Western Australia-East Java Sister State Audiology Development 1994-2007

Ian Henderson, Audiologist

1. First Steps

This story began in 1994 with a chance meeting between Mrs Patricia O’Sullivan (Founder, Patricia O’Sullivan Humanitarian Project) and Mr Warren Butler,at a trade fair in Jakarta.  Mr Butler was Operations Manager of my Australian Government employer, Australian Hearing. The Governments of Indonesia and Australia had recently signed an MOU on Health. This included the modeling of Indonesia’s hearing services on those of Australia’s 50 year old Commonwealth program. Mrs O’Sullivan was inspired by the work of Professor and Sri Haryono at Sekolah Karya Mulia and Bina Anaprasa on a previous trip, and vowed to assist with their future progress. One of her key allies in doing so was the WA Department of Commerce and Trade, and it’s Surabaya representative at the time Mrs Annemie Gilbert.

Mr Butler and Mrs O’Sullivan’s agreement to improve services for deaf children at in Karya Mulia lead to my first visit. Funding and practical support came from the WA-East Java Sister State relationship, the Australian Commonwealth Government, Meerilinga Young Children’s Foundation of WA (Inc) and King Aid P/L. It was included staff training and the fitting of donated hearing aids at Karya Mulia and Dr Soetomo Hospital.

I was impressed on that visit by the work of many people, including the Haryono’s, Dr SoekesiHernomo, Pak Benny Sampirwanto and Pak NurHadi.

Dr.Soekesi(Dr.Soetomo Hospital) and Dr.Faisa(Kasoem, Jakarta) collaborated with me on a one day presentation to the ENT Society and guests, “Seminar Audiologi Dan Permasalahannya”. The themes were low cost to high tech audiology and the future needs of East Java.

A half day parent seminar at Karya Mulia was also conducted. It focused on language stimulation at home and the experience of children with different degrees of hearing loss (with and without hearing aids). Some of the parent’s questions included

-          “how can parents encourage speech and language development of children living in a boarding school?”

-          “what can you do if a child is embarrassed to wear hearing aids?”

-          “can long term hearing aid use lead to better (auditory-alone) skills?”

This was the first in a series of parent seminars to be held in Surabaya and Malang.

Following this visit a Hearing Services Needs Report was drafted. It was based on discussions with officials, practitioners and parents; observation of services; and local statistics.

2. Infrastructure & Training

It was quickly agreed that skills and infrastructure development were needed in order to make real changes for deaf children and their families; and for teachers and health professionals themselves to be change-makers. So, under the Sister State banner many staff from Dr Soetomo Hospital and KaryaMulia travelled to Perth and Darwin for training modules.  They developed skills in the following

-          assessment of paediatric and adult hearing

-          early detection and intervention

-          hearing aid fitting and evaluation

-          auditory verbal therapy and sign language

-          ear mould manufacture

-          technical repairs, calibration and equipment maintenance

-          stock control

-          national and international sourcing of materials

Key hosts included Speech & Hearing Centre, WA Institute for DeafEducation, Cottesloe School for Hearing Impaired Children, Dr Harvey Coates ENT Clinic, MeerilingaYoung Children’s Foundation of WA (Inc), Australian Hearing (Perth & Darwin) and Pierce Laboratories. In the 2 latter placements, practical competencies were assessed and exam papers translated to Bahasa.

3. Multi Disciplinary Team

It was obvious that audiology development in isolation of educational, education and medical support would be unsuccessful.  All visits subsequent to my “lone ranger” effort were therefore made by a multi disciplinary team.  These included 2 Audiologists, 2 University of WA Audiology students, a Technician and 3 Teachers of the Deaf. Of the latter, Mrs Marie Kormendy continues to work on the development of Special Education for children with hearing loss in East Java.

Professor Haryono guided me whenever cultural or religious questions arose e.g. the challenge of optimising language stimulation for a hearing impaired child with many siblings, local views on disability.Sri and Sinta Gutomo of Yayasan Aurica provided advice over these years also, based on their extensive experience of early intervention as practitioners and parents.

Dr Nyilo Purnami and Pak Benny Sampirwanto have meanwhile emerged as the agents of organisational change necessary to improve services “on the ground”.

4. Technical Workshop & Ear Mould Laboratory

An ongoing issue is the prohibitive cost of hearing aids to most parents, and their long term maintenance. It was therefore resolved to establish an ear mould and technical laboratory at Karya Mulia.  While the question of hearing aid cost remains unresolved, the goals of affordability and sustainability were promoted significantly by this initiative.

Mr Ian Bruckshaw, an experienced Technician fluent in Bahasa worked on this facility for many years. He and his trainees at KaryaMulia, Pak Eko and Pak Adib formed a close team. One outcome was an impressive level of skills in hearing aid repair and equipment calibration. Another was the manufacture of quality soft compound moulds, of importance to the successful fitting of high powered hearing aids. Prior to this hard acrylic moulds predominated.

Hearing aids were donated by Australian Hearing’s 70 or so Centres across Australia, and Lions Foundation in Perth. Many were used for spare parts. As the pool from which these were drawn was the mainstream adult population, high powered aids were uncommon – yet required for the mostly profoundly deaf children at Karya Mulia. Another challenge was the transition from analogue to digital hearing aids – the latter requiring computerized programming for each hearing loss. The Rotary donation (below) therefore included technology suitable for digital hearing aids.

During this phase, equipment destined for the workshop found their way into the baggage of many Australian visitors.

5. Ibu Basofi Sudirman and Mrs Marlena Jefferey: Sister State Project Patrons

These hearing projects and the early childhood development initiatives of Mrs. O’Sullivan  were formally endorsed by the then Governor’s wives of the 2 Sister States, Ibu BasofiSudirman and Mrs.Marlena Jefferey. They became project Patrons and supported the joint projects with their generosity and official status. A visit to Ibu Basofi by Professor Haryono and Australian team members in 1995 helped raise the well known profile of this project further. In 1996 a WA Government House Civic Reception was held in honour of the visit of IbuBasofi and Professor and Ibu Haryono.

   

6. Rotary East Java Hearing Project 1995-01

An historic partner of fundamental importance was Rotary – thanks mainly to Mr Guy Setiadi in Surabaya and Dr Brian O’Brien and Mrs Marie Kormendy at Floreat Club (WA).

Mr Setiadi’s contributions included fundraising and architectural design, while Dr O’Brien spearheaded the WA/EJ Rotary Matching Grant project (per the Rotary Foundation of Rotary International) – a major donation of audiological, medical, educational and technical equipment plus hearing aids. Yayasan KaryaAdi was another other partner while Australian Hearing’s role was sealed by MOU with Floreat Rotary. 350 kilo’s of equipment valued at over $200,00 was sent from Perth, Sydney and Darwin to Surabaya.  Initial and consolidation training programs were built in to this program, with the help of the WA Department of Commerce and Trade.

The design and building of an infant assessment booth with test equipment at DrSoetomo Hospital was another outcome of this generous donation.

7. Final Projects

The last 2 of my 8 visits to Surabaya for were for specific purposes:

In 2006 I conducted an East Java Early Childhood and Community Development Needs Assessment on behalf of POSH.  This was to serve as a guide to current resources, Government policy and future directions for child development, overall (not just hearing).  In the process I convened a meeting between officials of the Departments of Health and Education. One principle acknowledged at the meeting was the value of sharing data on early childhood between Departments – so that in principle, early detection can more quickly lead to early intervention than is currently the case.

Incidental to the Needs Assessment, asignificant clue was given to a possible future funding source, the corporate dollar – a brief visit to a multinational stevedore resulted in funds ($10,000) sufficient to rebuild a dilapidated early childhood centre. At least then, local legislation required companies to contribute 3% of profit to community welfare projects. On the one hand, key people such as Sri Haryono, Ibu Lani and Dr Nyilo have a solid track record of attracting external resources for projects and materials. On the other, it was agreed that developing this capacity further through grantseeking coursesfor select personnel would be of obvious future benefit.

In 2007 I supervised 2 Audiology Masters students, Ms Dilani Wijeratne and Ms Ha Nguy in their Surabaya placement – a joint University of WA/POSH project. The ladies honed their skills in hearing assessment and hearing aid fittings at Dr Soetomo Hospital and Karya Mulia.Longer placements with the help of Australian funding programs for young adult volunteers and Rotary NSW were later explored.

Summary

The result of these projects included:

-          audiology and technology skill development

-          development of atechnical workshop and ear mould laboratory

-          installation of a wide range of technology for hearing assessment and rehabilitation

-          several hundredhearing aid fittings for children and adults of low income

-          ENT, GP and teacher training

-          KaryaMulia policy development,in consult with (the late) Professor Haryono and Sri Haryono.

Lessons learned fromEast Java projects were later applied elsewhere i.e. training programs in Jakarta, Bogor, Madang and Denpasar.

Factors which helped produce positive outcomes were:

 i) a stance of “technique before technology” i.e. new equipment only introduced with attendant training, and an emphasis on human qualities alongside (but not subsumed by) technology;

ii)the development of long term WA-EJ partnerships and friendships;

 iii) a commonly shared andgenuine desire to improve services for families and deaf children and

 iv) the exceptional vision of key identities, in particular Professor Haryono and Mrs O’Sullivan.

More recent developments reflect these strengths plus a keen awareness of past weaknesses. The short courses and equipment donations described were invaluable however on their own,couldn’tbe expected to produce sustainability. While a generous spirit prevailed from Day One, the flow of resources – both material and time - was also inconsistent. The momentum required for elevating the combined projects to “the next level”consequently remained elusive. It is encouraging therefore to see more recentWA-EJ plans* for education, infrastructure and resource centres in East Java i.e. new servicestangible to the public, plus the long term investment of tertiary education.

Terima Kasih

For all your advice, generosity and time, I would like to sincerely thank “keluarga besar”** - project partners, mentors and friends.

Ian Henderson

Audiologist

June 2012

* A joint venture between Hearing Aid East Java (incorporating the Patricia O’Sullivan Humanitarian Project), Tim Pengembangan dan Manajemen Anak Berkebutuhan Khusus’ Jawa Timur and The Disability Services Commission, Western Australia.

** translation: “big family”