Fighting For Something That Matters

For this young African leader, being discouraged by obstacles to better hearing health is not an option.

Kate Kgwefane

by Joseph Cerquone, CAE

A graduate of the audiology program at the University of Cape Town, South Africa, Kate Kgwefane is from the southern African country of Botswana where she works at a public hospital in the capital city, Gabarone. Through the Mandela Washington Fellowship for Young African Leaders Program, a U.S. State Department initiative, Ms. Kgwefane is interning with the American Speech-Language-Hearing Association in Rockville, Maryland. Only 500 of the nearly 50,000 applicants to the fellowship program were selected to participate this year. They are described as “some of the brightest young leaders in the 49 countries in sub-Saharan Africa.”

Recently, Ms. Kgwefane sat for an interview with the International Communication Project 2014.

What is the most important thing to know about communication disorders in Botswana?
There are different needs in different sectors of the country. It is most important to raise awareness among employers and employees in major industries like mining and meatpacking. Some think wearing ear plugs alone is the solution. But the high level of noise has to be considered, too. Employees need to be rotated away from the excessive noise levels more often than they are now, and they should be given hearing screenings more frequently. There is a much room for improvement even with the use of ear plugs. For the most part they are standard issue plugs that don’t always fit well. People find them uncomfortable so they take them out, or they remove them when they want to converse. In the deboning units of meatpacking houses, people spend a full eight hours every work day exposed to noise levels that reach 119db. I see people in my work who can’t work anymore because they have hearing loss, some of them as young as age 40.

Why isn’t more done to provide more workplace hearing protection?
Actually, legislation passed in Botswana that created hearing safety standards. The problem is enforcement. There are lots of gaps.

Why?
In part, no one is checking. Also, there’s lack of knowledge and disinterest. Companies might view making changes as costly. That might be the case in the short term. However, longer term, better hearing protection benefits employers and employees alike.

Where does this leave the general public? People with hearing problems?
Impaired hearing is a hidden disability. You might not know someone has it unless you talk to them. People choose to struggle in silence. They hide their condition because they don’t want to be stigmatized, viewed as less intelligent, a common misperception of people with hearing difficulties. This makes it hard for them to seek services. Gaborone, where I work, is in southern Botswana. The rural northern part of the country is remote, more impoverished. Those geographic and socio-economic challenges, as well as an insufficient number of trained professionals in Botswana causes care to be inaccessible. A prevalence of hearing problems stemming from infections and disease is going untreated.

There are other challenges, too. The good news is that in Botswana you can get a hearing aid basically for free. However, they are in short supply and not the best quality. From the point of diagnosis, waits for them can be as long as one year.

Where did you train?
There isn’t an audiology training program in Botswana. My program at the University of Cape Town is dedicated to producing students who are proficient in “soft skills” that facilitate patient engagement. In my work today, this training is very helpful, especially when things like debilitating hearing loss or long waits for hearing aids are causing patients great frustration.

Do you foresee conditions improving?
Perhaps. A highly publicized controversy in Botswana involving care of tuberculosis patients has gotten the attention of the Ministry of Health. Some of the patients have suffered profound hearing loss and can no longer work. The publicity involved is helping to shine a light on the importance of healthy hearing. The power structure of health care in Botswana is dominated by doctors and nurses. The allied professions try to be in the meeting room when funding allocations are decided, but for now we are just able to peek through the windows.

In Botswana, people with disabilities are not mainstreamed. The care system is not empowering. Public attitudes are the same–a mother would rather carry a disabled child until her back breaks than accept a care approach that provides tools for independence. Consequently, people with real potential are being left behind, not having opportunities to make the most of what abilities they have and surmount their disability, whether it is a hearing problem or something else.

I hope to play a part changing this picture. For example, I want to help restructure an organization that serves deaf children so it can access funds and help provide them with the education that is every child’s right. And I want to advocate for greater awareness of hearing protection and other measures such as implementing hearing screening for everyone born in a health facility in Botswana. With steps like these, close to 50% of the hearing problems in the country could be avoided.

Those are admirable aspirations. You are not discouraged by the challenges involved?
Of course obstacles exist. When I encounter them, I first step back and reflect on the best way to deal with them. Then I try again. Getting discouraged is not the answer, especially if you are fighting for something that matters. The only mistake is not to speak up. If I did that, I would be asking myself constantly why I was wasting my life.