China had One Audiologist - Kit Roberts Johnson

China had One Audiologist

Speech therapy took me to China!

In 1986, I joined a Speech Pathology and Audiology Educational Exchange with China as an SLP Delegate. We traveled to five cities in the country. In each city, we exchanged information with local schools, clinics, or hospitals. Because I had recently attended the internationally acclaimed Mayo Clinic for five days of laryngectomee rehabilitation training, I used that information for my exchange. I prepared a talk about esophageal speech and packed an electrolarynx, which I could demonstrate and pass around to the attendees to see and try. On that three-week trip, I had my eyes opened to the depth of fear, poverty, and lack of services available to the Chinese people.

A Chinese American audiologist traveled on our tour. She had relatives in China, and naturally, she wanted to see them if possible. She expressed to me her worries about entering the country and her even deeper concerns about leaving it. I knew China was a Communist country, but I didn’t understand its depth as a police state.

When we arrived at the airport, Customs detained her. A guard took her away into a dingy room. Our tour hosts did their best to find out the issue. One of them stayed behind while the other one helped the rest of us leave the airport and find our hotel.

Four hours later, the audiologist was released. She said they questioned her over and over about her family. Time passed while she waited for the higher-ups to respond to the airport guards about what to do with her. As an American citizen with an American passport, they couldn’t have kept her forever. It unsettled all of us, to say the least, that she was detained in the first place.

The information we shared on the educational exchange flowed in both directions. We, therefore, had the opportunity to learn what the Chinese were doing for people with speech and hearing problems. In one city, we visited a junior high school for the deaf. Once they graduated from elementary school, the deaf students attended a trade school. At this facility, they learned to make dentures. They did excellent work.

The students spoke in sign language. Not one had hearing aids, and oral instruction wasn’t offered. I asked one of the teachers about elementary school, “What methods do you use for younger children?”

“Sign. All teaching uses sign.”

There was nothing wrong with that, especially if hearing aids weren’t offered to the children. Only knowing sign language, the deaf students couldn’t communicate with non-deaf people, but they developed a complete language with sign language. That is a definite positive. And probably their spelling and written language had also been developed. We didn’t learn anything regarding reading and writing.

Sending hearing-impaired students to a vocational school at such a young age had its benefits. These people developed a trade, which provided an income if they were hired after they graduated.

This small school was one of several trade schools for the deaf, each with a different trade. It held fifteen students. I wondered what happened to the thousands of deaf children who didn’t get into one of these trade schools. I wondered about that for our own deaf children in America. What were their prospects for work after graduating from school?

Most of our programs combined oral and sign language. If the student could benefit from hearing aids, they acquired them. At the time, about two to three of every 1,000 American children were born with a hearing impairment. There were over one billion people in China in 1986. I will leave it to my dear, gentle reader to do the math on how many children born in China had a hearing impairment that year alone. How many could have benefited from hearing aids, but had no access? The number is staggering. Although bush Alaska had the economy of a developing country, a hearing-impaired child received hearing aids. But did they learn sign language?

The next day, we went to a big hospital in Beijing. As I walked into the large lobby area, I saw hundreds of people waiting to be helped. A wide staircase on the back wall ascended several steps, turned and then went up again to get to the second floor. Our delegation walked through the waiting people, some standing in lines and some sitting on the discolored steps.

The cement steps were worn and sagged in spots from all the people that had reluctantly or fearlessly stepped on them. I didn’t want to touch the handrail area, made of the same cement, as it was grimy and browned as if it hadn’t been cleaned in years. The walls were painted a pale yellow, but that had chipped off in many areas. Old white or green paint was visible underneath the chips.

It must have seemed cheery when it was first painted a soft yellow. But now the walls were dirty, dingy, and decrepit. The hospital reminded me of one I’d seen in a WWII movie about the Philippines.

The only audiologist in China worked in this hospital. Yes, I mean he was the one audiologist in the entire country of China. There were no speech-language pathologists. He presented a case to us; a twelve-year-old girl with a cochlear implant. That surprised me.

Cochlear implant was a relatively new treatment for sensory-neural hearing loss. It meant that her cochlea, the organ of hearing, didn’t function. The implant used an electrical current to stimulate the cochlea, so sound could reach her brain. The device returned hearing to those who had lost it due to injury, illness, or damage to the cochlea.

A few years before this trip, I visited the House Clinic in Los Angeles, whose staff performed cochlear implants. I learned about the surgery, the pros and cons of it, and the kind of person that benefited from it. A good candidate had normal hearing, or at least some hearing, before the age of two. If a child didn’t hear during the first two years of life, the part of the brain that analyzed sound pruned itself. By not receiving stimulation, the brain could no longer “hear.” This is called being cortically deaf.

The same held true for seeing. If a person was blindfolded for the first two years of his life and then the blindfold was removed, thus restoring his visual access to the world, the optical analyzer in his brain/cortex wouldn’t work. He’d be cortically blind, even though he had perfectly normal eyes.

If one was born deaf, therefore, inserting a cochlear implant years later was futile. If one had no hearing aids, no auditory stimulation, and had a profound bilateral, sensory hearing impairment at birth, a cochlear implant was not indicated. This recommendation was based on years of research with the device. What were we about to see then, as this twelve-year old Chinese girl had experienced profound deafness since birth with no hearing aids?

The audiologist treated this young lady wonderfully. He was proud and protective of her. She came into the room wearing a pretty dress and a sweater, her long black hair held back with a headband. He asked her to turn on her device so that she could hear. Since her surgery a year ago, he had been working with her. He asked her to say some words that they had practiced. Her voice was high pitched, much like the voice of any deaf child when they first try to speak. Through her sign-language interpreter, we were able to ask her questions. Someone asked her how she liked hearing. She shyly indicated, with sign language, that it was too noisy.

Not having been exposed to any sound for her whole life, I imagined how jarring sound must have been for her. It was meaningless. I didn’t have much hope for her, but it wasn’t my place to say anything. I didn’t specialize in it, and who knows what miracles could occur? After thirty minutes, we politely thanked him and left.

Finally, I lectured on laryngectomee speech rehabilitation, at a medical school attached to a hospital. I stood in front of a classroom, filled with young men, all sitting at individual desks like we would have in high school. Through an interpreter, the students listened closely to my talk and asked questions. They were interested in the artificial larynx, which I passed around and let them use. Everyone laughed appropriately when I demonstrated the esophageal speech technique, a kind of burping sound.

I completed my obligation. Hopefully, they found my information useful. There were high incidences of laryngeal cancer in China due to smoking and cooking with fire. Perhaps someone in the audience would be inspired to provide this form of rehabilitation.

During the cultural exchange, our group met with several doctors (all men) who lectured us on the use of acupuncture for surgery. As usual, this small clinic was old, drab, and dimly lit with fluorescent bulbs. We all sat in large, faded chairs, upholstered in shiny faux leather, though the shine had worn off on the seats and arms. The doctors served us tea and were calm and polite. They seemed confident in what they were about to share.

They revealed that they studied the use of acupuncture to perform laryngectomy and that acupuncture worked just as well as anesthesia, but without the side effects of anesthesia. Obviously, they knew much more about acupuncture in China than we did in America to get those results. I didn’t want to be one of the patients receiving acupuncture anesthesia and I wondered why it was used? Perhaps it was done because they didn’t have enough anesthesia or anesthesiologists trained to perform the number of surgeries needed? Maybe it was a way to use old methods with modern surgery? If it worked, more power to them. They had a billion people.

One of our exchange destinations included visiting a preschool for children ages five and under. It surprised me with its uniqueness. In one room, I observed little girls in matching pink tutus. They practiced a ballet routine, with their hair tied up in a knot on the top of their heads. Their actions were crisp and uniform, considering their age.

Another room swelled with children who had small violins. I heard them playing together, over and over. Once again, for their age, I was impressed with what they were able to do. Some concern, however, crept into my mind.

On the one hand, I felt like I had entered some bizarre Stepford world that took children and made them alike. If they succeeded, they continued to be rewarded. On the other hand, what if they couldn’t keep up? What was their fate?

I knew a “model” preschool had been selected for us to see. But the amount of pressure that had been placed on the children to be able to perform this way at such a young age must have been tremendous. I probably watched the cream of the crop. Where were the children with special needs? What were they doing?

One evening, we were on our own for dinner, in a part of town filled with street vendors selling food. The locals descended from their apartments holding containers for their soon-to-be-purchased meals. Tables and chairs were available outside as well. It seemed like a routine event.

How simple to come home from work, saunter onto the sidewalk, and buy some dinner. And with it being so warm outside, I wouldn’t have to heat my apartment by cooking. Since there were so many food choices, I wouldn’t get bored with what I was eating. It appeared so inviting and an opportune chance to experience the local culture and food. The audiologist and I decided to step out and buy something from a vendor. She spoke Chinese, so I felt comfortable that we would get some delicious local food and know what was in it.

As we crossed the street from our hotel to the other side of the road, a mob of people started to crowd around us. I was a head taller than most of the people and blonde, so I stuck out. Clearly, I was not Chinese. They were talking to us. I was smiling. I didn’t know what they were saying, but the audiologist was speaking back to them in Chinese. Pretty soon my audiologist friend said in a concerned tone, “We should go back to the hotel.”

It seemed that the masses weren’t making positive remarks. In fact, they were offensive and aggressive. So, I experienced discrimination against an American woman. Since I didn’t know what they were saying at the time, I never felt afraid. It was a reminder, however, that I wasn’t in a free country, and that I hadn’t been taught to believe Americans or Chinese were bad people. It demonstrated the hatred of discrimination, and why we should all fight against it in all its forms, always. Discrimination is a learned behavior and needs to stop. I surely wanted to try some of that food, dang it.

Wherever our delegation traveled, we were always treated politely by our counterparts.  We were welcomed, shown to our seats, and served tea. The Chinese treated us with respect, even though we were Capitalists, and they were Communists.

We were in China for three weeks. During that time, I wore less and less makeup, my hair got greasier and limper, and my clothes mutated to rumpled and lifeless. Except for my blonde hair, I resembled a local. When we boarded Singapore Airlines to head home, I was stunned at the beauty of the employees.

The Singapore Airline flight attendants appeared tall with their black hair pulled up and tucked under a red pillbox hat. They wore matching, vibrant red skirts and white blouses with a red floral print. Small, red scarves were tied around their necks. They wore pearls. Their glowing skin and makeup were flawless. I stared at them in amazement. These women look like models in a magazine.

Then, I realized that I was going back, returning to a different world. The world I was used to was starkly different, but we had one thing in common in Alaska—poverty.

I recently looked up the statistics for the number of audiologists and speech pathologists in China in 2020. Surely in those thirty-five years great progress would have happened. The estimate for trained audiologists was 2,000. That was for 1,411,788,724 people (that’s one billion…). In America there were four qualified audiologists for 100,000 residents. At least the Chinese have more access to hearing aids and the diagnosis and treatment of children and adults with hearing disorders. It is clear they need many more audiologists.

When I visited China there were no speech-language pathologists. It was estimated in 2020 that there were 1200 SLPs, working mostly in medical settings. Loma Linda University School of Allied Health helped to educate and graduate some of those SLPs. Therefore, the work of sharing, as I experienced, had grown to a real education and a great benefit for the people of China. They had one speech pathologist for every 1.3 million people. In America we had forty-one qualified speech pathologists for every 100,000 residents. People with communication disorders are everywhere and deserve qualified treatment. The Chinese are no exception. May their audiology and speech pathology programs flourish and thrive. We must continue to bring treatment to those who suffer, whether they live on the tundra or on the Li River.

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