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Ten Years On: How Two Australians Kickstarted Malawi’s First Hearing Training Centre

Mar 4, 2024

In October 2023, Malawi’s first audiology training centre – the African Bible Colleges Hearing Clinic and Training Centre – celebrated its 10-year anniversary. Developed by two Audiology Australia (AudA) Accredited Audiologists, the centre has been instrumental in expanding and retaining hearing health services in the landlocked East African nation in the face of a population boom.

Bec Bartlett with Alinane Malili, lecturer and head of department Audiology at ABC, with third year students.

As the nation’s population hits 20 million, the centre and its Bachelor of Science in Audiology degree are already playing essential roles in meeting growing demand for ear and hearing care, having produced 18 audiologists. An important step in fostering local expertise.

While still small in scale, the initiative has helped place Malawi on equal footing with the rest of the continent which averages 1 audiologist per million people. A world apart from Malawi’s situation 10 years ago when the nation had no local audiologists.

Peter Bartlett, who co-developed the centre and the program with his wife, Bec, spoke to AudA about the milestones, revealing with pride its enviable status on the continent. For Peter, a training program is key to retaining talent where it is needed.

“We’re in a good position because other than in Malawi, South Africa and Egypt, there are no other audiology degree programs in Africa. And if you have no training programs, then there’s a high chance that you won’t have any audiologists unless they leave the country and come back.”

Building Healthcare Capacities in One of the World’s Poorest Nations

The idea for the centre and a program originated in the early 2010s, after Peter and Bec – who were by then already well-known for their outreach initiatives across remote Australia and the Asia-Pacific – decided to uproot their family and commit the next stage of their lives to building an overseas audiology program from the ground-up.

“We had felt so blessed to have a university qualification and work as audiologists and we wanted to give back in a bigger sense. We had already spent months working in locations like PNG, the Philippines, India, and Cambodia, and with Aboriginal and Torres Strait Islander peoples in their communities, but we wanted to do more,” says Peter.

Backed by EARS. Inc, a non-profit Christian organisation that Peter had co-founded in the 1990s to set up hearing healthcare training programs in low-income countries, and based off the EARS Inc. project run in the Dominican Republic by AudA Accredited Audiologist Dr Donna Carkeet, the couple put out the call to their networks. Eventually, they discovered and resonated with African Bible Colleges and Malawi – a nation known as the ‘Warm Heart of Africa’ for the deep generosity of its people despite its significant economic challenges.

Before they knew it, the couple had successfully pitched the program to the college and were sitting on a plane with their three daughters, departing Melbourne for the multi-city flight to Lilongwe, Malawi’s capital, 10,000 kilometres away.

“Bec happened to come across African Bible Colleges and everything was lining up: they had a university, a primary and secondary school, and a medical clinic, so we put out an expression of interest. What we didn’t know was that the director’s wife had done speech pathology training and out of her understanding of our services quickly said that we could join them and run audiology out of the hospital,” says Peter.

“I would never recommend anyone sell their possessions and take three young girls to a place that you’ve never been to before, but we just felt a strong call to step out in faith and trust in God’s provision.

“We became the first two registered audiologists in Malawi at a time when there were 14 million people.”

Rebecca and Peter Bartlett with their three children.

 

“It’s Taken a Village”: Designing Malawi’s First Audiology Curriculum

For Peter and Bec, the implementation of a program at the African Bible Colleges proved to be challenging. The couple were granted permission to train students at the colleges in audiology units from August 2012, before the establishment of the clinic, however it wasn’t until years later in 2017 that the Bachelor of Science in Audiology was officially launched with their first intake.

Part of the delay was due to the African Bible Colleges’ initial proposal to run a diploma-level training course being declined by the Medical Council of Malawi, which preferred a degree-level course to be initiated by the colleges.

“We didn’t want to have a brain drain from Malawi. Our fear was that if you got to a degree level, you’d become internationally recognised and we knew that some students would want to study and work overseas, which they had every right to do. Unfortunately, this is what has happened with five of the 18 audiologists we have graduated, who are now working successfully in the NHS in the UK, to support their families back home,” says Peter.

With additional administrative issues that demanded their attention and unexpected regular phenomena from the tropical environment, the Bartletts began to find the humour in the daily challenges that came their way.

“We used to call these issues the ‘surprise of the day’ and yell out ‘surprise!’ whenever we were dealing with one. I remember one day in my first year, I was managing the hospital, and the radiographer came into our management room to tell us that there was a snake in the X-ray machine.”

Lecturer in audiology Kamuzu Chiponde doing wax removal with Ruth, an audiologist at the hearing clinic.

Through the challenges, there was one clear constant: the resilience of the local students who had taken it upon themselves to break new ground as Malawi’s first generation of audiologists and make a difference in the world of ear and hearing care.

In fact, an entire community was beginning to rally, with staff at the colleges and people from the local towns eager to support their children. The community also grew further abroad, with international donors, and overseas audiologists from different walks of life who had heard about the work of the Bartletts and come to offer their services through ABC and EARS Inc.: AudA members Lois Grant, Rosie Leslie and Rosie Morrison, Helen Brough (UK), Dr Jenna Vallario (US) and Dr Lawrence Hill (UK).

“It’s about sharing a vision, and I think that’s the real miracle of Malawi: that other people capture the vision for what you think is important. You know the phrase, ‘It takes a village to raise a child’? Well, it’s taken a village to raise the child of audiology in Malawi.”

The strength of the local community was a source of comfort to the Bartletts during years of hard work to establish the program. It also gave them confidence they were leaving things in good hands when they decided to return home to Australia. Right to the end the sense they were building a ‘village’ remained.

“I remember during my last outreach in 2016, before I left the country, we were sitting in a village in the kind of place you couldn’t find on a map. I remember cleaning out an ear canal and just sat up and looked around and saw my team around me, including Helen, and then seeing our team of Malawian trainees doing the same thing: some doing hearing tests, others making moulds and fitting hearing aids, and just realising that aspect of multiplication through a culturally appropriate model,” Peter recalls.

How the Bartletts Continue to Support the Program from Australia

Today, the college’s Hearing Clinic and Training Centre is highly regarded within Malawi’s Ministry of Health. Three of its graduates are now employed in the country’s central hospitals to amplify their hearing healthcare services. The centre’s audiologists are also being given international research and other collaboration opportunities, with one audiologist recently travelling to the 2024 American Auditory Society’s Population Hearing Health Care Conference to present findings on the prevalence of outer and middle ear pathologies at the clinic.

Since leaving Malawi in 2016, the Bartletts have kept a promise to remain involved and continued supporting the program from Australia. The pair regularly work long hours outside their clinical work as audiologists, with Bec providing regular administrative support while Peter continues to advocate. In one memorable stunt he organised a 200km ‘fun run’ wearing a set of giant foam ears to raise money and awareness for EARS Inc.’s activities in Malawi.

“When we left, we made sure that everybody understood that we have an ongoing commitment to the program,” says Peter. “The 200km run came because EARS is such a small organisation and I wanted to expand our awareness initiatives. I had the idea to get people to donate to EARS Inc. and become an ‘EARS CHAMPION’ to receive videos, which demonstrate the work being done.”

Peter has very kindly shared one video that he sent to donors below:

Both audiologists take turns to return to Malawi, with Bec meeting in December with the Speaker of the House of Parliament in Malawi, the Honourable Catherine Gotani Hara, who was Health Minister when she officially opened the Hearing Clinic and Training Centre. Peter is gearing up for travel in June to provide management support, and ensure the equipment EARS Inc. has donated to the country’s Ministry of Health is being used in their four central hospitals by the first six audiologists ever employed in Malawi’s public health system.

“We do try to head back. A few years ago, we were unfortunately unable to attend the graduation of the first cohort of students because of COVID, but we are so proud of them. They’re the real heroes. One of our original 2012 students is now the Head of the ABC Audiology Department, having attained her Master of Audiology through further online training.”

While Peter admits the couple’s commitment to such large-scale outreach work isn’t for everyone, he challenges others to adopt new mindsets and consider ways they can use their skill and expertise to make a difference in the world. Big change can come from even small and incremental impact.

“I challenge you to do whatever you’re good at to the best of your ability, because you’ve been given great gifts to bless other people with,” says Peter.

World Hearing Day 2024

Sunday 3 March 2024 is World Hearing Day. This year’s theme is “Changing mindsets: Let’s make ear and hearing care a reality for all!”

Change is the only constant and in the realm of ear and hearing care it’s an absolute must, with over 80% of the world’s ear and hearing care needs remaining unmet.

To play your part and create change, please consider sharing this story on your social media channels to promote the importance of ear and hearing care for all.

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