Interview with Dr Shelly Chadha, Hearing Healthcare Officer at the World Health Organization
Latest estimates from the World Health soon realised that, no matter how many cases we
Organization (WHO) are that 360 million people in the world have disabling (moderate or worse) hearing loss. This staggering figure represents 5.3% of the global population. 32 million are children and 80% live in low and middle income countries. Sadly, this figure is getting even bigger because of ageing populations, the effects of excessive noise expo- sure, inadequately managed ear infections and a num- ber of other causes all of which are far more common in poorer countries.
This is a massive but neglected challenge that demands a global reaction. Only WHO can lead this response, but WHO does not have the internal budgetary resources to fund a post in Hearing Health.
This is a massive but neglected challenge that demands a global reaction. Only WHO can lead this response, but WHO does not have the internal budgetary resources to fund a post in Hearing Health. Furthermore, the World Health Assembly (WHA; representatives of 34 countries that comprise the WHO Executive Board) has not considered Prevention of Hearing Impairment since 1995 and in the intervening period WHO estimates of disabling hearing loss have trebled. A consortium lead by a British charity, the Hearing Conservation Council (HCC), and joined by the International Federation of Otolaryngological Societies (IFOS), the International Society of Audiology (ISA), the American Association of Otolaryngologists (AAO) and the Christian Blind Mission (CBM) came together with other organisa- tions that work with WHO in order to provide funding for a post at WHO specifically responsible for the Prevention of Deafness and Hearing Impairment (PDH). Together they have raised funds well in excess of $500,000 so that this work could be started.
Prof Michael Gleeson spoke recently with Dr Shelly Chadha who was appointed to the post at the WHO in Geneva in December 2011 and has already made huge progress.
Tell me about your upbringing and education
I was born and brought up in New Delhi and obtained my medical degree from the University of Delhi. It was there that I decided to specialise in otorhinolaryngology and was eventually awarded a chair, being made a professor. A very large part of the work in my department was related to ear diseases and their complications. At our hospital I encountered many deaf children. It never ceased to amaze me that the majority had never been investigated or treated for their hearing loss previously. In terms of rehabilitation, options were available but only at a tertiary centre and accessible by very few. In the community setting, there was a total lack of awareness, meagre services for those deaf patients that were recognised and, worse still, an overwhelming stigma attached to deafness. I very soon realised that, no matter how many cases we operated on every day, we were only just scratching the surface of the overwhelming problem of ear diseases. It eventually dawned on me that if we really wished to reduce the problem of ear disease we needed to follow a public health approach and not merely a surgical one.
A training in otorhinolaryngology is one thing but public health medicine is quite another. How did you get the experience to qualify for your post at WHO and develop global hearing programmes?
Having developed a strong interest in the public health aspect of otorhinolaryngology, I had the opportunity to work with the Ministry of Health in the Indian Government to develop the National Programme for Prevention and Control of Deafness in India which was launched in 2006. At the same time I was invited to join the Sound Hearing 2030 programme that was initiated by WHO at their South East Asia Regional Office (SEARO). My appointment as advisor to CBM’s South Asia Regional Office (SARO) and later as a member of CBM’s advisory working group on ear and hearing care helped me to experience both ends of the health provision spec- trum – the community or grass root level as well as policy making at an international level. So, when the position of technical officer for PDH in WHO was restarted and advertised, I felt that I was ready to take on the challenge of making a difference, not just in the community or at a national or regional arena, but at the global level.
How are you going to make the changes in hearing health that you so obviously want? Tell me about your strategy at WHO.
The main aim of my work at WHO is to promote ear and hearing health at the global, regional, national and community levels, to ensure that fewer persons develop ear diseases and hearing loss and that those who do, are able to access suitable care and services.
I follow what I like to call a two-pronged approach. The first prong is ‘advocacy’. Advocacy needs to be carried out at all levels: global, regional, national, sub-national and community level in order to raise awareness. The tools for raising awareness at each level are different and it is WHO’s role to ensure that suitable tools are developed and actions initiated to undertake this advocacy.
The second prong is ‘support to Member States and partners’ in developing technically strong, effective, sustainable programmes for ear and hearing care. It is WHO’s responsibility to provide technical inputs for developing such programmes and support these with the required tools for training, awareness creation, rehabilitation, monitoring and evaluation.
You have only been in post for just over 18 months. What have you achieved during that time?
Following the two-pronged approach, I have worked to undertake advocacy within and outside of WHO. The development of suitable technical and advocacy documents was pivotal and we have released new global estimates for hearing loss and its causes in an effort to raise awareness. I have promoted ear and hearing health within WHO and developed partnerships with those programmes which intersect with our field., such as Disability and Rehabilitation, Assistive Devices and Essential Medicines, amongst others. Linkages are also being strengthened with the regional offices and countries. A regional workshop on ear and hearing care will be held in the Eastern Mediterranean region in November this year and a similar workshop in another region is proposed for the next year.
Efforts are ongoing to promote 3rd March as the International Ear and Hearing Care Day. This has served to raise awareness about the problems of ear diseases and hearing loss within WHO and its International Partners as well as amongst Member States. An increasing number of the Member States are observing this day and using this opportunity to promote ear and hearing health.
A very important task is to improve accessibility to hearing aids in developing countries through technology transfer. A meeting about this was held earlier this year and a ‘preferred product profile’ is under development. Over the last two years, a number of Member States have initiated or carried forward the process of development of their national plans and programmes for ear and hearing care, with technical support from WHO, either through on- site meetings and workshops or through online technical support.
Which countries have you decided to focus on and why?
At WHO it is the Member States or countries (i.e. the WHA) that form and drive the agenda. WHO responds to the requests of its Member States for technical assistance and input. Certain countries have been prioritised due to the interest expressed by their ministries, and others due to the opportunity created by the pres- ence and interest of International Partners. The countries which are currently focussing on ear and hearing care include Sri Lanka, Malawi, Nicaragua, Morocco, Republic of Guinea and Samoa.
Your life must have changed considerably since working in Switzerland. It must be a huge contrast to your work in India? How have you coped?
Oh gosh yes! Before coming to WHO I had worked in one of the leading and largest medical colleges in India. My day was divided between clinical work and teaching both undergraduate and post graduate students. Outpatient clinics were an exercise in clinical and managerial skills with 60 – 70 patients in every clinic. I dealt with the whole spectrum of diseases from otitis media to advanced head and neck malignancies. When I first arrived in Geneva and got to work in my new position, I was like a drug addict deprived of her daily fix. Working here in a more sedate and organised environment, I miss taking care of my patients and the satisfaction of helping them. I miss the interaction with my students, who always kept reminding me of all that I don’t know and who have taught me many valuable lessons in life. And, certainly, I miss the feeling of hands-on research, undertaking school screening, going to the community and much more. But, I tell myself that I am working here for a greater cause and pray that I am justified in thinking so. What drives me is the knowledge that together we can make a difference and I hope to serve as that force which can help join all the indi- vidual efforts across the world and help create the ‘we’ which shall be a tidal force, changing the landscape of ear and hearing care across the world.
So far the consortium led by the Hearing Conservation Council has been the catalyst for your very important work. Do you believe that every national ENT society has a moral obligation to help support the post at WHO? After all, a problem shared is a problem halved and relatively small amounts of money all add up.
I do believe that all agencies relating to otolaryngology and audiology as well as persons with hearing loss, need to join this effort to develop a sustainable programme, which will help to draw more attention worldwide towards ear and hearing care. This joining of efforts has to be both financial and technical. Considering that there is no long-term stability for the WHO post currently, ensuring the sustainability would need to be the first priority.
Do you get time to relax and what are your outside interests?
Over the past few years, I have developed the habit of regular meditation, which helps me to stabilise myself and deal with the daily ups and downs of life with a relatively calm mind and positive outlook. I like to read old English classics as well as modern day thriller fiction. As a family unit, we love to travel and experience new places and cultures. But, what I enjoy most is spending time with my family; my husband, children, parents, sister and all the aunts, uncles and cousins who are an integral part of an extended Indian family. My idea of the perfect time-off would be to spend a day talking, laughing and eating with my family.
Shelly, thank you so much for finding time to talk with me. I have learned so much from you and look forward to reading about your progress on the HCC website – www.hearinguk.org .
This article is reproduced by kind permission of ENT & audiology news and Pinpoint Scotland Ltd.
Interviewed by Prof Michael Gleeson, MD FRCS FRACS Hons FDS Hons, University College London Hospitals, UK.