The Rotary East Java Hearing Project involves extensive participation by Rotary and professionals in Western Australia and East Java, helped by the fact that the two are Sister States. It is coordinated by the Rotary Club of Floreat and the Rotary Club of Surabaya, in the regional capital of East Java. It was enabled by Rotary Foundation under Humanitarian Grant No 7781. Key partners are Australian Hearing, Dr Soetomo Hospital, the Karya Mulya school, Rotary Foundation, and the Karya Adi Foundation.
The Project has two immediate aims. First, it sets-up and equips Indonesia's first public hearing centre, in Dr Soetomo Hospital in Surabaya, East Java. A wide variety of diagnostic and testing equipment has been assembled together with essential electronic and
other facilities to calibrate and maintain the equipment. Australian
Hearing has provided expert, technical guidance for the early
detection of deafness.
Second, the project has provided extensive new diagnostic and
teaching equipment, including toys, books and other learning
devices, to the Karya Mulya School for deaf children, also in
Surabaya. Over 350 kilograms of materials have been provided, with
Mrs Pat O'Sullivan providing expert and enthusiastic guidance on
toys and teaching devices.
The needs to improve hearing services in East Java, with a focus on children, are unimaginable. Half a million children in the Surabaya area have hearing problems. Only about 2,000 children have access to deaf schools. Hearing aids are a luxury. There is a desperate need for diagnostic equipment, calibration and testing facilities, and proper training of staff. Rotarians have been moved to action by an increased awareness of the needs of the deaf in Australia and elsewhere. The word "alingual", meaning a child without any publicly-recognisable language (because of deafness), reveals a profound individual and family tragedy.
In July, 1997, the Rotary Clubs of Floreat and Surabaya fonnally sought a Humanitarian Matching Grant from the Rotary Foundation to set up the flfst public hearing centre in all Indonesia, at Dr Soetomo Hospital. In November 1997, the Rotary Foundation Board approved, offering US$15,225 in Grant #7781 to match the Australian contribution (OS$7, 725) and Indonesian contribution (OS$7,500).
But the extreme political and economic impacts in Indonesia in
1997 and 1998 caused a shortfall ofUS$4,000 (approx. Aus$6,400) in the available Indonesian contribution. The rupiah devalued sixfold. The Floreat Club and individual donors most generously and quickly made up the shortfall, and the Rotary Foundation accepted the revised budget.
The prompt response by Floreat Rotarians to the Indonesian
tragedies provided persuasive leverage convincing others to do
likewise.
A Memorandum of Understanding was signed between Floreat Rotary and Australian Hearing. With the aid of Ian Henderson, Peter Howes and Peter O'Byrne, the project has received reliable refurbished equipment from Australian Hearing to the value of over Aus$50,000. Ian Bruckshaw, Senior Technician, provides invaluable technical advice. Dr Harvey Coates and Dr Ian Wallace have donated equipment with a nominal 20-25 year life, worth some Aus$12,000. Since 1991, Mrs Pat O'Sullivan had also been discussing with Prof Harjono how to assist Karya Mulya School for Deaf Children. The Project enabled her to obtain and ship about 350 kilograms of toys and equipment to the school, giving exciting and efficient synergies with the Hospital.
Graham McHarrie, deputy-co-ordinator, a Floreat Rotarian and
Assistant District Governor, and David Edwards, Director of the
W.A. Trade Office in Surabaya, provide a variety of invaluable assistance.
ROTARY EAST JAVA HEARING PROJECT
A Partnership of . Rotary Foundation Humanitarian Grant No 7781 . Rotary Club ofFloreat (Co-ordinator) . Rotary Club of Surabaya . Australian Hearing . Dr Soetomo Hospital, Surabaya . Karya Mulya School, Surabaya . RotaryDistrict 9450 . Rotary District 3400 . Karya Adi Foundation . Rotary Club of Surabaya-Darmo . Western Australia Rotary Alumni Association
Framework for a needs assessment for the provision of audiology services
to children in East Java.
(1) CURRENT SERVICES
·What current ENT, Audiology and Speech Therapy services are available in Surabaya/East Java?
·Where are they located?
·Who provides the service?
·What type of training do the professional staff have?
·What education facilities are there for deaf and hearing-impaired children before they start school?
·What training do teachers of the deaf have?
(2) CURRENT HEARING HEALTH INDICATORS
·What is the prevalence of permanent hearing loss in children in East Java/Java/Indonesia?
·What are the major causes of hearing loss in these children?
·What immunization programs are currently available, and is this available across the whole paediatric population?
·What proportion of deaf/hearing-impaired children have hearing aids or cochlear implants?
·What is the age at which most children are first fitted with hearing aids?
·What proportion of deaf/hearing-impaired children use sign language. What sign language do they use?
·What is the cost of hearing aids and batteries?
·Where do infants/children go for the fitting of hearing aids? Which professionals do they see, and how often are they seen?
(3) WHAT WOULD NEED TO BE DEVELOPED FOR THE PROVISION OF EARLY IDENTIFICATION AND INTERVENTION SERVICES FOR DEAF AND HEARING IMPAIRED CHILDREN?
3.1 Newborn hearing screening
·Where would the testing be performed? (Are most children born at home? Do most children attend an infant clinic for health monitoring/immunization?
·Who would perform the hearing screening testing?
·What training would these staff need?
·What equipment would be needed?
·Where would children go if they have failed the screening test?
·Who/where would full diagnostic audiology services be provided?
·What training/equipment would be needed?
·What would this cost?
·What are the timelines for implementation?
3.2 Early (infant and pre-school) intervention services
·Where would children/parents go for support services once a child has been diagnosed with a permanent hearing loss?
·Could early intervention centres be link to current deaf schools?
·Would teachers/speech therapists need additional training for providing educational support to pre-school aged children (e.g. auditory-verbal training, sign language training?)
·What training/equipment would be needed?
·What would this cost?
·What are the timelines for implementation?
3.3 Hearing aids for children from diagnosis
·What would be needed to start a government program that provides hearing aids/batteries to children diagnosed with hearing loss
·Could a program be developed where government is able to purchase large numbers of hearing aids/batteries for children (at reduced cost through tenders)?
·Could hearing aids/batteries be at least partially subsidized by government with contributions from parents?
·Where would these services best be delivered? Hearing Centres connected with schools for deaf children, hospitals or independent hearing clinics?
·Who would provide these audiology services and what training would be required?
·What costs would be involved?
·What are the implementation timeframes?
4. Government Offices and other Institutions with whom we need to talk to.
Visits to at least the following places would be very helpful:
Criteria of success And Technical guidelines In Ear and Hearing Care CBM‘s advisory working group in EHC The following document is a compendium of articles produced by the members of the CBM‘s advisory working group in ear and hearing care. It has been reviewed by other professionals in this field of work and it is intended as a support tool for regional directors, regional advisors, programme coordinators and professionals in ENT, audiology, primary health care, community based rehabilitation and any other area of service and public health where CBM is involved, with the purpose to improve the quality of life of people living with hearing loss, to prevent the occurrence of hearing impairment and to manage its consequences in both the person and the society.
It is not designed or intended as a final rigid operative manual; on the contrary, it is presented as a flexible working tool, a document to be adapted and accommodated to the perceived needs of the local community where it is to be used and, if required, further developed.
There are two types of documents:
1. Criteria of success.
Designed to provide the ideal standards of service, care and management for the main aspects of the work in this mandate. Ten documents on criteria of success have been produced, grouping relevant topics which share similar outcomes and standards of practice.
They have been developed considering the differences applying to such a wide diversity existing in geographical, economical and socio-political circumstances in which the CBM projects are functioning. They are presented as a reference document, not a policy, for directors, advisors, co-ordinators and/or planners at local, district, national or regional level.
2. Technical guidelines.
Designed as practical tools to have at hand when working in developing countries in the mandate of ear and hearing care. There are 15 topics for which technical guidelines have been developed, considering their high prevalence and/or relevance, as per the advice of people working in the related areas of this field.
This set of technical guidelines is not a complete or comprehensive list, but a set of documents produced in the hope to be able to aid the CBM workers and their projects when serving at the front line of care. 4
Structure table Back
Table showing technical guidelines distributed as per criteria of success. Cos nº
Inclusion is an ideology and not
a programme.It is a concept of
effective schools where every child has a place to study and teachers become
facilitators of learning rather than providers of information. Inclusion is the
general goal in developing nations and the ways of facilitating inclusion are
many. Inclusion has different connotations in different nations.For some countries, refining the entire
educational system is the objective of inclusion whereas for some others entry
of a special needs child in general classroom itself is inclusion.Yet for some others, inclusion is a macro
level policy issue whereas for many, inclusion at the micro level (school) is
the major concern. In some nations, the child with disability has an option for
inclusive schools or for specialized programmes whereas for many developing
nations, inclusion is the only option/chance.However, accessibility, availability and affordability emerge as issues
to be addressed in inclusive settings.
The idea of making education of persons with disabilities as an INTEGRAL PART of the general
educational system is the academic interpretation of ‘inclusion.’ This implies
that the general classroom teachers should be equipped with skills to address
the educational needs of children with special needs with minimum or no
assistance of special teachers.This
calls for strengthening the pre-service general-teacher preparation programme
by including adequate component of education of disabled children in the
general curriculum.The concept of
effective schools will flourish only when the general educators understand the
individual learning requirements of disabled children.
There are three
major principles of inclusive education.The concept of inclusive education recognizes
the fact that every child in the class is special in a way or other.The children are not categorised on the basis
of the achievement or cognitive abilities or even sensory defects.They are treated as individual children
having specific strengths and limitations.This approach makes the teacher to see the child as an individual, which
is very vital for the overall development of the child.The second principle of inclusive education
is that true learning happens in a non-threatening environment. This approach focuses on using all flexible
methods of teaching in the classroom.The third principle is that the teacher plays the role of facilitator
of information rather than provider of knowledge.These fundamental principles provide strength
to the concept of inclusive education.
Parameters of successful inclusive education:
The following are
generally observed as the most common parameters for inclusive education.
1.Readiness of the general education system to accept
responsibility for education of children with disabilities.
2.Encouragement provided by the community for including
children with disabilities in local schools.
3.Readiness of parents of children with disabilities to admit
the children in local schools.
4.Basic knowledge of general classroom teachers about the
education of children with disabilities.
5.Admission of all types of disabled children in local schools
irrespective of the extent of disability.
6.Enrolment rate of children with disabilities at least on par
with that of non-disabled children.
7.Presence of proactive and flexible Government policies and
programmes to promote inclusive education.
8.Retention of children with disabilities in schools.
9.Ability of the general classroom teachers to modify teaching
learning strategies to teach children with disabilities.
10.Availability of support from peer-group to children with
disabilities and vice-versa in teaching-learning processes.
11.Provision of support materials such as assistive devices and
books.
12.Comparable achievement of children with disabilities in
curricular, plus curricular, and co-curricular activities on par with their
capabilities.
13.Availability of specialist teacher support, if possible, to
the regular classroom teachers.
14.Adequate allocation of resources to mainstream education of
children with disabilities.
15.Periodical monitoring and ensuring the accountability at all
levels in mainstreaming education of children with disabilities especially
girls with disabilities.
Among
the above (15) parameters, the first seven are related to the creation of an inclusive
climate whereas the remaining eight items are related to the inclusive
education of these children. Mere
creation of an environment for inclusion will not suffice and there should be efforts
to provide real educational support in the inclusive setting.
Inclusion of children with hearing impairment:
Though
the principles of inclusion can be applied to a large extent to all categories
of children with disabilities, certain categories pose specific challenges that
should be addressed for their effective inclusion in mainstream schools.In the case of hearing impaired children
communication is one of the main problems to be addressed in inclusive settings
and the learning environment should be adapted to overcome this major channel
of learning.
The
following broad guidelines are suggested for the success of inclusion of
children with hearing impairment:
1.The understanding of
the regular classroom teachers to the educational needs of children with
hearing impairment is the basic criterion in the success of their inclusion.
2.Even if the teachers
are not aware of sign language to communicate with these children, their
effective use of gestures will help them in learning.It will also help other children in the
classroom.
3.Use of visual cues in
the classroom in terms of flashcards, charts, teaching aids, etc., is vital to
supplement the understanding level of these children.
4.Though preparatory
training with hearing impaired children need not be mandatory for inclusion,
provision of such training, if possible will definitely enhance their inclusion
skills in classrooms.(Consider the pre primary
system in the community to help in this regard so that the mainstreaming
process could be initiated from the beginning)
5.Exemption of language
for learning should be left to the children.The adults who have passed out feel that English language learning is
useful as they are able to use their knowledge later when they learn computers
and use technology.
6.Parents have to be
involved in the education of these children and they may be encouraged to learn
sign language in order to communicate effectively with their children at
home.They must be encouraged to make
judicial use of oral communication as well as sign language with children with
hearing impairment.The same should be
insisted upon with teachers.
7.Availability of a
resource centre in the vicinity of the school when the child is enrolled may be
useful for augmenting learning experiences but this should not be treated as a
pre-condition for the inclusion of children with hearing impairment.
8.A specialist teacher
assistance occasionally will be beneficial to both hearing impaired children and
the classroom teachers for enhancing the learning of children.Over dependence on specialist teacher,
however, should be avoided and the children must be trained to depend more on
general classroom teachers, peer group and parents.
9.In order to facilitate
effective inclusion of children with hearing impairment, the specialist
teachers wherever available should encourage regular teacher involvement in
educating these children and they can offer suggestions on methodologies to be
used and at any cost should not be prescriptive.
10.Working with the
National and State Bodies concerned with the teachers’ training to incorporate
issues related to facilitating the children with disabilities as part of their
curriculum.
In
addition to the above general guidelines, the following points are suggested
for the respective stakeholders who facilitate inclusion of children with
hearing impairment
School management:
·The lighting of the black board should be good and the
children with hearing impairment should be seated in such a way that the board
is clearly seen. It is better that the child sits in the first row so that the
child is able to see the teacher clearly
·The classroom may have minimum sound distraction.
·Children with hearing impairment may be encouraged to take
part in NSS and other extracurricular activities
·The school management should follow a non discriminatory and
proactive approach in facilitating the education of the children with hearing
impairment by ensuring reasonable accommodation and regular teacher skills-upgradation
initiatives.
·Management should ensure the representation of the parents of
children with hearing impairment to actively take part in the School Managing
Committee (SMC) and other Parents-Teachers Association (PTA) meetings and discuss
specific and general issues for appropriate action.
Teachers
Role:
·Teacher should face the deaf child and speak (Face to face)
·Teacher should have the knowledge of hearing aid and its
operations
·Teacher should encourage peer group learning and peer tutoring
·Special class may be arranged for hearing impaired children
to understand abstract contents
·Repetition in teaching may be encouraged whenever necessary
·Group discussion involving hearing impaired children may be
encouraged
·Teachers should have regular follow up with parents
·Other children in the class/school should be sensitized to
understand the hearing impaired child and the specific needs and educated to be
proactive and treat them as one among them.
·Teachers should be handling the issues arising out of the
challenges with positive and reinforcing methods rather than labeling or
exposing the limitations in public.
Parents’ Role:
·Parents should not discriminate the child at home on the
basis of hearing impairment
·Parents should regularly contact their child’s teacher and
know the status of the improvement of the child
·Parents should have the knowledge of hearing aid and its
operations
·Parents should encourage child to use hearing aid
·Parents should allow the child to communicate in sign
language too
·Parents should be actively participating in the SMC/PTA
meetings and support inclusive environment.
General:
·A preschool for children with hearing impairment at each
block may be initiated which will be helpful in auditory training and speech
training.
·Training on new trends in the field of hearing impairment
should be given to regular teachers
·Change of hearing aids should be insisted at least once in
two years
·A sign language interpreter and speech therapist may be made available
at block level resource centre/health system.
·An interpreter may also be made available in the examination
hall
·Advocating for the introduction of basic identification and
stimulation supports the pre primary schools (Balwadi/Anganwadi).
·Advocating for affirmative policies and budgetary supports by
the concerned Governments and Departments/Ministries to ensure inclusive
programmes and schemes.
·Advocating for the timely availability and access to
appropriate assistive devices at an affordable cost.
·Advocating for ensuring access to higher and professional
education leading to employability and mainstreaming.
Implementation of the
above guidelines may facilitate effective inclusion of children with hearing
impairment.
