Nancy is six years old and has recently started school. She was looking forward to going, but now she finds it hard to follow the lessons. Her teacher has also noticed that Nancy appears not to listen, and doesn't pay attention in class. He presumes that is because Nancy has poor hearing. Her father is very worried and has brought his little girl to Dr Piet van Hasselt's clinic.

When Dr van Hasselt examines Nancy's ears with the otoscope (an instrument for visual inspection of the ear), he sees that Nancy has otitis media, or middle ear infection. The pus that has collected behind her eardrum stops the thin membrane from moving and transmitting sound waves. That is why Nancy is hard of hearing. The test shows she has only 40 per cent hearing in her right ear and only 60 percent in the left. The thick secretion is removed by suction through a small incision in the eardrum. Dr van Hasselt then inserts a tiny tube into the eardrum to drain any further fluid. The minor operation is successful, and Nancy can immediately hear much better.

Not all children are fortunate enough to have their condition diagnosed in time. If they do not, the consequences are dire. Many people in Madagascar, children and adults alike, are hard of hearing or deaf because their chronic otitis media has never cleared up completely. "Otitis media is normally left untreated in Madagascar," Dr van Hasselt reports. "We find many children here who have gone deaf as a result of this condition."

One of the main tasks of the former CBM co-worker was therefore to convince the people of Madagascar not to take otitis media lightly. In rural areas, so many babies and children have suppurating ears that it is considered normal. Because the secretion from the ears is white, many people believe it is mother's milk leaking from the babies' ears. It is no coincidence that the Madagascan language uses the same word (totongan-dronono) for middle ear infection and mother's milk. This mistaken belief has fatal consequences. Some mothers stop breastfeeding their babies, which makes them more susceptible to diseases.

One of a kind
In Madagascar, ear treatment is considered a specialism, which means that hospital staff in rural areas do not treat even the simplest ear infections. None of the public hospitals – only one per province anyway – takes care of ear complaints. The CBM-supported hospital opened six years ago in the Madagascan capital Antananarivo is the only one that treats ear and hearing problems.

The CBM medical advisor was the only ear surgeon for the country's 17.5 million inhabitants. He is also the only doctor who operates on patients to remove proliferations of infected tissue (cholesteatomes) that may occur in cases of chronic ear infection. He also operates on a further dangerous complication of otitis media - mastoiditis. In this, the infection spreads to the bone behind the ear. If left untreated, this may lead to meningitis and paralysis of the face and eye muscles.

Passing on knowledge
Dr van Hasselt visited Madagascar two to three times a year to treat as many patients as possible. Since these visits are not enough, during his stays he trains two Madagascan doctors in how to insert tubes and repair holes in the eardrum – two of the most common surgeries that immediately improve the patients' hearing. "Helping poor people is part of my Christian belief," Piet van Hasselt says of his work, which is financed solely by the donations of supporters.

Photos: Wim Hendrix

Read more: Prevention of Hearing Impairment
Further information: What is Otitis Media?