You Can’t Not Focus on Rehab: An Interview with Vera-Genevey Hlayisi
Vera-Genevey Hlayisi is a lecturer and PhD candidate at the University of Cape Town teaching and researching rehabilitative audiology. Trained as a clinical audiologist, Vera has broad insight into person-centered care from both a clinical and research perspective and is a fervent advocate for a person-centered approach to audiological rehabilitation.
As part of our partnership with the University of Cape Town, Vera and colleagues are organizing a training workshop at the University of Cape Town later this month. The workshop will support the integration of person-centered care and Ida tools in audiological rehabilitation. The purpose is to ensure that lecturers and clinical educators are able to train and assess students as they transition from academia to clinical practice.
Vera also recently introduced person-centered care and Ida tools at the first congress of the Botswana Audiology Association held in Gabarone in June. We spoke to her about the challenges of rehabilitative audiology in South Africa and beyond, and how she sees hearing care making a shift towards a more person-centered approach.
How did you start working with rehabilitative audiology?
I started working clinically in a state hospital. I quickly realized that, in as much as there aren’t enough of us to do the diagnostic work, and the prevention work, there isn’t enough that we’re doing for the patient after we fit them with hearing aids. Especially in state hospitals, the big issue to me is adherence. How do we make sure we see our patients again and are able to follow them across their lifespan?
I was frustrated not to know what would happen to the patients once we had diagnosed and fitted them with hearing aids, so I started doing a little bit of research: How many people am I screening? How many people am I diagnosing? How many people am I fitting? And how many people are coming back for a follow-up?
Patient buy-in wasn’t something that we focused on. Many of our patients had other primary health concerns. I started realizing, “Maybe they don’t really understand how important this is because in comparison to other health conditions, they don’t consider their hearing a priority.”
It occurred to me then that in order for us to be successful in treating the patients that we’re seeing, we need to understand how they ended up at our door, and what their needs and wants are. At the time, I wasn’t familiar with person-centered care although that was in fact what I had identified as missing.
The “Aha!” moment only hit me later when I started my academic career at the University of Cape Town. There was a little bit of fate, because the teaching area where they needed me to fit in was rehab. This is when it became very clear to me just how important a person’s hearing and communication is to the entire being of who that person is. I learned that to get the results that I want from the rehabilitation, I have to help this person realize that I’m helping them get the results that they want. And the results that they want may not always be directly connected to their hearing.
Why are the rehabilitative aspects of hearing care important to you?
With the atmosphere in audiology today, where automated testing and over-the-counter hearing aids are gaining ground, there is a global realization that audiology is changing. The role of our profession is changing towards being less and less concerned with the diagnosing and the quantifying of hearing loss and more about addressing our big concern, which should be, “Who is this person that has hearing loss? How can I help them with this hearing loss?”
If you pay attention to how technology is influencing our profession, you can’t not focus on rehab. I think a lot of my peers are sleeping on it, some by circumstance. There are countries, especially in Africa, where audiology is at a very early stage. In these countries, they are now using new technology to do screening, prevention and awareness raising to get them into a clinic. But it’s going to take them a long time to get to a point where they discover that after you do all of that, you need to take people through their diagnosis and talk to them about what it means and how to help them manage their hearing loss. There’s a lot of foundational work that needs to be done.
A lot of African countries don’t have audiology training programs. South Africa is one of the more privileged ones with five or six training institutions, where we are turning out 20 or 25 audiologists every four years. If you look at how big the continent is and how big the need is, you realize for us to even be having a conversation about how we can do rehab better, we’re actually a bit ahead. But we need to keep up so that when we’re building these new training institutions, these new clinics, we’re able to embed person-centered hearing health care and rehabilitation from the start.
What are the challenges of implementing person-centered care and rehab in South Africa?
Structurally, we never had a system that encouraged person-centered care because the main focus is on the numbers. “We have 100,000 people that might have hearing loss. Let’s test all of them.” We need to test all of them, but we also need to reframe how we follow up.
Some people have argued that rehab and person-centered care are concepts developed in Western countries and can only be implemented there. There is some truth to this. As an audiologist in South Africa, when you walk into a clinic, there are 50 people waiting at 7 o’clock in the morning, and you don’t have the time to ask each and every person what their needs are. All you have time for is to test, fit, and refer those who need to be medically treated. The people who need to come back for fittings and further counseling will come back. I think we also need to be very aware of the patients’ expectations. Sometimes you are trying to be more empathetic and use motivational interviewing, but half of the patients are looking at you like, “You’re not going to ask me what my symptoms are? You’re actually asking me what I do and what my day looks like? Are you a shrink? Are we in the psychologist’s office?” Also, there are cultural expectations that need to be taken into consideration.
Despite all of this, there is a growing awareness about the importance of the rehabilitative aspects of hearing care and I think the profession, with time, will be reshaped to become a rehabilitative profession, and that the training needs will evolve to reflect what’s happening in practice and what’s happening in the market. There’s no point in me training a diagnostician when there are five million apps and ten million computer programs that can do it much faster and much more accurately. The real job will become to rehabilitate. So, I think these are exciting times.
How do you use Ida tools and resources in your work?
I use Ida’s ethnographic videos a lot. As a lecturer, it’s just so much easier to find a video on the Ida website than to come up with something on my own. I also use the Ida website to keep up with what’s happening and connect with peers. It’s the cheapest way to find experts to collaborate with rather than going to a congress. Being part of the Ida community also helps me build my own professional path and establish myself as an expert in the field.
I like the Telecare tools because they help me show the students how to apply telehealth in practice. The Time and Talk tools are genius when you’re doing tutorials. Adherence is quite a big thing for me, and the Ida Motivation tools are quite useful because they help you get to the crux of, “What is your issue and how can I help you help yourself?” The Dilemma Cards are quite effective to use with patients to identify and discuss concrete communication situations and issues that are important to them and help them address those issues. The Reflective Journal is also quite useful to help students think about their work. Those are my favorites.
I can also highly recommend the CPD accredited courses in the Ida Learning Hall. With the Learning Hall, I can just send students a link and say, “Log in and do this and we’ll have a chat next month and you can tell me where you’ve had challenges.” Whereas before I would have to go and meet students who are placed in a non-central area or have them come on campus, but now I can just send them a link.