Audiology in Mozambique Profession Nonexistent 10 Years Ago in Southeastern African Country World Beat
World Beat  |   August 01, 2008
Audiology in Mozambique
Author Notes
  • Dee Naquin Shafer, an assistant managing editor of The ASHA Leader, can be reached at
    Dee Naquin Shafer, an assistant managing editor of The ASHA Leader, can be reached at×
Article Information
Hearing Disorders / Professional Issues & Training / International & Global / World Beat
World Beat   |   August 01, 2008
Audiology in Mozambique
The ASHA Leader, August 2008, Vol. 13, 28-29. doi:10.1044/leader.WB.13102008.28
The ASHA Leader, August 2008, Vol. 13, 28-29. doi:10.1044/leader.WB.13102008.28
Malaria, 60 indigenous languages, and fundraising are just a few of the obstacles that audiologist Jackie L. Clark faces on her annual humanitarian visits to Mozambique to provide audiology services. There’s also the little matter that on her first visit 10 years ago, audiology did not even exist in this African country. As a professor at the University of Texas Callier Center (Dallas) and a managing editor of the International Journal of Audiology, Clark is well-equipped to take on the challenges.
Mozambique gained independence from Portugal in 1975 after nearly 500 years of colonial rule. In 1985 the country entered a civil war and has been at peace since 1995. Clark says this history has shaped the attitudes and culture of the Mozambicans, who were “brutalized” as a colony.
“They are the most tolerant and patient people I have ever come across,” Clark said. “They’re stoic. I’ve seen children and you know they’re hurting, but you won’t see them cry. They’ve had so many disappointments, but they keep their chins up and keep going.”
Her first trip took place in 1998 after an invitation from fellow church members in Dallas, who had traveled to Chicuque, Mozambique, to teach English the previous year. Clark e-mailed the missionary nurse at the Chicuque Rural Hospital to learn more about the community’s needs.
“It’s a teaching hospital that trains nurses. I told them I was an audiologist and would be happy to do some training with their medical technicians or whatever the need might be,” she said. “I had no idea what was possible.”
Overcoming Barriers
That first trip was funded through financial contributions from friends and equipment donated by manufacturers. Clark brought some stock ear molds. After surmounting that hurdle—fundraising—she next dealt with the language barrier.
Out of the 60 tongues spoken in the country, Clark settled on the national language of Portuguese and worked with a translator. She taught medical technicians how to do basic screenings and other basic pure-tone air and bone conduction tests.
“I showed them a hearing aid—they had never seen one. They call them ‘hearing apparatuses,’” she said. “I was able to dispense hearing aids out of the handful I brought. The first person to receive an aid was an orphaned boy.”
The boy appeared to be about 14. As a toddler, the boy was on the streets during the civil war—an example of the harsh conditions endured by Mozambicans. Because he couldn’t hear or speak, his story is unknown, Clark said.
Making Progress
A greater challenge for Clark arose in 2004 when children who are deaf were mainstreamed in schools. In making this change, Mozambique was following the lead of other developing countries. But education for children who are deaf had started only five years before.
“It was poorly planned. Children who can’t speak or hear Portuguese are being mainstreamed,” Clark said. Many children progress only to fourth or fifth grade, because no instruction in sign language is allowed beyond that age. “It’s not unusual to have a 21-year-old in the first grade. To be promoted, you have to speak and write Portuguese—and that’s not going to happen for these children.”
It is a sign of progress, however, that children who are deaf are being educated at all. In Africa a man’s wealth is calculated by the number of his children, Clark said, adding, “If the child is ‘broken,’ the child doesn’t count. In the past, a man did not want any ’tarnish’ to show in his wealth.”
Because tribal languages include both an oral component and signs, Clark has recruited a local young man to learn sign language to help with translation and to tutor the school children who are deaf. Every year she seeks to improve services and hopes someday to have a school for the deaf. One recently implemented program trains social workers to screen the hearing of children in the remote villages so that they may try the school system.
For the past three years, Clark and her team have been screening students in the first, third, and fifth grades in one school—a total of 1,800 children. Last year Clark was awarded a research adjunct teaching position at the University of Witwatersrand in neighboring Johannesburg, South Africa. This appointment may help in her quest to involve more South Africans in the hearing screenings and improve the continuity of hearing services.
“The most fun is when you see the kids who are hearing their mother’s voice for the first time,” she said. Families will walk hours to get to Clark’s hearing clinics.
Hakuna Matada
To reduce the possibility of contracting malaria, Clark schedules her travels to Mozambique during the North American summer, when it is winter in the southern hemisphere. Even then, she must still take anti-malaria medication.
The most difficult aspect of her travels is raising money for the trip every year. Clark says she calls the different hearing aid manufacturers annually and has a core group that is very helpful. She also has spent many years organizing a humanitarian audiology committee.
“We’re working on ways for it to be easier for audiologists to serve on humanitarian projects,” she said. Some years, students and other audiologists or professionals accompany Clark, and the team can range from 12 to 24 members.
Clark said she is a “Type A personality” and calls six weeks before her trips to confirm the schedules and accommodations. Aside from insufficient money, one of the difficulties she faces is that Mozambicans are not as focused on planning ahead as she would like.
“It’s so different,” she said. “The attitude there is ‘hakuna matada’ [no worries].”
Jackie L. Clark, a clinical assistant professor at the School of Behavioral and Brain Sciences, University of Texas/Callier Center, Dallas, can be reached at
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August 2008
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