After a whole lot of airport delays, I’m back from the Dominican Republic and excited to share with you all that I experienced about hearing loss in the developing world.
First, some background. It is estimated that there are approximately 78,000 children with hearing loss in the Dominican Republic, but statistics are inexact. There is no national program of infant hearing screening, and many children with hearing loss are not identified until they fail to develop speech by five or six years old, when the parents realize that there might be a hearing problem. Hearing aids and audiological services are not covered by the country’s health program, and good hearing health services are scarce even if people do have the money to pay for them. Only a handful of cochlear implants have been performed in the country. There is great stigma against people with hearing loss, and people with disabilities in general. They are usually isolated in their homes, segregated from their communities, and given few educational or vocational opportunities. Accessibility of public spaces is poor at best, and, if children with disabilities receive education or rehabilitation, it is almost always in a separate school (often privately operated) and rarely integrated with peers in typical public education. In the Dominican Republic, people with hearing loss are still referred to as sordomudos, or deaf-mutes. Every morning when we entered the taxi and told the driver where we wanted to go, each driver, every single one, every single day, said, “La escuela para sordomudos [the school for deaf-mutes]?” Umm… no. The school for the DEAF. There is still a huge misconception that hearing loss means people are deaf, mute, and stupid, not that they just have a problem hearing.
We arrived in the Dominican capitol of Santo Domingo on Tuesday evening and headed immediately to Boca Chica, a small city outside of the capital. After dropping our bags at the hotel, we went to a local Lions Club meeting. It was so heartening to me to see that, all over the world, there are good people working together to make their communities better. On the night that we visited, the club was discussing a project to donate toothbrushes and toothpaste to two thousand local children and educate them about dental health. We shared gifts from an American Lions Club, told the Dominican Lions a little about the hearing loss project, and headed back to get a good night’s sleep before beginning our first full day of work.
The next morning, we headed to San Andres, a very small, very poor town close to Boca Chica. We visited CASSA: Centro de Asistencia para Sordos San Andres (Center for Assistance for the Deaf San Andres). CASSA is a play on the Spanish word casa, which means house. The school runs in an old house and has about fifty students in two programs – the morning program is for younger children who communicate using listening and spoken language and the afternoon program is for older children who need sign support. In the morning. Most of the students in the morning program wear at least one donated programmable hearing aid. To compare, most, if not all, of the hearing aids used in the US today are digital with high-level technology with settings that can be customized on a computer, whereas these children had hearing aids that could be more roughly programmed by adjusting screw-like switches on the body of the aid. Some children could also connect into a body-worn group FM system. Some, however, had lost or broken aids, or were so profoundly deaf that the available technology was of little benefit. The school, located on a busy street, was also very, very noisy. Streets full of loud music and motorcycles combined with open windows, tile floors, and cement walls do not make for an ideal listening environment! In the morning, I observed Ling checks (how similar we are all around the world. I wonder if Daniel Ling ever thought that his name and idea would be performed thousands of times every day all around the world?).
Next, we went to speak with the an official in the local education district about the possibilities for children with hearing loss to learn to listen and talk and the idea of inclusive education. It is always very exciting to have a chance plant the seeds in peoples’ minds that children with hearing loss are capable of so much – including learning to listen and talk! Hopefully, over time, local and national education officials in the Dominican Republic, and all countries, will grow in their understanding of the potential of ALL children and their willingness to include ALL children in integrated education programs as appropriate.
After the meeting, we headed back to the school where the children were learning more about their current unit (food
and nutrition) by making a fruit salad on the back porch. The children ate lunch cooked at the school, and piled in to the school’s brand-new gua gua (bus/van) to be taken back to their houses. Then, we sat down with the school’s four teachers and two parent consultants (parents of children with hearing loss who visit the other students’ parents to strengthen the home-school connection and provide support). We talked about some listening and spoken language teaching skills and general matters of the running of the school. It was a fantastic stretch of my skills to provide coaching and training in Spanish and I loved every minute of it! The teachers are women from the community with no formal training in speech and hearing science, speech pathology, or deaf education. They have maybe a high school degree and have received “continuing education” – type training in previous missions. Even though so much separates us, we have so much more in common. We all deal with managing student behavior, we all want more opportunities for children with hearing loss, and we all love and support our students so very much.
Before leaving, we peeked in on the children in the afternoon program. These children are older (upper elementary to early twenties), later identified (maybe at 5-7 years or even later), and many had not previously received any kind of education. They communicate using a mixture of home signs, ASL, and Dominican Sign Language. On that particular afternoon, volunteers from a local religious program had come to do crafts with the students. They were making various goods to sell at local markets. They got a real kick out of having their pictures taken and seeing the images on our digital cameras (technology they may not have seen before). It was sad to me to see children who, in the United State, could have been learning algebra or English or biology making what were essentially arts and crafts to peddle during their “school” time, but when you consider that the alternative for these children would be to be isolated from the community and hidden at home, I guess this is better than nothing. But better than nothing is not good enough for our kids. Better than awful is better… but it is not always good.
That evening, we spent a little time on the beach of Boca Chica. While an afternoon at the beach is usually supposed to be a relaxing activity, this one left me profoundly disturbed. There is little sanitation in the Dominican Republic. Any open land or empty lot becomes a garbage dump and breeding place for disease. Only the nicest houses have plumbing and running water, and sewage runs through gutters in the streets. As a result, the water at the beach is very polluted, and tap water in the country is unsafe to drink. On the beach, there are small, small children selling various things to earn the equivalent of a few cent in the U.S. Many of them have been sent out of their homes to beg or are being abused by someone who forces them to go out and make money that they must immediately give to the “boss.” There are also people with disabilities who walk along the beach to beg… or they crawl. I was sitting on the beach when, out of the corner of my eye, I saw a figure moving across the shore. It took me a while to realize that it was a man, hunched over with limbs bowed by rickets or some other cause, crawling along on all four limbs. This man, a human being with dignity and worth, was crawling like an animal, alone and ignored. How can you see something like that and not come away changed? I will never forget his face.