
groups of hearing impaired children, one in the Cape Metropole and the other in the
Boland/ Overberg have been identified for the research project. Ear moulds have been
manufactured for the group of children in the Cape Metropole Region. Prior to the fitting
of the aids the need to re-assess the children's hearing and the need to work closely with
the parents of the children was recognised. This resulted in some time delay however it
was felt imperative that the audiologists work closely with the parents regarding the care
and use of the hearing aids so as obtain reliable results in the future.
The Department of Logopaedics will act in support of the research project in terms of
providing sophisticated technology, which will allow for an objective hearing aid fitting
to be undertaken for each child in January 2000. Evaluation of the efficacy of the hearing
aids will be undertaken using quantitative and qualitative measures at three and six
months post fitting of the hearing aids.
Future research to be undertaken in 2000:
The sensitivity and
specificity of the Developmental Screening Tool for the
screening of hearing impairment in children between the ages 0-18
The role of an interpreter
in aural rehabilitation and parent training programmes for
hearing impaired children
concerning hearing impairment in the Western Cape
9. DATA COLLECTION/ STORAGE/ANALYSIS
Each patient's case history and audiological information is collected and filed on site.
This information is then entered into a data base at the Deaf Child Centre.
Recently, the HARK Project was provided with assistance from a student recruited through
the Job Opportunities Bureau (UCT) and funded by the Kellog Foundation. The student's
assistance allowed for all the data gathered over the past four months to be stored using
the software "Statistica". In order for the student to be able to undertake this
task, she attended a course on "Statistica" offered by UCT. The cost of her
course was funded by the Deaf Child Centre. This package allows for an in-depth and
efficient means of analysis of the data.
10. FUND RAISING
Liaison with the Development Office at UCT has been undertaken. Through the Development
office fund raising proposals have been forwarded to two possible sources of funds.
Additional funding is required to support the salary of a cultural broker who will assist
in the interpretation of linguistic and cultural issues.