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  Newsletter 1998-1S - published April 1998 

Hans Verschuure, Secretary-General ISA 

This issue is a special issue for the AAA meeting in Los Angeles. It
was, unfortunately, not possible to compile a full newsletter because I
have been ill and full compilation and reproduction could not be finished in time. 

We wanted to have a newsletter to distribute at the AAA meeting and
our third newsletter was not particularly interesting as the greater part of its contents dealt with the changed constitution. 

This newsletter should give you some idea of what a normal newsletter looks like although it is only half a newsletter. The presented articles deal with the international aspects of the work of the International Society of Audiology, its connections with the developing world through Hearing International and with WHO. 

One of the HI-IFOS-ISA Centers is located in Costa Rica. The aims of these HI-IFOS-ISA centers are to raise awareness of auditory problems and to find ways to implement services in the country using its own infrastructure. One of the best examples of such a service is the Costa Rica Center that has done a prevalence study in Costa Rica schoolchildren. Preliminary results of this study were reported on a PASA meeting organized at the AAA meeting in Fort Lauderdale last year. Here is an update showing how such an initiative can develop into general acceptance in a country and a good dissemination of knowledge. 

Report from Costa Rica 
Dr. Juan J. Madriz, MD. (Director "Costa Rica IFOS/ISA/HI Regional
Centre"; San José, Costa Rica) 

The year 1997 has been a very productive year in the Central American isthmus, from the point of view of communication disorders and audiology. Major developments are taking place in the different countries of the area, in a moment when democracy and development are rapidly taking over the years of struggle and discontent. 

In Costa Rica, the "First National Prevalence Study on Deafness for School Age Population" completed its data collecting phases and the data analysis has started in the Hearing Research Institute (HRI) of the University of Nottingham (U.K.) and in the National Institute for Deafness and Other Communication Disorders (NIDCS) of the National Institutes of Health (NIH) in the U.S.A. A presentation about the preliminary results of this research was done in Boston at the Annual
Convention of the American Speech-Language and Hearing Association (ASHA) in November. 

Major changes are taking place in the Health Sector in Costa Rica, where the Ministry of Health has engaged in profound reforms concerning the control and surveillance of disabilities. The new Division of Health Development created a unit that will take the "Regional Centre" as a key arm to monitor the status of hearing disorders, working on prevention of deafness and hearing impairment, promotion of ear care, continuous education for professionals in the field and from now on, early
identification activities will be the direct responsibility of the Costa Rican Social Security. 

Several major continuous education activities have taken place in the region - some promoted by the "Costa Rica IFOS/ISA/HI Centre" - including lectures on "Otoacoustic Emissions" (Dr. Ignacio Mora - Mexico), "Screening Methods in Audiology" (Dr. George T. Mencher - Canada), Prevention of Voice Disorders (Dr. Juan J. Madriz - Costa Rica). The University of Costa Rica started training a new generation of technicians in audiometry and the Universidad La Salle graduated its first generation of teacher for the deaf. 

Finally, the first steps have been taken to integrate the audiological efforts of the region through an initiative to network the different institutions, agencies, universities and individuals working in the field of audiology and communication disorders. This is aimed at creating an inventory of resources in the area, supporting needs for development of better services, training programs and facilitating sharing of information through the Internet. The home page (NetSalud) of the Ministry of Health will start a section of Disability and Hearing Disorders. 

1998 looks as a challenging year ahead and we will show our accomplishments through this ISA newsletter. 

ISA and IFOS have been involved together in trying to establish centers
around the world. Originally this was done by direct action, later an
organization was founded, Hearing International. The goings of this
organization has not always been smooth, particularly not in relation to ISA. On the other hand some enthusiastic people, primarily from Japan and Thailand have raised interest and money. A report on the nitty-gritty of international cooperation. 

     ISA and Hearing   International 
     Hans Verschuure,

     There has been an ongoing  discussion in the ISA Board about
     the cooperation with Hearing  International (HI). This had to do
     with the fact that procedures in Hearing International were unclear and  actions were not accounted for in an acceptable way. Some friction had  built up over the last couple of years. 

     The governing principle of the relationship between HI and ISA has always been full support of the goals of Hearing International. ISA as one of the founding organization of Hearing International has never questioned the intentions or the goals. ISA has shown its commitment in the past. After the call for action by Sir John Wilson at the Santa Barbara congress (1984) the  ISA funded activities of newly formed centers in Bangkok and Mexico. 

     It was our perception that the role of ISA was played down and our attitude  was often considered as uncooperative. Our problems had to do with  sharing responsibilities of the work and a lack of accountability. 

     The issues were discussed with a group from the Board of HI in Bari and  the ISA group had the impression that our concerns were to a great extent  accepted. Unfortunately this did not result in action then. 

     After a change in the Board of HI we discussed matters again with the
     new Secretary-General of HI at the EFAS conference in Prague. The
     issues were recognized and a meeting was proposed between HI and its  two parent organizations, IFOS and ISA. Prof. A. Parving of Copenhagen organized this meeting that was held in Copenhagen in November. At the same time a Board meeting of HI was organized to which ISA was invited, although not represented in the Board. 

     The issues were discussed in a group of representative of HI (Prof. Suzuki,  Prof. V. Newton and Prof. S. Prasansuk), IFOS (Prof. P. Alberti, Prof. E.  Offeciers) and ISA (Prof. A. Parving, Prof. G. Mencher and myself). Most of these people also form the HI Centers’ Committee. Because of preparatory work the issues were discussed and in a one-day talk the issues could be settled. 
These include: 
A new and detailed application procedure for new Centers was

     Criteria for the acceptance of centers were formulated; a center
 should be located preferably in the developing world, should have a  reach-out program, should have a clear educational goal and should
  be well established (financially, economically and politically) in that
  particular country or region of the world 

A procedure for the advisory board of a center was drafted 
A visitation procedure was established before the actual acceptance
 as a center 
 A review procedure was established after the first two years and
   every four years thereafter 
The different membership categories of HI were discussed. It was
   decided that recognized centers could be no members but would be
   targeted as recipients of support of which reports should be widely
  published  An auditing procedure was established 

   The new rules would involve more contacts with the centers and this would  unfortunately increase the overhead costs if members of the Centers’  Committee would always do visitations. It was accepted that ISA or IFOS  or HI members living nearby or on a visiting trip could do the visitation. 

     These Rules were accepted at the next-day board meeting of the HI
     attended by Sir John and Lady Jean Wilson, Prof. Hinchcliffe and the
     others mentioned above. Also Dr. A.W. Smith of the WHO office
     (PHD-Program) in Geneva participated in the meeting. 

     National chapters of Hearing International and its goal. 

     A major issue at the meeting was the establishment of national chapters.   These national divisions are essential for the work of Hearing International. They are functioning now only in Japan, Thailand and India and one will soon start in the UK. The significance and role of national divisions was discussed at length: the major goal of Hearing International is to raise awareness of hearing impairment and of the consequences for those  suffering from it. A second (but not unimportant) goal is to raise money for  research projects in the country itself and in the developing world. Such  fundraising is usually done in cooperation with service organizations like  Rotaries or industrial companies. One has to realize that awareness  campaigns can only be effective if well-defined and appealing goals can be  formulated. A list of good projects in a number of countries should be made available. It will give HI the possibility to present projects to interested  service organizations or companies for research support. Hearing  International (and through it IFOS and ISA) should guarantee the quality of  the project and should organize the monitoring and auditing of the project. In  this respect the new rules for the recognition of centers are important, although projects should not be limited to the HI-Centers. It is
 understandable that good projects from recognized centers will be
  prioritized; good projects from other centers will be closely monitored and  recipients have to accept monitoring and auditing. 

     After the two-days meeting it was felt that partners had come much closer  together and could / should cooperate more. The differences of opinion  were removed and a common position was reached on a number of points.  It was also felt that if HI would not get to a good start within the next year,  we should rethink our strategy. 

     An example of a working chapter of Hearing International is Hearing
     International Thailand, which organized a conference and a fund
     raising meeting. A report. 

Thailand International  Conference on Pediatric  ORL and Otology Update. 
     Hans Verschuure, Secretary
     General International Society of

     In January 1988 Prof. S.  Prasansuk in Bangkok organized a      fund-raising activity. Additionally to this fund-raiser a congress was
  organized as an update of the activities of the Bangkok HI
     Center. HRH Princess Mahachakri Sirindhorn opened the congress. A
     round Table was organized to get a survey of the result of 15 year activity  in Bangkok to raise awareness in South-East Asia and to discuss the  relationship between the Bangkok center, Hearing International, Hearing  International-Thailand and the founding organizations IFOS and ISA. 

     Most impressive were presentations from Thailand, Indonesia, India, the  Philippines and Malaysia. In these countries audiological services were  virtually non-existent 15 years ago. Now surveys have been carried out and prevention programs have been started, particularly primary (how can we avoid people from becoming hearing impaired) and secondary (how can we  restore impaired hearing to normal hearing) prevention programs. Sofar rather little attention has been giving to tertiary prevention programs (like hearing aid provision etc). 

     At the same time a meeting of the Board of Hearing International took
 place. In this meeting the developments since Copenhagen and the
 difficulties of implementing the changes were discussed, particularly the  deviating structure in the only HI division that really raises substantial amounts of money, Japan. The decisions of Copenhagen were endorsed and the financial reports were discussed in view of these decisions. 

     The importance of national chapters was reiterated and key persons were  identified. We call upon all our members to think about starting a national chapter or division. It seems a necessity to raise awareness in the population and amongst politicians. Hearing impairment is one of the most common health problems but is not recognized as such in many countries. It should get its proper place and the foundation of a national division of Hearing International in which professionals, industry, service organizations  and political organization can work together seems to be essential. Further information can be obtained from the 

Secretary-General of Hearing International, Prof. Valerie Newton, e-mail: 

or by mail: Prof. V.E. Newton, Centre of Audiology, University of  Manchester, Dept. of Education of the Deaf and Speech Pathology, Oxford  Road, Manchester, M13 9PL Manchester, UK 

     ISA also participates in consultations with WHO. At WHO is a program  for the Prevention of Deafness and Hearing impairment (PDH). This  program organizes informal consultation each year. This years
 meeting was held 3-4 February 1998 at the WHO headquarters in     Geneva, Switzerland. 

     Consultation meeting of the PDH-program of the WHO 
     Hans Verschuure,
     Secretary-General ISA 

     In a two-day meeting in  which amongst others Hearing International,
     IFOS, the WHO-Centers and ISA participated the  results of last-years
     activities were discussed, as was the program for the coming year. Some  reports from interesting activities were given like an awareness campaign in Brazil and an educational training program was presented. The importance of further education adapted to the needs of the country involved was stressed. 

     Further discussions involved strategic planning. The old concepts of
  pathology, impairment, disability and handicap will be abandoned by WHO as this emphasizes the negative aspects; positive words like activities and participation will be used instead. 

      Attention was given to the themes of the program. In the past the primary and secondary aspects were strongly emphasized in OME programs and  the program on the use of ototoxic drugs. From the floor (primarily IFOS and ISA) came the suggestion to start programs on tertiary prevention, which means rehabilitation. There is a high prevalence of sensorineural hearing impairment and it is growing through noise pollution and aging. The number of hearing aids in use is small. The reasons for the discrepancy  have to be further assessed. An important issue seems the lack of an  infrastructure in the majority of the countries. This and cultural problems could even be more important than the price of an aid. A meeting will be organized at the end of the year to discuss these problems and to find  solutions for the future. 

      International Society of Audiology  Membership fee including journal Audiology, Newsletter and HI newsletter is $66 annually. Apply for membership at secretariat or booth