A Conversation with One of Africa’s Best Known Better Hearing Advocates

While in town from his home in Zambia, Dr. Alfred Mwamba stops by the studio to share with Dave how he got into audiology via tennis, the idiosyncrasies of hearing loss and hearing health in Africa, advocating for better hearing, and making the choice to serve and change lives.

Link to full transcript

Transcript

SPEAKER_01 0:02

Welcome to Starkey Soundbites. I'm your host, Dave Favory, Starkey's Chief Innovation Officer. Our guest today is Dr. Alfred Wamba, an audiologist based in Zambia, Africa. Today, he is the executive director of the Starkey Hearing Institute in Zambia. And I've had the pleasure of working with him numerous times in Africa. I think we first met in 2014. And it is uh such a pleasure to have you on our podcast today, Alfred. Thanks for being here.

SPEAKER_00 0:31

No, thanks. It's it's great fun. It's it's uh always fun to have a chat with you, Dave.

SPEAKER_01 0:36

Well, I appreciate that. And let's let's talk about a little bit of your story. One could say, given that I happen to know that you share your birthday with World Hearing Day, you could argue that you were born to be an audiologist.

SPEAKER_00 1:04

It's an honor. You know, I think I think World Hearing Day came after I was born. Because you're old now. You're really old. On my birthday, I feel old. Older and wiser. Yes.

SPEAKER_01 1:16

Well, yes, indeed. But but talk a little bit about your journey. What you know, you grew up, uh you you live now in Lusaka.

SPEAKER_00 1:24

Yeah.

SPEAKER_01 1:24

But you didn't you weren't born in Lusaka, I don't think. You were born outside.

SPEAKER_00 1:28

I was born in the northern region of Zambia, the Copper Belt region. So that was the commercial hub of the entire country. That's where the mining is done. So I grew up in Indola, which was the processing town, because each town in the Copper Belt has a specific um industry. And for Indola, it was a refinery place. And um growing up in Indola, everybody knew everybody. It's like a small town. Um so everybody who grew up in in my time, we all knew each other because we lived in the same neighborhoods, we went to the same schools.

SPEAKER_01 2:03

Did you think you would work in the mining industry? Was that sort of an e uh expectation? It was.

SPEAKER_00 2:10

I mean, that's what we we saw. You know, the the mining was it's it still is the main industry in the country. So everybody looked forward to go work in the mines.

SPEAKER_01 2:20

Yeah.

SPEAKER_00 2:20

So I was no exception for that.

SPEAKER_01 2:22

And it's been said you can't be what you can't see. And you probably didn't run into an audiologist at that tender age.

SPEAKER_00 2:28

That you you say that you can't be what you can't see. And so I would never have thought of being born on 3rd of March that I would want to be an audiologist because there were no audiologists to look up to.

SPEAKER_01 2:40

Right. Yeah. So so then what happened? So so here you go, you're a young boy growing up there. And at what point in time when you made the trip over to the U.S., uh where you know, talk a little bit about that journey because I know there's some tennis in there, and then you end up in Purdue, and let's hear.

SPEAKER_00 2:59

All right. So I'm how do I end up even going to college? So I'm from a humble background, but um I was blessed enough to have a good um family. My my parents were very strong in making sure that I got a good education. My mom was a teacher, and my father was a salesman, and I loved to play tennis. So I spent so many hours on the tennis court. It was it was my favorite thing to do. So I don't know any other sport. I I can't play soccer. I try to play soccer, I got smashed in the face. I said that this is not for me, and that's why I loved tennis because you you're much more of a gentleman or gentlewoman's game.

SPEAKER_01 3:39

Yes.

SPEAKER_00 3:40

But that tiny little bowl when you hit you hurts. So um after I graduated from from um high school, I I moved to South Africa to try and become a professional tennis player. Um I was about 16, 17 years old at that time. And whilst I was playing there, there were a lot of South Africans who were in college tennis in America. So they would always come and and I would hit with them. And then one of them just planted a seed in my head. They said, Hey, why don't you come play college tennis? I said, You can do that. Like, I can't afford that. They said, No, no, if you're really good enough, you know, you can get a tennis college. I'm like, wow, this America place must be really cool. I I want to do that. And, you know, it all happened very quickly because this guy asked me about playing college tennis. It's like maybe a week later, I have to go take my SATs. Okay. Like, okay, what are SATs? Wow, just that quick. It was like then a week later you took the SATs. Pretty much. Okay. And I thought it was just some, oh, it's some math and English. My goodness, that is not English. That is not even the Queen's English. That's just like some Latin English. Um, and I remember words like boisterous, and I, you know, those were big words for me. I'm growing coming from from a little town in Zambia. Who whoever says words like gregarious? No, nobody does that. And they ask you about these yachts. What's a yacht? I've never even seen a ship. No. It's pretty inland, yeah. Very much so. So um at that time, I I went and I got their little booklet, I studied it, um, I sent them my scores. And then, fortunately for me that week, there was a big tennis tournament, and I and I happened to go play in it, and I beat the 14th ranked South African. Wow. South Africa is very strong in tennis.

SPEAKER_02 5:33

Very long history.

SPEAKER_00 5:34

So at that time, like their top players, like world class.

SPEAKER_01 5:38

Yeah.

SPEAKER_00 5:39

So when I beat that guy, um, I sent those results over to uh American colleges, five, six colleges. A couple weeks later, I get a call from Hampton University in Virginia, Dr. Robert Screen. And he says, Hey, is this Alfred? Like, yes, this is Alfred. Yeah, I'd like to talk to you about recruiting you to come play tennis. I'm like, Really? Like, I thought I was dreaming. Like, oh, really? I thought this was just something you you try and see if it will work, and you never really expect it to work. And he said, We've seen your videos because you got to send them videos when they're recruiting, and we really like the way you play, and we would like to offer you a scholarship. Um, I said, but I I can't afford to come to school. He said, No, what a scholarship means is that you know we will pay for it. So he gave me a full scholarship to go playing um at Hampton. And at that time, because I was really entrenched in in tennis and I I was actually studying to be a tennis coach, I said, I want to go study sports psychology. And so, you know, long story short, I I find my way to Hampton University, and my life in America starts. And it it was very weird because I I always knew North America as this cold place, and then college starts in like August. Sure. So I'm leaving home with the biggest jacket my mom could find me. I don't know where they got this jacket from. And so I show up and I fly into um actually there's there is one one important story about my travel to America, which I should share. Um because I couldn't afford to purchase the ticket, even though I had a full scholarship, I had to go and ask for help. And so I went to all of the big airlines and I asked Coca-Cola Company, I asked everybody, anyone who would be able to help me get to America, and I wasn't I wasn't having any joy. Two days before my the expiration of when I had to be in America, I walk into um British Airways and I write on a piece of paper that I'm heading to America and I need to just get to America, and I'll be very grateful if they could help facilitate that because I was uh committed to coming back home to to come and make a difference in whatever it is.

SPEAKER_02 8:11

Right.

SPEAKER_00 8:12

And British Airways had never ever given anybody a ticket in its existence. They decided to gift me the flight to and from America. Wow.

SPEAKER_01 8:26

So that was the very first time. A round trip.

SPEAKER_00 8:29

And then they said, okay, pick any destination we go to. I'm like, okay, here's the map. I don't really know where to go to. So I picked Philadelphia because I remember some white tires that I would see on TVs. Like, okay, that looks like a cool place. It's close enough. So I end up and I fly into Philadelphia with my big coat in the middle of summer. Uh huh. And Philly is humid and hot. Oh, I look like an idiot coming out of that plane.

SPEAKER_01 9:02

But so you made it there. You you uh you played tennis on a tennis scholarship. Still haven't told me how you got to audiology. How'd you most of us have stumbled into this discipline? Mine came in through pre-veterinary medicine, but I still want to hear and have everyone hear how you found my journey into hearing.

SPEAKER_00 9:22

Yep. So in my so I'm now I'm settled at Hampton University doing my sports psychology, and I'm taking uh Sigmund Freud and Carl Jung, and you know, I guess everybody does those courses in your first year. And in my second year, my grandmother dies. Um, she dies from a stroke. Uh but this was the second stroke. So the first stroke she had, um my my family calls me. Your grandmother has had a stroke, and she's not speaking very well, and we can't really get any help for her. And you know, she and I were very close, and um that touched me a lot. So I shared that story with my tennis coach, and he just happened to be the head of communicative sciences and disorders at Hampton University. What a coincidence. So he suckered me into it, really. He said, he said, son, um your country needs people in this field to go help people like your grandmother. Because he was struggling to recruit guys into the program.

SPEAKER_01 10:28

He's who we uh he's who respon who's responsible for you becoming, and you're always quick to remind me, you're not the only audiologist in Zambia, but the first.

SPEAKER_00 10:39

But the first.

SPEAKER_01 10:40

And that's aspirational. And it is testimony to the fact that you upheld your promise to British Air and to return to Zambia after you got your master's degree at Purdue at Big Ten University like the one I graduated from the U.S. Boilermaker, U of M, the golden gophers aren't nearly as uh as tough a mascot as a Boilermaker, but nonetheless, uh it came out of great education, then back to Zambia?

SPEAKER_00 11:10

Yes. As a matter of fact, you know, I I've been blessed with a lot of strong mentors. Making a transition, a young African boy moving to America, enjoying all of the luxuries that America has to offer, enjoying a great opportunity. And you know, I'm I'm forever grateful because it would never have been possible in my wildest dream that I would ever come from Mundola and be educated at such a prestigious um university. And to be able to remember and stay grounded to that vision of you gotta remember why you went into the profession, first of all. Um fortunately for me, the the mentors I had, uh Dr. Robert Screen, Dr. Robert Rengo at Purdue, um, they kept reminding me, Alfred, why are you here? Why are you here? And and I think that was a very strong component of developing that sense of servantship. Yep.

SPEAKER_01 12:11

Um You had to have it in you, but they helped pull it out of you.

SPEAKER_00 12:14

They always kept me grounded. And so with with that, when the time came to go back home when I finished my master's degree, it wasn't an easy thing to do. Because here I was, you know, uh and at Purdue, I was very fortunate again to have a fellowship. So like you can go to school and they pay you to go to school. I love America.

SPEAKER_01 12:38

Don't tell this to any of the audiology students these days, because unfortunately, since you graduated and certainly since I graduated, the educational situation is very different. And there's not as much in the way of that support. But uh but at the time that you were in school and I was, it it was really um helpful because I came from a pretty humble background too, and I couldn't have afforded to pay to college, and I certainly am not a good tennis player.

SPEAKER_00 13:03

So we do owe it to the generation that we pay it forward, yeah. You know, and and the best way that I could pay all of the blessings that came towards me is to pay it forward in service to to the people of Zambia and the people of Africa and the people of the world.

SPEAKER_01 13:19

So when we first met, you were working for a hospital in back now uh in Lusaka, and um and we bumped into each other, I believe, for the first time in around 2014. 2014, July. And uh uh we were meeting at a conference and I was presenting uh results from uh some evaluations that we had done where we were using a behavioral fitting model to try to uh focus on scalability and sustainability uh to really help address and again, given your your birthday is shared with World Hearing Day, uh we know the current numbers are somewhere around 430 million people around the world that have measurable hearing loss. Uh we um you know we lament in the U.S. that the adoption rate is about 34 percent of those with hearing loss wear hearing aids. What's the situation back in your home country in Zambia? What percentage of people who have hearing loss actually uh get hearing aids?

SPEAKER_00 14:26

I wouldn't give you our a specific number because the statistics are not readily available, but to give you um an idea of of how big a burden hearing loss is, you know, every year the Ministry of Education publishes information on the children who are in schools with hearing loss. So and this is not measured, so most of them are close to death, or they have some hearing loss, and because they haven't been exposed to speech, so they don't learn how to speak. Um at the beginning of my career, they were um publishing between grades one and nine over 28,000 schoolgoing children with hearing loss. Um and none of them were getting any hearing aids. And you know, 28,000 between none were getting zero, zero were getting amplification. And uh of course there were some agencies which uh were available to assist people with hearing impairment, uh the National Association for the Deaf Zambia National Hearing Impaired Association, but even they did not have the access to the hearing aid. So um they would get occasionally donated hearing aids, but they wouldn't only just serve the the schoolgoing children, they had to serve the whole population. So even with that, I would say, you know, if we went statistically about 4% of the population having hearing loss, we're looking at 600,000 plus people. You know, and if we go with a higher percentage of like uh six percent, we're close to a million people with with hearing impairment. And so the uptake, well access rather than uptake, access very, very limited. So if you are born in um a province which is not close enough to the capital city where I live, then you're out of luck. There's absolutely no service. So the number of people who currently are using hearing aids, of course, have have increased because you know uh my presence there and having other professionals, um hearing instrument specialists in the country has really helped to open up the country.

SPEAKER_01 16:46

So the things are looking bright, but still like the rest of the world, uh low and and arguably. And and I think for North Americans like myself, I mean, and as you know, uh although I'm from North America, my adopted continent is Africa, and uh and having uh had the great fortune of being there many times to really see the situation through uh uh the situation in Africa is that while many of us here are talking about, well, as you get older, the older you get, the more likely you are to need hearing aids. In many countries that I've been to in Africa, you know, where the average life expectancy is around 50 ten years ago when I first started going, that they don't, in many cases, live long enough uh in order to acquire presbaccois. So talk a little bit about the nature, what are the biggest causes of hearing loss? Now, Zambia is is different than that. It has a longer life expectancy. So you have uh the same troubles that we have in the U.S. uh. with uh the aging population feeling like hearing aids will make them look older, the stigma. But you talk importantly about accessibility and affordability, and also some issues that we take for granted in the U.S., issues like malaria or quinine, um, which uh it treats malaria but also causes hearing loss. Talk a little bit about that with regards to the pediatric population.

SPEAKER_00 18:14

You see, Africa is a young continent. You have countries like Uganda with 42 plus million people with an average um age of 15, you know. And as much as yes, there are countries which have advanced a little bit more, the expect the life expectancy in in a place like Zambia is only 57. Yeah, still 57. So you we're still in that um transition point where as healthcare is improving, more and more people are getting older, but that's not the primary population that use hearing aids in in Zambia. Most of the hearing loss is from autotoxicity. We have a lot of infectious diseases still. And and every now and then, as much as uh vaccination programs have have increased and improved significantly, and that that also has helped to reduce these infections, um, we still we still have so many people um falling through the gaps and and not being able to get the the vaccination that could prevent you know um the need for autotoxic medicine. So you you mentioned um you call it quinine.

SPEAKER_01 19:34

Quinine? Quinine. Quinine. Okay, thank you. Okay.

SPEAKER_00 19:38

Well, we are in America, so we'll call it quinine.

SPEAKER_01 19:41

Quinine, I'll go there. Um We know that Artisunit uh is not autotoxic, but it costs a dollar more a patient, or $1.40, I think, is more a patient.

SPEAKER_00 19:52

It does cost more money than quinine and so I think hearing is worth more than $1.40.

SPEAKER_01 19:57

It is but nonetheless it's really awareness, I think.

SPEAKER_00 20:01

You know, beyond awareness, you you're dealing with uh a lot of physician-driven health um departments. Um and and no disrespect to physicians, but prevention is not their primary um objective. It's it's that they they fall more towards treatment. And you know, we speak a lot about hearing loss being bloodless and painless and it takes a long time.

SPEAKER_01 20:32

And taken for granted.

SPEAKER_00 20:33

Yeah, and it's taken for granted. Um when you deal with with um health systems which are dealing with tuberculosis, malaria, HIV, the these big three, that takes uh you know it's it's not a priority. Yeah. So consequently, the investment into that is not so high. So when a child has has malaria, um severe malaria, we call it malaria plus plus, cerebral malaria, you you do have a choice, and because there's so many of those children having to to be treated uh as a government, do you only buy a few um non-autotoxic meds, or do you buy a lot of autotoxic meds, but you save lives?

SPEAKER_01 21:18

Obviously, the choice is obvious at the end of it as long as there are limited funds, and there's always limited funds.

SPEAKER_00 21:24

And and that's that's you know, so that has led to a situation where even in when I was a young man, I I actually don't know what silence is. It took me going into this field to know that that people don't have ringing in their ears. I thought everybody had ringing in their ears. So when I was a young man, I got very sick. They pumped me with quinine when I was um around nine years old. I've had ringing in my ears. My hearing is normal, but I do struggle with speech and noise um as a result of having that constant ringing. Um, now that I mention it, I'm listening to it. Okay, well we'll keep we'll keep going.

SPEAKER_01 22:02

Uh we'll keep talking.

SPEAKER_00 22:03

But we were talking about um the you know causes. Yeah, the causes. So the causes.

SPEAKER_01 22:08

So you mentioned malaria.

SPEAKER_00 22:10

Malaria. We have a lot of ear infections.

SPEAKER_01 22:13

Yeah, a lot of middle ear infections.

SPEAKER_00 22:16

The the worst thing about it's not that the middle ear infections are the biggest culprit. It's the lack of knowledge in the you know the medical fraternity on how to treat them that leads to a lot of these um hearing losses that we see. So we get to see a lot more infection-driven um hearing losses um and also hearing losses from treatments from infectious diseases, as well as the infectious diseases themselves that can cause some hearing loss. So that's the big chunk of um causes of hearing loss that we deal with.

SPEAKER_01 22:55

Yeah, and you're really just at this point where, as you say, as we said, with a life expectancy of 57, just starting to see presbyclusis in that population. But as health care continues to improve uh in your nation and surrounding nations, you're going to see that uh increase in hearing loss that comes with aging as well. But but it just was interesting to me is that wasn't really top of mind for working with patients when I first started traveling to many African nations. And so we we had this shared passion for hearing, um, different sides of the same coin, perhaps, me working primarily with aging populations. You certainly in your role were working and really looking at improving that accessibility and affordability and access, as you mentioned. Uh and then we intersected in 2014, uh and we were both at a conference in Oxford, uh, and our our first interaction, do you want to you want to So I was presenting uh on how we were working on the WFA fitting model to uh improve sustainability and scalability, to treat more people, um, you know, to really consider all of those thousands of people that couldn't receive access. And your first words to me, well, if this is good enough for Africa. Yeah. And I'll tell you that if you'll remember, I mean, it it it it made me stop and think. And uh and uh I would say our friendship started at that moment of conflict, if you will. It was productive discourse. And I think we've at least on my end, we've been fast friends ever since. Because you will all I can always count on you to challenge me. And I think my response was, well, it should be. And and it's interesting because now we come eight years later, and uh as we look at over-the-counter hearing aids, which are becoming uh a reality in the U.S. and trying to again look at accessibility and affordability and looking at solutions for behavioral fitting methods that may not be dependent on the audiogram, I can finally say that it it is and it will be. And so um, you know, I think it's been really interesting to see the way that things have intersected, and and then it has been interesting to see your growth as a professional and and uh counting on you as a friend and colleague now, in the sense that you uh talk a little bit about your role now at the Starkey Hearing Institute.

SPEAKER_00 25:26

So going backward forward in the sense that you know we we we we had this discourse, you and I, about the fitting method that was being used, the WFA uh community-based model. And um it it is it's very important that you raise that question and and you remind me of that question because a lot of my own perceptions have changed. Um what seemed to me at that time as being a non-scientific or non-clinical way of doing things is actually what it should be. You know, we we do a lot. I mean, I I'm American trained, and and so I can relate to a lot of American audiologists in in thinking that well, you have to go through all these protocols in order for you to get satisfaction. But at the end of everything that we do, we ask one simple question, how does that sound? You know, so who's the boss there? Right, you know, so we we we have to to sort of look at how this evolution is actually from from where I'm sitting, I I think that no one should should look at um over-the-counter hearing aids as a problem. I see it as a big solution. And you know, I can only share the work that we have done, you know. So um we have a training program where we're training hearing instrument specialists in in all methods. So we train them to be able to do um the most stringent verification methods that that are there, um, to simply working with your two hands in the middle of a field um with just nothing but a hearing aid and and an individual in front of you. You know, you have to provide that service. And so the my mindset and my growth has been as a result of that first encounter. Why isn't it good enough? And and when I look at over-the-counter hearing aids, I'm saying, hey, you know what? I actually have seen how a method where you're getting somebody access and they enjoy what they're they're hearing, of course, we will get people argue, say, well, they don't know what they're hearing. Well, you don't know what they're hearing either. Trevor Burrus, Jr.

SPEAKER_01 27:51

Right. If we start with audibility and then balance between the two ears and preventing loudness discomfort, we're beginning to meet the patient where they are. Absolutely. And then you know, absolute best practice should always be appropriate to the environment that is available that will provide that best accessibility, affordability with uh you know something that's scalable and sustainable. And I think you know there there's there's not any argument there from the standpoint of focus on the patient too.

SPEAKER_00 28:23

Focus on the patient. And and the patient, the patient guides you. I mean, how many times have you, Dave, clinically um worked with the patient and you're pumping your chest? I have programmed my hearing aids to the best ability. You put it on the patient's uh ears and they're like, what the? You know, I'm always out funny. Exactly. Okay, back to square one, and then you have to work off of their feedback. And I think, you know, uh the lesson that I would share from our work is that by providing that access to sound, you know, you change people's lives, and they will want more sound, they will want better sound, and we're well placed as audiologists and hearing care professionals to be able to serve even more people. So I feel it is more of an opportunity that the lessons that we shared, I mean, I had a backlog of um a few thousand people because I was the only one in my country providing service. You came in, you were you were at the very first, you know, um uh program we had where we were uh serving a lot of people at at a go. And I can I can assure you, because I stayed on the ground, that a lot of those people received so much benefit. Of course, there's going always going to be a percentage who would need further um sort of services, but we provided them that initial access. And that's all we advocate for. You know, let's let's let people have a chance to hear and be the best version of themselves, and then we will make sure that we get them to the best possible level that they can get to.

SPEAKER_01 30:06

How can you argue against that when our biggest competition is non-compliance or non you know, non-access to try to have the possibility that people can hear better and then a continued focus on trying to get them to do as well as they possibly can given the resources that are available. And I think a large part of that resource in Zambia is the same as you know our focus in the U.S. We're we're all for over-the-counter hearing aids as a means of getting people on their hearing journey.

SPEAKER_00 30:37

Right.

SPEAKER_01 30:37

But we also recognize that the role of the professional is exceedingly important. And with your role at the Institute, I think one of the things that's that's most impressive to me is you're training individuals to assist with patients who are wearing amplification to ensure that they know how to insert them in their ears, how to change the batteries, how to clean, how to do the proper protocols, as you said. But but the fitting really isn't the the finish line. You know, it's the starting point. And talk a little bit. The cohorts you have at the Institute are typically around 16 to 20 individuals. Yes. And they are there for a period of how long?

SPEAKER_00 31:17

An academic year, uh essentially 10 months, um no breaks. Uh you know. The the thing about what we have, what we have done and have managed to achieve is to increase access in more than 16 countries across the continent. 16. 16. Yeah. So whilst I might be the first audiologist, um I'm proud that we have over 22 hearing instruments specialists in Zambia. I can be here and have this podcast with you, and I'm not worried about someone having to not get access because I am not there. And that's what our profession is about. Yeah. You know, empowering people, empowering the patients that we work with. And we have now trained 67 people in all of these countries, and and we're receiving great stories about how they're changing people's lives. We have people working in the community with just their bare hands and and some hearing instruments that they are fitting on people. We have people working and running tertiary level um hospitals, teaching hospitals. And you know, I think the focus in in our training is more on the competency rather than on the qualification. Because if if you're competent and you can change, I mean I if if you allow me to share why I personally have been inspired to change um my mindset and and work on capacity building. When I first, when I returned from America to go to Zambia, the very first person that I met was my brother's bar man. Okay. His name is Patsen. And Patson had this big smile, very good positive energy, good, good, good individual. And I, you know, I was kind of like, okay, why is this guy so happy? You know? He's always happy. Uh but I worked with Patson for so many years when I started working to a point where I personally experienced this young boy that I uh he had served from when he was younger, run up to him and give him this big hug of embrace, you know, and the family was so appreciative. And and for me, it's light bulb. You know, we gave that young man an opportunity to excel in his school, and now he's going to secondary school. And we gave this bar man an opportunity to transform people's lives. You know, it's it's really not about that title, it's what you can do to change people's lives. And that's exactly what the Starkey Hearing Institute has done in changing people's lives every day and providing access. I mean, what a better calling than that can you have? You can't. You know?

SPEAKER_01 34:05

Well, I do have a question. We talked about the fact that you know you are skewed towards younger uh patients than we are typically here, uh, with the life expectancy being greater in the U.S. Um Do you have the same stigma or is the stigma different as it relates to hearing loss and particularly hearing aids? Because you don't have that issue of they're gonna make you look older, because in many cases, sadly, as you said, with a life expectancy of 57, um you don't it how is the stigma different?

SPEAKER_00 34:37

It's kind of I mean, I I think maybe if if we go a little bit further back, even though ideology started from you know World War I and then World War II, sorry, yeah, with that. Um the stigma that we we the stigma that might have existed there, and I'm imagining this, was more that all of these deaf veterans are now using hearing aid. So it was more the hearing aid was associated with deafness. Sure. It's that's where we are, because we have a lot of young people who have hearing loss, and they're the ones who use hearing aids. So the stigma is more if you are using a hearing aid, then you are likely to be seen as deaf. As deaf.

SPEAKER_01 35:21

Okay, interesting.

SPEAKER_00 35:22

Yeah, so uh not so much old because we don't get a lot of old people that's a throwback to that kind of yeah. But you know, things have changed, you know, since the since having all of these um readily available smartphones, everybody wants headsets, and so it's very difficult now to be able to notice a hearing aid. As a matter of fact, with with the cool technologies that we have with streaming capabilities, um, and I I wear my my hearing aids um for listening to to um audiobooks and you know they're and I wear them and and people say, oh, that's that's a cool set of headphones. So I think that there is that stigma which is disappearing as a result of people always having things on their ears. I mean, now we've we've spent three years of our lives wearing masks, so we always as used to seeing people having something on their ears. So I would say that the stigma is is a little bit different. It's still there, but it's not quite it's it's reducing with time.

SPEAKER_01 36:26

Well, and and as a member of the baby boom generation, I I say that in comparison to my parents who were from the traditional generation, those born before uh World War II, that they were indeed in in this country stigmatized uh by hearing loss, and their primary concerns were cardiovascular disease and cancer. Um now with the baby boom generation, being more educated than our parents, um uh cognitive decline is an issue. Yes. I'm not as stigmatized by what hearing aids uh will make me look like. Uh my gray hair does that, but but I have higher expectations for what they can do. Like you said, we I want my pay, my dream come true, is when I have the opportunity to have to explain to somebody what modern hearing aids can do, and then they say, I want that, and I don't even have hearing loss. And if we make them desirable, if we make them a little cool, and then get people uh to say, you know, this is my superpower, this is something that I can augment what I naturally have. That's sort of the best of both worlds.

SPEAKER_00 37:27

That's the best of both worlds. And when you look at some of the innovations, teleaudiology, I mean which has to be huge in Zambia, right?

SPEAKER_01 37:36

The potential for that.

SPEAKER_00 37:37

The potential is massive. Yeah, you know. You you have to, however, realize that we are so used to traditional medicine having a doctor sitting in front of you. So it can be a little bit different and uncomfortable for certain people. Uh, believe it or not, there are still people out there who have never seen somebody talking to them from a distance on some, you know, uh gadget. It's it there are people like that in where I where I'm coming from because they live in rural areas and they don't have access to those sorts of technologies. But at the same time, it is an opportunity that has, you know, just exploded our ability to reach more people. And we can leverage, I can I can mean I can be in the middle of Mongu somewhere in Zambia, and then I can pick up the phone and say, hey Dave, uh I'm having this challenge with this individual. What do you think I should do? I mean, even that is great value because now we are better able to serve people because we have that interconnectivity. You know, we spoke about how many people across Africa have received our graduates who are now serving there. Yeah. But this interconnectivity means that we're more like a hub and everybody's connected to each other and we can help each other at any time. And I think that's the beauty of what technology is doing. And you know, I'm really excited about um even when they say, oh, self-fitting hearings, I'm like more opportunity for us to provide better than the other.

SPEAKER_01 39:09

Not a threat, it's more opportunity to engage. And in a way, like you said, telehealth is like that ancient continent, Pangaea, where they were all one continent. And the phone, the cell phone. And the cool thing for me is to see how cell phones really are ubiquitous in in Zambia. I mean, now they're not all smartphones, but they're cell phones. And I think what I remember is some of the biggest challenges is people will have phones that have prepaid service and then they they go, they're depleted, and then they get a new phone number. Right. So, you know, one of the challenges still comes down to accessibility. Not that they don't have a what they have a wireless and a cell phone connection, but keeping that number the same uh still remains a challenge in some cases.

SPEAKER_00 39:49

Yeah, in some cases. Uh things have improved quite a lot. And and and you know, it's it's it's hard not to find network. Yeah.

SPEAKER_01 40:00

Yeah, that's good. That's a good thing. Yeah, you want sometimes to be off the grid.

SPEAKER_00 40:04

You do want to be off the grid sometimes, but you know, things are improving. Uh we a country like Zambia is not densely populated. So because it's not densely populated, you know, it was lots of dead areas. But when you go to a place like Malawi, there's barely any space. And so there even there, their connectivity is is much better. Yeah. So these are the opportunities that we have available to us, and you know, we're just looking forward to more and more.

SPEAKER_01 40:31

And yeah, well, uh tell me what you need, and we'll keep working on it. I know one question, one more technology question, and then I see already we're almost out of time. But um uh rechargeable batteries versus replaceable batteries. One of the issues has been in some of the areas you know where you're you're um really remote areas, um the hearing aid, again, is just the beginning of the journey because you have to have b uh batteries to supply them. But with rechargeable, um, has the adoption rate for rechargeable uh in Zambia been similar to the the rest of the world where it's quickly going that way in hearing aids, or is there still a need and desire for replaceable zinc air batteries?

SPEAKER_00 41:11

I would say that for most of the new users, they prefer the rechargeable option. Because they're used to charging their phone. I mean anyway. And and so what's charging a hearing aid? Because you charge your devices every day. For those who are used to batteries, they have it a little bit difficult because they they tend to forget, even though they charge their phone, but they tend to forget to charge their their hearing aids. So you're right when you say that there is a push for more people to have rechargeables, but it it it also just makes sense. It it saves them.

SPEAKER_01 41:50

For the environment is better, and you're throwing out th less waste. Absolutely. Um it saves the expense and the need to go out and find batteries, even sometimes if you're not.

SPEAKER_00 42:00

I mean, if you're in a remote area and you can't get to Lusaka, then you won't be able to get batteries. Then you get batteries from from for for the watch, which only lasts a few hours, and and it's much more expensive than a hearing aid battery. So those are the some of the challenges that I am excited that you know rechargeables are able to sort of take care of that problem for us.

SPEAKER_01 42:20

Well, thank you for that and sharing a little bit about the situation as it relates to access, for the technology, uh service as as you know how how soon uh will there be a doubling of the number of audiologists in Zambia, do you think? 24 months. Excellent. At least that's the target. Yeah. Well, and and really, this has been the first time in over two years that I've been able to see you. I've had the pleasure of uh you and Sheba, your wonderful wife, uh opening your home uh for visit, and I look forward to visiting again. And uh as we wrap today, I'm wondering if from your journey from a young man uh born uh in uh uh the northern part of Zambia, finding their way through Hampton University, Purdue, Salas was where you got your AUD. Um what advice do you have for um someone considering a career in audiology now, or the younger professional looking to find their way, seeing all of the threats, but not seeing the opportunities? And when I think of some of the obstacles that you've overcome, uh even to get your first flight here, you know, and your determination. What advice do you have for someone starting out uh or considering a uh a profession in audiology?

SPEAKER_00 43:40

You know, recently I I I met a friend who said that you you never switch off your ears. Uh well i we all know it, but very few times do you hear that. But then, you know, with with hearing, you you connect love emotion. When you hear someone tell you, I Love you, you know. You feel something, it changes you. And one of the things that is very addictive in this line of work is having people reconnected with the people they love, and you have to put yourself in that position, and that comes first. Yes, we get school loans and we have to pay them off. But if you build it and you truly serve the people, there is nothing that you would do wrong. Because, you know, for me who is a spiritual person, that's a higher calling to be able to change people's lives. I I never left America to go back to Zambia to go get rich, you know, but I'm not starving. You know, my needs are taken care of. And it's because I choose to serve. And so if it's it's a young professional coming into this field, it's that service to humanity, service to connecting people to each other. And I think that's that's where the focus ought to be, not so much on what is what can go wrong and how will I survive? You know, it always works out.

SPEAKER_01 45:05

Yeah. And you mentioned you really it's that emotional connection to hearing when we think about. I mean, I think it was Maya Angelou that said people won't remember what you said, but they'll remember how you made them feel. And uh so when you think of your favorite sounds, can you identify what a couple of your favorite sounds are as somebody who's now devoted a significant part of your life to hearing?

SPEAKER_00 45:30

I I like to walk in the woods and it's and it's quiet, and you just hear the rustling of the leaves, the peace that I feel when I'm in that environment. I I can't explain that. So I'm not so much of a beach person and water waves. I I like that that freedom. I I feel connected to to the planet Earth when I'm in that woody kind of space. You know, it's really beautiful.

SPEAKER_01 45:59

I share that with you, except that usually the woods where I'm walking are a lot colder than they're wherever you are. But uh well, Alf, I can't tell you how much of a pleasure it's been to have you on the podcast today. And uh I hope you come back, and I look forward to seeing you again soon. And I wish you all the best. And uh and once again, it's it's not often you get to interview someone who's had a day named in their honor with World Hearing Day.

SPEAKER_00 46:26

Well, I I I would like to balance my head as I walk out of here. You know, I appreciate that. And you know, it's it's a great pleasure to be able to share these stories with with other professionals and other people because the joy is just immeasurable. So thank you so much for taking time to have this podcast with me and happy world hearing. Thank you very much.

SPEAKER_01 46:49

And to our listeners, thank you for listening to this episode of Starky Soundbites. And if you enjoyed this conversation, please rate and review us on your preferred podcast platform. You can also hit subscribe to be sure that you don't miss a single episode. So we'll see you and hear you again soon. Thank you.