Thida is a 72-year old woman from rural village in Kompong Speu province. Like many older people in Cambodia, Thida feels she is perceived as helpless and an unproductive member of her community. Indeed, poverty in old age is strongly associated with reduced capacity, a condition from which few escape, and it is both caused by and perpetuates chronic intergenerational poverty.
Opportunities to employ physical strength, often the most critical asset of poor people, are reduced in old age. Social exclusion on the basis of age represents a formidable barrier for the poorest older people in their efforts to achieve income and social security, and crucially their health.
There is little by way of state support. Government agencies responsible for providing basic services to the elderly lack the necessary resources to respond effectively to the needs of older people. The lack of action of government and civil society to address old age poverty indicates that ageing remains distant from the overall social development agenda.
To Thida, sounds seem distorted and voices difficult to understand. She also experiences further problems in situations where speech is imbedded in background noise, or where there is more than one speaker. Thida also has the associated phenomenon known as cochlear recruitment, which can lead to moderately loud noise becoming physically uncomfortable, even painful.
We first met Thida at the All Ears Cambodia clinic in Phnom Penh where she had a consultation regarding her hearing problems. After undergoing a hearing tests, it was evident she was suffering from presbyacusic hearing loss.
Hearing loss caused by presbyacusis is permanent and cannot be reversed with medicine or surgery. It can, however, be treated using appropriate hearing aids. An aural impression was taken to make an ear mould. She was fitted with a mini behind- the-ear hearing aid on her right ear a week later and followed up some four weeks after the fitting appointment.
Follow up appointments are also given where patients are encouraged to provide candid feedback, from which individual management strategies are instigated. These may take the form of re-prescription of hearing aids, binaural hearing aids, and further instruction regarding the management of the hearing instrument, ear mould modifications, and/or further counseling.
Thida duly returned and said she was delighted with her new hearing aid. She no longer feels isolated or depressed because of her inability to hear others around her or join in on conversations. Her greatest joy now comes from being able to hear her grandchildren and great grandchildren too.
(Name of person and location have been changed)