In October 2021, Dr. Sione Pifeleti successfully delivered the World Health Organization (WHO) Primary Ear and Hearing Care (PEHC) training module to a group of 19 participants at the workshop in Samoa. It was the first time that this course was given in our country.
Dr. Pifeleti is General Surgeon/ENT and Acting Head of ENT Department at Tupua Tamasese Meaole (TTM) Hospital in Apia, the capital of Samoa. When he re-established the ENT service in 2017, his dream was to simultaneously build the skills of fellow healthcare professionals in primary ear and hearing care nationwide. The WHO PEHC training module was therefore submitted to the Samoa Qualifications Authority for accreditation; participants who completed the training had to pass the course to obtain a formally recognized qualification in the provision of primary ear and hearing health care. Accreditation was officially granted in March 2021 for all three levels of the training program – basic, intermediate and advanced.
The first group of participants invited to the course in October 2021 was mainly composed of colleagues from the national reference hospital TTM: five registrar doctors (district hospital, acute primary care clinic, emergency, paediatrics, surgery) three graduate nurses in ENT , two registered nurses from the surgical unit (i.e. operating room), two registered nurses from the surgical department and four registered nurses representing the departments of pediatrics, emergency, obstetrics and gynecology and the acute primary care clinic. A special invitation has also been extended to the staff of SENESE, the non-governmental organization that works with children with disabilities in Samoa. Their work includes school-based support for students with hearing loss. Three SENESE staff members participated in the course.
The intermediate level of the WHO PEHC training module was selected as the most appropriate level for this first group of trainees. The course consisted of seven modules, shown in Table 1, which were facilitated over a two-day workshop. We were honored that Leausa Toleafoa, Dr. Take Naseri, CEO and Director General of the Department of Health, Government of Samoa, showed his support for the PEHC training by attending the official opening day of the workshop.
All the course facilitators emphasized the content of the course as it relates to our Samoan context (ie orientation pathways). The first four modules were facilitated by Dr Pifeleti. The fifth module on Middle Ear Diseases was presented by our visiting ENT specialist, Dr. Zhi Yu, who is in Samoa for six months as part of the Chinese Medical Team Volunteers program.
The final two modules were delivered by Dr Annette Kaspar, an Australian research audiologist who specializes in developing strategies to address hearing loss in the Pacific Islands. She has been based in the Pacific Islands for 10 years and has spent the last two years working in the ENT department of Samoa. As the WHO PEHC training kit was published in 2006, updated information has been included based on the WHO World Report on Hearing which was launched in March 2021. As its two ENT colleagues, Kaspar adapted the course content to the Samoan context. For example, although there are currently no newborn/infant hearing screening programs in Pacific island countries, the updated Samoan National Baby Health Book will include a checklist of developmental milestones of hearing, a questionnaire on risk factors for permanent hearing loss and basic information for parents. about ear health care. Similarly, given that non-communicable diseases are a major public health crisis in the Pacific Islands, course participants were informed that the updated national diabetes guidelines for Samoa will include routine health screening of ears and hearing in the care plan for all adults living with type 2 diabetes mellitus.
One of the highlights of the workshop for the course facilitators was the engagement of participants in the hands-on components and scenario activities. The enthusiasm of the course participants for the role plays of parents, children and health workers generated lots of fun and laughter!
The WHO PEHC training kit includes a pre- and post-test assessment of each student for each module. In addition to assessing knowledge improvement, our course participants had to achieve a minimum mark for each module in order to pass the course. We were delighted to see that all participants successfully achieved high scores for all modules and were able to receive the PEHC course certificate.
Course participants were also asked to complete a course evaluation form. Based on this first experience delivering the PEHC training module, as well as feedback from course participants, Pifeleti and Kaspar will make changes to future PEHC course workshops as appropriate. This may include providing the pre-test and post-test questions in the FaaSamoan language, as well as English. Over the next two years, our goal is to deliver the PEHC training 10 times (five times a year), especially to community health workers in rural/remote areas of Samoa. Course facilitators will travel to rural/remote areas to allow for maximum number of course participants and to ensure that the training is relevant and context specific (i.e. management/treatment plans are based on availability of resources, referral pathways take into account transportation difficulties/cost).
BUILDING THE SKILLS OF PROVIDERS
It would be unethical for our department to provide fellow health care workers with enhanced knowledge of primary health care delivery without also equipping them to put their new skills into practice. Since most district clinics do not report any working otoscopes, successful completion of the course will entitle the participants clinic to at least one otoscope. The provision of otoscopes will significantly improve primary ear and hearing health care and should therefore reduce the number of patients requiring referral to the hospital ENT department for advanced stages of ear disease and associated hearing loss.
We share our experience to promote similar initiatives in low- and middle-income countries, especially among our Pacific island neighbors where ear and hearing health specialists are virtually non-existent. Strengthening the skills of primary health care workers is expected to significantly reduce the preventable burden of ear disease and hearing loss in the Pacific Islands. This aligns with the current philosophy of task sharing, as advocated by the WHO Division for the Prevention of Deafness and Blindness. We take this opportunity to thank the Royal Australasian College of Surgeons for their financial and resource contributions that have made the WHO PEHC training dream for Samoa a reality.