By Nicolas SandersPosted on 22-09-2019Modified on 22-09-2019 at 22:19

Some 466 million people worldwide suffer from a disabling hearing disability, including 34 million children. On 23 September, World Deaf Day is dedicated to raising awareness about deafness and the presentation of deaf culture, including sign language. In many African countries, general awareness of hearing loss is low, and lack of resources results in a lack of auditory screening programs.

Hearing loss may be due to genetic causes, birth complications, certain infectious diseases or chronic ear infections, use of certain medications, exposure to excessive noise or aging. In Africa, and particularly in countries south of the Sahara, measles, ear infections and certain bacteriological infections are the main causes of deafness in children. According to a study recently published in The Lancet , between 20% and 25% of African deaf children are ill because of meningitis, and about 10% because of measles.

" There are many hearing impaired people in Africa, usually because of infections. But the most important thing is cerebrospinal meningitis. It causes deafness. At the school of the deaf of Bamako, nearly 60% of children suffer from deafness following meningitis, "explained Professor Alhousseini Ag Mohamed, ENT doctor at Gabriel Touré Hospital in Bamako, in a bulletin of the WHO. West Africa is desperately short of structures for the care of people with hearing loss. Some institutes exist but they must be equipped and above all, provide them with qualified personnel. There are only seven speech therapists in Burkina Faso. The profession of speech therapist in Africa remains nascent and still little known to the general public in Africa.

In Burkina, we use American sign language

According to Justin Dabiré, former head of the Orthophonie section of CEFISE (Center for Integrated Education and Training of the Deaf and Hearing) in Ouagadougou, where he now practices in his own practice, the first problem encountered in the management of Deaf children is illiteracy. " The care of people with hearing loss comes at a time through the use of sign language. When the person has not gone to school, so can not read, sometimes we are limited in certain actions. Secondly, there is the equipment : all people with hearing loss do not have access to it. Not only in relation to the knowledge of the existence of the apparatus, but also in relation to the cost. For the moment in Burkina, we are not at the stage of implanting hearing aids .

His experience at CEFISE has allowed Justin Dabiré to become familiar with sign language, but most speech therapists do not master it very well. " Sign language is only learned by a very small minority of the deaf community, in fact it is about people who have gone to school. Some schools teach sign language. Outside of school, there is no formal framework for learning sign language , "says the practitioner. In Burkina, against all odds, it is the American Sign Language (LSA) that is in force.

" One is never a very good speaker of the signs when one is hearing "

A huge amount of work has nevertheless been done in Burkina to establish and structure a sign language, with the establishment of a dictionary that mixes the LSA and traditional signs that were used in the villages. « It's the work of the Burkinabè pastor Abel Kafando, an extraordinary man I had the chance to know » [deceased a few years ago, his wife Thérèse Kafando is still director of the school of deaf children of Ouagadougou , remembers Elizabeth Sepulcher, a French speech therapist who in the Speech Therapists Association of the world has carried out several missions of assistance and assistance in Africa.

The LSA is the most widespread in Burkina, she says, because the first schools of deaf children in West Africa were created by American pastors in the middle of the twentieth century. " The LSA is not too different from the LSF, the French sign language, we get to understand each other, it's not too much of a problem, " she says before adding that " we 'is never a very good speaker of the signs when one is hearing '.

But any diffusion of a sign language is complicated, because the language evolves, so the sign language dictionaries must be in video, which is the easiest for the transmission. The Internet and all the dematerialized means of transmission really help a lot and will help more and more to the diffusion of these means of communication, estimates Elizabeth Sepulcher.

Adaptation to the Beninese culture

If the means of communication in the care of the deaf child remain complex, African speech therapists strive to adapt their knowledge to the field, which is never easy when all tools and assessment tests reflect a French culture rather than African. An additional difficulty that Daniel Affo, Beninese speech therapist established in Cotonou, has worked to circumvent. " Depending on the skill to be evaluated, we use European tests. I managed to set up an assessment test for hearing impaired children in collaboration with a French speech therapist colleague, in 2018. In this test I updated in the context of Benin. There are images that can be presented to children and they are not necessarily images that they know in Beninese culture. For example with the image of a cherry, which must be replaced by a local fruit .

This is also the observation made by Justin Dabiré in Burkina: " I use the TERMO (evaluation test of the reception of the oral message by the deaf child) but there is no test or battery so far adapted to the cultural context of the populations. The TERMO comes from France, but we can not pass all the items of the test, because there are some words that seem a little foreign here in Burkina, especially for a hearing impaired with a reduced lexicon. We do not yet have any material specific to our culture .

" When there is sickness, we prefer to turn our head "

In Ouagadougou, Cotonou and elsewhere in West Africa, the socio-cultural factor remains the biggest obstacle to proper care for children with hearing loss. " The literacy rate in Burkina is around 80%, I think, and it's not uncommon to meet patients who have not been to school. Often this is a problem in parents' understanding of what we want to do with patients. Another problem, we receive late, which is still habits. When there is sickness, we prefer to turn the head ... Sometimes they do not know where to go, they go to the wrong center. They do not reach our speech therapists until late, "explains Justin Dabiré.

" The main difficulty is when parents fail to pay for rehabilitation over a long period , points Daniel Affo. Even on vacation periods when schools close, when they return, speech therapy sessions often have to start from scratch. Nothing is reimbursed, the parents pay themselves but sometimes they have to stop the sessions, whether in school or in a health center .

► Three questions to Elizabeth Sepulcher, President of the Speech Therapists of the World NGO

What is the purpose of the missions conducted by Speech Therapists of the World in Africa?

Speech-language pathologists intervene only in response to requests from associations or professionals. Our interventions differ according to demand. Their main purpose is to train professionals who work on site with deaf people, children or adults. Deafness is a significant part of our interventions. We help professionals put in place everything that will help them acquire a language, often in a context of bilingualism, that is, sign language, on the one hand, which is their natural language and then on the other. as far as possible access to the oral or written language.

When we receive a request for a mission, we take a lot of time upstream to interact with the applicants, to understand what they need and to see if we can meet part of these needs. Speech-language pathologists who go on mission are always volunteers, they are short missions that are repeated eventually. We usually go to two speech therapists selected by the steering committee based on their knowledge of this mission. We can intervene in other areas than that of deafness.

What general observation do you make in the light of your missions?

My last mission, last year in the Comoros, allowed me to see that the situation there is much more difficult than in some other African countries. Because there is no school dedicated to the deaf children, nor besides other handicaps. In partnership with Unicef ​​Comoros, we have been working for several years to inform and educate teachers in the three main cities of the archipelago, around disabilities in general and around deafness in particular. To think about the means of transmitting knowledge to children who do not hear. It is a beginning of work that must continue in the years to come.

Deafness is often detected very late compared to European countries, and supported late or not supported at all. For a deafness to be taken care of, it is necessary that the parents of the already deaf child can have access to a hospital, to a hospital, a screening center, where the deafness to actually be proved and distinguished from other problems .

I remember seeing in Togo in a center for children with mental disabilities children who were in fact deaf children, undetected. Measuring the hearing of a child in some African countries, especially far from major centers, is much more difficult than in France.

A note of hope in the care of deaf children in Africa?

Things are changing a lot because now there are speech therapists who are trained, as at ENAM Lomé in Togo, and who do both the work of prevention, screening, and early management. They are still few and of course the work is huge. During my first missions in Africa 20 years ago, things were different. On the ground there were very very few speech therapists, and very few specialized teachers for young deaf people.

But any diffusion of a sign language is complicated, because the language evolves, so the sign language dictionaries must be in video, which is the easiest for the transmission. The Internet and all the dematerialized means of transmission really help and will help the diffusion of these means of communication more and more.

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