Humanitarian Audiology Here & Abroad: An Interview with Randa Mansour-Shousher, Au.D.



AP Staff Reports

Dr. Mansour-Shousher, thank you for taking time to discuss humanitarian audiology. Can you share some details about what led you to establish HearAide as a nonprofit?

Dr. Mansour-Shousher: My private practice, Northwest Ohio Hearing Clinic, introduced its nonprofit audiology program in 2015, to provide hearing assistance for the growing number of uninsured and under-insured in the Toledo community. Today, HearAide is the only nonprofit hearing center serving Lucas County and Wood County, Ohio. The clinic offers a full suite of diagnostic testing and hearing aid fitting services to individuals who would otherwise go without these services.

HearAide is structured to provide a long-term no-cost or low-cost care solution that benefits the patient and society. We use a “Circle of Giving” program that requires HearAide patients to volunteer in the community. The service requirement promotes self-sufficiency, builds feelings of self-worth, helps prevent social isolation, and ensures that HearAide patients are invested in their own hearing healthcare. It also makes it easier to distinguish patients who genuinely need financial assistance from those who do not.

In addition to the efforts of HearAide to serve your community in Northwest Ohio, you have also expanded your humanitarian efforts to serve the global community. What prompted your decision to go global?

Dr. Mansour-Shousher: I am a citizen of the world! My parents were Palestinian immigrants. My father first came to the United States with $75 to his name. He worked hard and served in the US army during the Korean War, after which he earned a science degree, while selling carpets door to door in the South. Dad went back home and married mom, who became a refugee in 1948 when her family lost their home and business during the war in Palestine. My parents left Palestine and resettled in Paris, France, where I was born—yes (oui), I am a French girl! After my father completed his medical residency, it was au revoir Paris and hello, Toledo!

I arrived in the United States at 5 years old, with a heavy French accent and no friends. I was self-conscious, shy, and isolated. I communicated very little. I was lonely. Looking back, I believe this experience influenced my desire to become an audiologist, and in the same way, my immersion in different cultures from an early age, seeded my desire to serve internationally.

Understanding the history and the struggles of our extended family made a lasting impact on me and my siblings. My parents never forgot their homeland or their duty to help their fellow countrymen (and women) obtain education, adequate food and housing, and opportunities for mentoring. My husband, Hussien, had parents with similar values, so we both learned early on that an essential part of a happy, healthy life is being able to be of service to others. While visiting family in Jordan and Palestine each summer, we learned more about the culture and also the great need for hearing healthcare services.



What are some of the biggest differences between serving patients in the Middle East compared with Northwest Ohio?

Dr. Mansour-Shousher: Unlike in the United States, a large percentage of Palestinian and Syrian refugees have hearing loss due to lack of medical care, genetic complications, and war-related trauma. Those with middle ear pathology often go undiagnosed. It is extremely common to encounter large groups of individuals with severe to profound sensorineural hearing loss that has been left unidentified or untreated. The influx of Syrian refugees into Lebanon and Jordan has compounded the need for hearing health services and diluted available resources. It is impossible to address the hearing health needs of the refugees without negatively impacting access to care for Jordanian and Lebanese citizens. In Palestine, the situation is exacerbated by increasing unemployment and physical/geographic restrictions that prevent citizens from seeking care. None of these areas have a universal hearing screening program, let alone any type of hearing screenings in the schools. Hearing aids are a luxury in this part of the world. None of these Middle Eastern countries have ready access to cochlear implants (CIs). Many individuals, even children, are denied care because they cannot produce required documentation of citizenship or a national identification number.

For example, Mirna and Maya are twin sisters who were born with a severe-to-profound hearing loss that was left untreated. They live with their mother, aunt, uncles, and cousins in a three-room home in a refugee camp in Madaba, Jordan, where I met them for the first time. I felt immediately connected with them and wanted to help. Our team returned the following year and the girls had still not received assistance.

Mirna and Maya were not able to be helped with traditional hearing aids and required cochlear implants. However, the implants aren’t available in the refugee camps. Making it even more difficult, the twins were born to a Jordanian mother and a Palestinian father. Because their father is Palestinian, they lacked the necessary identification number required to get medical treatment in the camp.

After we were unsuccessful in obtaining CIs through the Jordanian government system the third year, I came home and took responsibility for their care as a pro bono case. Cochlear Americas graciously donated a complete system including all accessories for implantation. I was able to secure the otologist, anesthesiologist, and audiologist in Jordan who also donated their services. HearAide raised funds to secure the hospitalization costs and rehab cost for pre- and post-implantation. We are still in constant contact with the family and tracking their progress.

Do you have recommended best practices or helpful tips that audiologists should consider when providing humanitarian audiology services abroad?

Dr. Mansour-Shousher :When planning an international humanitarian audiology mission, please consider the following suggestions:
  1. Partner with local experts for success. Identify and partner with organizations that are familiar with local customs and the political climate. HearAide works with the United Nations Refugee Welfare Association (UNRWA), which is an arm of the United Nations. UNRWA has helped us on the ground during the mission trips to the West Bank/Palestine. Their social workers complete home visits to determine qualifications and maintains a record of individuals in need of audiology services. In many cases, UNRWA can provide patient records, including audiograms if they are available, which can be sent in advance of the trip. This allows us to prioritize those who are eligible and filter out those who may not be helped with hearing aids.

    It is a good idea to follow up with audiologists and/or physicians in the area, and the Ministry of Health. These local clinicians can often help identify individuals who may live in remote areas or who have been overlooked by other organizational partners. It is essential to have people on your mission team who understand the local language, culture and customs.
  2. Organize and replicate (as much as possible) a clinic design that will facilitate success and good patient flow. HearAide has found through experience that stations work very well.
    • Registration: At this station, collect identification (names and numbers) to better identify patients and reduce duplication of services. If possible, develop complete patient files with photos as many people may have the same names.
    • Triage: At this station, an audiologist should review prior test results and/or check hearing aids, if applicable, and perform otoscopy
    • ENT/Medical Clinic: At this station, a medical doctor can assess conditions that require medical intervention and/or assist with cerumen removal to save time with the audiologist. It is a good idea, if possible, to assign a volunteer assistant to work with the physician.
    • Screening: Set up OAE and tympanogram stations and perform tests. If possible, use local audiologists and audiology students to assist with testing.
    • Testing: At this station, the audiologists will conduct air-conduction and bone-conduction tests. The audiologist and volunteer document the results of the audiogram and bring patients in and out.
    • Earmold lab: At this station, the audiologist takes the impressions and volunteers make the earmolds.
    • Hearing Aid Fitting: When possible, it is most efficient to set up two fitting stations, equipped with Real Ear or another method of verification. Assign a volunteer to assist, in addition to two audiologists.
    • Counseling: At this station, the patient will review an instructional video and receive verbal instructions. HearAide has been lucky to have a speech pathologist as part of the team.
    • Art Therapy: At this station, children can draw, paint, and tell their story while they are waiting.
    The entire process takes about 1.5-2 hours per patient and (if warranted) they leave with hearing aids and supply of batteries.
  3. Remember that people are people and patients are patients. People and patients around the world have more in common than one may realize. The patients that we serve in the Middle East express many of the same emotions as our patients in Ohio. Stigma knows no boundaries. Many patients are self-conscious and either not willing to wear hearing aids or only want to consider CIC-style hearing aids, even though BTE-style hearing aids are often more durable. Some individuals insist on a certain brand of hearing aid, even if they are unfamiliar with the features or specifications. Other individuals have a difficult time accepting the new that they don’t qualify for a hearing aid, or that a hearing aid won’t help their condition. Finally, patients in the Middle East feel the same joy and get the same Hearing Smile as patients in Ohio when they hear the world for the first time.
  4. Strive to create a program that is sustainable and offers follow up care. The mission clinic should be equipped to minimally provide hearing screenings, hearing tests, and hearing aids. In some cases, manufacturers are willing to donate or reduce the cost of hearing aids for humanitarian audiology efforts but be prepared to spend a lot of time raising money to purchase hearing aids and batteries. Going back to the same location at regular (yearly) intervals is helpful for continuity. Another way we are working to sustain the HearAide program is by providing a grant to the local university, audiologists, and students to provide clinical space and follow-up services for patients. The grant allowed for the procurement of equipment and a sound booth that will allow for the latest treatment protocols to be followed.
  5. Get some experience before going it alone. Audiologists who have an interest in humanitarian audiology should join and participate in an international mission trip, before trying to plan one from scratch. HearAide and other missions are always looking for volunteers. It truly takes a village to organize and complete a mission! If you would like to help but are not able to travel, there are opportunities to fundraise and donate to the cause. Missions like HearAide are always raising money for hearing aids, supplies, and equipment needs. With the high CI population, we are also working on providing financial assistance to individuals who need medical surgical care. Keep in mind, there are a lot of audiologists such as myself who are willing to mentor those interested.
What are the most challenging and rewarding aspects of operating a humanitarian audiology program in Jordan and Palestine?

Dr. Mansour-Shousher: The greatest challenge is educating the community about the need for early identification and intervention for hearing loss, and from there, establishing a newborn universal screening program.

It has been most rewarding to be able to relate to the culture, to understand the language and the needs of the people and to provide my skills back to my parents’ homeland in their honor. HearAide has also grown into an even greater family give back program. During our last trip in September 2019, I was accompanied by my siblings and parents who all took a job in the mission and ran with it. I am also proud that my children, Yasmeen and Marwan, have joined on mission trips and have established their own philanthropic goals. Having a supportive husband, amazing children, and grandchildren has made me the luckiest wife, mother, and audiologist. Knowing the value of helping those who are in need will be carried on is PRICELESS.

Knowing we are helping those who may never have the opportunity, giving them the chance to complete their education, achieve their personal goals, hoping they would have an opportunity to leave the refugee camp and make a difference and give back in their own way. I leave praying what we provided will enhance their future. I want to make an impact in our local and global community and create a legacy. The gift of hearing is truly from my heart.    
Dr. Randa Mansour-Shousher is an audiologist with over 30 years of experience. She earned her Bachelor of Science degree from the University of Toledo, her Masters of Science degree from the University of Michigan and her Doctorate of Audiology (Au.D.) from A.T. Still University. Her specialties are tinnitus, vertigo and the latest hearing aid technologies. She is highly-skilled in diagnosing hearing loss, dizziness, tinnitus disorders and developing personalized treatment plans. She may be contacted at drrmasour@nwohc.com or (419) 383-4012.

If you would like to donate to HearAide, please visit: https://www.centeraap.org/funds/view-our-funds/hearing-call-fund/ or www.HearAide.org.