ABC Clinic

June 6th was our first day in clinic at the African Bible College in Lilongwe. We spent the night before with the Bartletts and ABC students having dinner and sharing memories about our previous trip in June 2012. It was great to see familiar faces and for our new students to get to know our hosts. We ate delicious food prepared by the Barletts and prepared for the upcoming week in the ABC clinic.

Our first day in clinic was a bit hectic, with many patients to see and poor communication about the expectations for the day. As the day went on, we got into more of a groove and worked better together as a group. It's always a challenge the first day of work, as we need to adjust to a new culture and working style. Overall we were able to see 17 very difficult to test patients using conditioned play and visual reinforcement audiometry. Each patient took a long time to test, but we were able to get reliable results from most and fit a few hearing aids.

Alex, Kristina, and Mandy all lectured on various topics (OAEs/ARTs, anatomy and physiology, and the science of sound) to the ABC students. They all really enjoyed the experience and were grateful to the ABC students for being receptive and willing to learn new material. The students are very enthusiastic and ask many questions, which is so gratifying to an instructor. 

At the end of the day we debriefed, which allowed us to plan better for the next day and iron out the challenges we were facing. We established a plan of attack for seeing patients and talked about some of the patients we saw. Everyone went to be early since we were exhausted from a hard day's work. 

June 7th was a much better day in clinic. Some of us even wished we had more patients to see because we were so organized that we had little to do while patients waited to be seen. Many of the patients seen were around the age of two and scheduled for visual reinforcement audiometry. Almost all had multiple handicaps (blind, visually impaired, motor delay, epilepsy, delayed speech, Down syndrome, etc) and took time to test. As the day went on, we discovered that there was a need for ABR and ASSR because of the inability to reliably test these patients with behavioral measures. Dr. Belus and Laura spent a great amount of time in the afternoon trying to get the equipment up and running. In the end we were not able to run the ABR equipment but conducted ASSR on a few patients. Because it was late in the day, many of the young children did not want to sleep, and therefore were unable to be tested due to artifact from movement. However, we were able to confirm profound hearing loss in one child with no speech and delayed motor milestones. The patients who we were unable to test will return on Monday for more testing. In the meantime we will continue to try to get the ABR working. 

Naomi lectured the students on embryology and pathologies relates to audiology. The students seemed a bit overwhelmed at first but really enjoyed learning about how to diagnose many of the disorders that we see frequently in Malawi. One student mentioned that he loves the diagnostic portion of audiology because it is like putting together a puzzle and each test is a piece to the puzzle. 

Overall, our second day in clinic went much smoother and as a group we felt confident in our organization and testing protocol. No crazy things in ears yet, but I know Courtney is waiting for it! At the end of be day it was great to debrief about our successes and the patients we saw. We all went to be very early (7pm at the latest) because we were exhausted!