Lasting Ear Care in Malawi Audiologist Courtney Caron spent four years in Africa creating a full-service hearing care clinic from the ground up. In the Limelight
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In the Limelight  |   November 01, 2018
Lasting Ear Care in Malawi
Author Notes
  • Jillian Kornak is a writer/editor for the ASHA Leader. jkornak@asha.org
    Jillian Kornak is a writer/editor for the ASHA Leader. jkornak@asha.org×
Article Information
Hearing & Speech Perception / Hearing Disorders / International & Global / In the Limelight
In the Limelight   |   November 01, 2018
Lasting Ear Care in Malawi
The ASHA Leader, November 2018, Vol. 23, 20-21. doi:10.1044/leader.LML.23112018.20
The ASHA Leader, November 2018, Vol. 23, 20-21. doi:10.1044/leader.LML.23112018.20
Name: Courtney Caron, AuD, CCC-A
Title: Clinical audiologist
Hometown: Las Vegas, Nevada
It was on her second month-long trip to Malawi in 2013 with the program Hearing for Humanity (HFH) that it hit Courtney Caron: She wanted to spend a lot more time there, devoting herself to building sustainable hearing care in the country. Although Caron saw significant progress in the scope of audiology services, she believed the key to long-term success was training local clinicians to provide care and decrease their dependency on global aid.
Fellow audiologists Rebecca and Peter Bartlett (a married Australian couple providing services in Malawi since 2010 and the program’s local partners) encouraged Caron to apply to Sound Seekers, a London-based organization that works to bring access to hearing health care services to developing countries.
What began as a casual conversation about Caron’s goal would eventually turn into a five-year project and lead to a self-sustaining Malawian audiology clinic.
Seeing a need
Audiology first took hold of Caron when she was an undergraduate at the University of Nevada Reno. “I liked the science, I liked the communication aspect, helping people with their communication issues,” says Caron.
Then, while pursuing her graduate degree in audiology at Arizona State University (ASU), she learned of Hearing for Humanity—an initiative founded by Ingrid McBride, ASU’s director of audiology, with a mission of providing humanitarian audiology services in Malawi.
Caron traveled to Africa three times with HFH, even delaying her graduation for three months for her final trip as a student. On the ground in Malawi, Caron realized how her skills and training could make a long-term difference with organizations like HFH and Sound Seekers—which provide the accompanying training and build-up of infrastructure—as opposed to other organizations that may perform only hearing aid drops without regard to local partners or follow-up care.
“What makes me so passionate about this is that every organization that I’ve been involved with has always wanted to provide a high level of care, regardless of where we are,” she says. “We do everything from comprehensive diagnostic testing to hearing aid fitting and verifying. We’re not just doing quick and easy. We’re taking the time to do every part of it.”

Patients viewed prevalent ear infections as typical. “Things like draining ears was thought to be a common ailment, like a runny nose.”

If you build it …
After researching the work of Sound Seekers, Caron saw the opportunity to make a lasting impact. Sound Seekers worked closely with the government of Malawi to lay the groundwork for a network of comprehensive audiology services, including education for children with hearing loss, sponsorship of mobile outreach services, and education and training for Malawian audiologists.
Caron signed on as a volunteer with Sound Seekers and, in June 2014, arrived in Blantyre, Malawi, the country’s second-largest city and its center of finance and commerce. Her goal was to set up a comprehensive audiology clinic at Queen Elizabeth Central Hospital (QECH). Caron got to work building the clinic from the ground up: from deciding where walls needed to go, to how many outlets were needed for equipment, to placing furniture. She also needed to create forms and official protocols, increase the medical equipment and supplies, work with the local government to obtain the proper permits, and assess the clinical competencies of local clinicians.
Originally, as the sole professional audiologist, Caron supervised three audiology technicians. She trained two additional technicians and an ear mold technician, and via Sound Seekers, sent two Malawian clinicians to the University of Manchester in the United Kingdom to obtain their master’s in audiology (a year-long program followed by about six months of clinical supervision back in Malawi with Caron).
Once up and running in 2016, the clinic catered to patients of all ages, with pediatrics the largest treatment population. Middle-ear problems were the most common, says Caron, as many patients were survivors of childhood illnesses like malaria and had suffered from treatment delays. Patients viewed prevalent ear infections as typical. “Things like draining ears was thought to be a common ailment, like a runny nose,” says Caron.
Outreach and education
A big part of volunteering with communities in need, stresses Caron, is providing a high standard of care while increasing health literacy. “There’s some fear about having to go to the hospital, about what can happen at the hospital,” she says. “But with education, the message definitely spread.”
Caron and her team also spread their message of hearing health services via a bright-yellow land cruiser. Provided by Sound Seekers, the cruiser pulled a mobile clinic, powered by a generator, on a trailer. Caron praises her fellow health care providers for making the outreach missions a success.
“I think our top number was 170 patients in one day, and that’s in about five or six hours,” she says. “In Malawi, people may be walking almost 15 miles just to get to a district hospital.”
Caron had assumed she’d mainly help to fit and verify hearing aids, but found a bigger need for medical treatment of hearing loss.
“One thing I really like to stress is how much treatment was needed for wax removal and infection … [but] we do need more hearing aids in general, because hearing aids don’t last as long there because of the harsh living conditions,” she says.

In Malawi, people may be walking almost 15 miles just to get to a district hospital.

Measuring success
Caron returned to the U.S. in July, leaving behind a full-service audiology clinic. The last several months of her stay focused on the hand-off to her Malawian counterparts. She’s confident that the quality of clinical care will remain high.
“In the last six months or so, people weren’t coming back to my desk and asking ‘Dr. Courtney, what’s this?’” she says. “I wasn’t getting as many questions and that was my biggest measure of success: To walk down the hall and see three patients being treated, and they didn’t need me.”
Caron hopes that other audiologists looking to volunteer abroad also consider, if possible, volunteering for long periods. “But if people don’t have the time, consider donating to a responsible program like Sound Seekers, Hear the World, Hear in Africa, or EARS, Inc.—charities that focus on high standards of care, abilities training, and building infrastructure.”
For audiologists interested in helping international communities in need, Caron also recommends attending the annual conference of the Coalition for Global Hearing Health. Participants can connect with others in their field, including teachers of the deaf and ENTs, who have experience in global health work.
“[Working abroad] is extremely rewarding. It is also extremely frustrating. I never felt so amazed over such tiny successes,” says Caron. “You really need to uphold a high standard of care. Just because there’s no electricity, [you may think] we can’t do this, we can’t do that … well, a lot of our work is battery-operated and there is power generator. There’s always a way.”
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November 2018
Volume 23, Issue 11