The Impact of Covid-19 on Auditory Rehabilitation in LMIC

Low and middle income countries have long been known to have deficient health systems when compared to developed countries owing to the inability of LMIC’s to possess a working system of health insurance that provides financial protection for specific sections of the population, increase healthcare service utilization and improve quality and lastly non- existent synergy with private entities to extend the reach of the health system. It cannot be overlooked that over the last few years, there have been some level of improvement in healthcare system in LMIC’s especially with the survival rates in areas of geriatric care that had previously led to increased deaths. The healthcare systems now have the capacity to
considerably manage some of the conditions hence reducing mortality; however an area of the health system that is seriously lagging is the provision of continuous care for patients that require rehabilitation services post-survival.

Rehabilitation in LMIC
There is little evidence on access to rehabilitation services in LMIC’s, however access is expected to be quite limited considering the workforce of rehab professionals which is a key component that determines access to services. In addition to that, review of healthcare systems in LMIC’s reported a similar challenge including limited knowledge of disability
services, guidelines and accreditation standards, and non-coordination amongst health sectors. The WHO estimates that there are less than 10 skilled rehabilitation practitioners per 1 million population in LMIC’s. With specific reference to hearing care professionals there is less than 1 practitioner per 1 million people in Nigeria while less than 5% of people requiring assistive hearing devices have their needs met. Needless to mention that unmet needs for rehabilitation has devastating impacts on individuals and their families, a huge economic burden to the country and a reduce in quality of life experienced.

State of Audiology in LMIC
The unavailability of Ear and hearing care services is thought to be associated to the non-existent comprehensive healthcare system in LMIC’s. This poses a significant challenge to the growing number of persons who require these services thus giving rise to the emergence of the Audiology profession in these climes recently. Approximately 80% of the 466 million persons living with disabling hearing loss are resident LMIC’s most of which lack the human or other infrastructural resources required to effectively combat the hidden disability that can easily go undetected and have compounding effects on quality of life.

Challenges in Audiological Service provision due to Covid-19
The pandemic has been an eye opener towards many new ways in which service delivery can be implemented remotely in the healthcare sector as questions surrounded how patients’ needs could be met without flouting Covid-19 response orders and putting the professional and others at risk. For the Audiologist, meeting up with the needs of clients posed a challenge at first as they constitute a specific section of persons whose therapeutic
activities were tied around having human contact. The response measures put in place to control the spread of the Covid-19 only amounted to isolating the already isolated. Social isolation has been a marker of hearing loss, thus the physical distancing measures put in place to manage Covid-19 further reinforced the feelings of loneliness experienced by persons with
hearing loss. In addition, the mandatory use of face masks which serves as an ally in the fight against Covid-19 presents a great challenge for persons with hearing loss as they reduce acoustic transmission of sounds and prevent speech reading. Asides the above, patients have reported that there is a high risk of knocking of their hearing devices when taking off their
facial coverings. Lastly, the increased reliance on remote communication technologies inadvertently segregates these category of persons as it may be difficult for them to follow the conversation due to sound distortion in these technologies.

Way Forward
Hearing rehabilitation professionals can continue to meet patient needs by making use of telehealth services when possible although this can never replace face to face professional services. Professionals can also continue to support their clients and families by reaching out to them to show solidarity and make them aware of their availability to support their communication needs in ways that align with safety precautions. Furthermore, persons with hearing loss can reduce the functional impact of Covid-19 by making use of Masks with a plastic panel over the mouth, make use of speech-to-text mobile apps and written scripts to aid communication challenges.
In conclusion, improving access to rehabilitation care in LMIC’s need to be seen as a priority area and this can be done by ensuring there is a sincere leadership and governance structure that promotes disability-inclusive development, strong partnerships in health sector, investment in infrastructure/human resources and research.