Two weeks ago, I attended an excellent presentation on deaf education in Costa Rica. The presenters were listening and spoken language educators, one of whom completed her training at Fontbonne in St. Louis, MO, USA. Together with other listening and spoken language professionals in Costa Rica, they are active members of Adis, an organization dedicated to:
1. Neonatal Universal Hearing Screening
2. Pediatric Audiology Evaluation
3. Etiological Evaluation of Deafness
4. (Re)habilitation Programs, where the children with hearing loss will develop communication and social skills according to their cognitive capacity
(from their website, www.adiscr.com — check it out, it’s available in both Spanish and English!)
They shared some fascinating facts about the situation for children with hearing loss in Costa Rica and what is being done to ensure that a listening and spoken language education is a viable opportunity for children in their country. Here is what I learned:
HEALTHCARE/AUDIOLOGY/COCHLEAR IMPLANTS/HEARING AIDS
Costa Rica has a public health system, known as CCSS.
All cochlear implant surgeries in the country are performed at one hospital, somewhat confusingly named “Hospital Mexico.”
Only 20-30 CI surgeries are performed per year. There is a waiting list and the order in which people receive the cochlear implant is governed by priorities determined by the government health organization.
Currently, late-deafened adults receive first priority for cochlear implant surgery. Children who need CIs are second in line on the priority list and thus many children receive the surgery at ages that would be considered “late” in the US (ages 2-4, if they’re lucky).
Currently, people with hearing loss in Costa Rica are only eligible to receive one cochlear implant. There is one child in the entire country who has bilateral CIs — her parents are both physicians and were very proactive in securing two implants for their child at a very young age. Other children are not so fortunate.
Bimodal amplification is rare in Costa Rica. Once patients receive one cochlear implant, they rarely continue use of a hearing aid in the contralateral ear (presumably due to cost).
The government pays for the CI surgery and cochlear implant, but does not cover mapping, rehabilitation, batteries, maintenance, etc.
The brand of cochlear implant available changes year to year as the government of Costa Rica negotiates contracts with the various manufacturers. Last year, all patients received Cochlear brand implants. This year, it’s Advanced Bionics. Patients are not able to choose their brand of CI.
The government also pays for hearing aids but, like CIs, does not cover therapeutic follow up, maintenance, batteries, etc. Every two years, hearing aid users receive a stipend for the purchase of bilateral hearing aids. People who want hearing aids that cost more than the government stipend must pay for the difference out of pocket.
There are currently ZERO pediatric audiologists in the country of Costa Rica. There is one student who has come to the US to study to become her country’s first audiologist with specialized training in working with children.
EDUCATION AND REHABILITATION
As noted above, the hospitals that perform cochlear implant surgeries do not provide (re)habiltative follow up — there is currently much discussion and debate in Costa Rica as to who should shoulder the responsibility for providing appropriate follow-up care for people with hearing loss — the health system or the educational system.
There is a strong capital-D Deaf Culture in Costa Rica which has historically had great influence over the Ministry of Education, especially before cochlear implants and hearing aids made listening and speaking a very realistic possibility for children with all degrees of hearing loss. As such, the public schools for the deaf in Costa Rica use what we would call a “Total Communication” approach, using LESCO (Costa Rican sign language) coupled with Spanish as their modes of instruction.
For parents who want their children to learn to listen and talk, there are 2 private preschools that provide listening and spoken language instruction (as well as integration with hearing children in a typical preschool setting) and private listening and spoken language therapist. There private programs are much more expensive than public education and, because there are fewer of them, they are less accessible to parents who desire this option.
Children with hearing loss who have learned to listen and talk are subsequently mainstreamed into public and private schools. There, they face problems of poor acoustics — classrooms are not carpeted and fans and open window add to the noise, as the schools do not have air conditioning.
WHAT IS BEING DONE?
The professionals who came to present at Fontbonne also are active in presenting a series of listening and spoken language workshops to educators in their home country. Though the ministry of public education has only total communication programs, organizations like Adis, combined with private listening and spoken language programs, are helping more and more children with hearing loss listen, speak, and succeed in the mainstream. Those examples, combined with workshops to raise consciousness about what is possible for today’s children with hearing loss, are slowly but surely changing attitudes about deafness and deaf education in Costa Rica.
Santa Paula University in Costa Rica has designed a cost-effective parent-infant program at their university clinic to provide groups of parents with deaf or hard-of-hearing children center-based listening and spoken language education in a natural, home-like environment.
Kinder Papillon, one of the integrated listening and spoken language/typical preschool private centers has started a series of parent support groups. The presenters noted that BOTH mothers and fathers of their students are active in this group — how wonderful!
Groups of students in the master’s degree program in both Speech-Language Pathology and Early Intervention in Deaf Education from Fontbonne University conducted a Spring Break service trip to Costa Rica last year. During their time in CR, the students helped to build a listening and spoken language resource library, perform hearing screenings for children in early education programs (similar to Head Start in the US), visited schools for the deaf of various modalities around the country, gave lectures and conferences on early intervention, deaf education, and cochlear implants at various universities, and visited the ENT program at Hospital Mexico.
GOALS FOR THE FUTURE
Establish universal newborn hearing screening for infants in Costa Rica.
Increase research on cochlear implants and hearing loss treatment in Costa Rica and develop assessments in both Spanish and English.
Increase the number of locations for therapy.
Increase the number of listening and spoken language workshops, raise awareness of auditory-oral/auditory-verbal methods.
Reach children with hearing loss in rural areas of Costa Rica.
Collaborate with neighboring countries (Nicaragua, Panama, etc.) to provide listening and spoken language options for children in Central and South America.
HOW CAN WE HELP?
Adis, the organization for listening and spoken language in Costa Rica, is in constant need of therapy materials, books in both English and Spanish, and information/books for parents on topics related to deafness, audiology, listening and spoken language, etc. Can you help bring the gift of listening and spoken language to the children of Costa Rica? CLICK HERE.
Elizabeth A. Rosenzweig 