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~~(ffio'lli\~~~A Journal on Innovation and Best Practices in Aboriginal Child WelfareAdministration, Research, Policy & Practice

Vo111111e3, NumberJ, 2007, pp. 96-105-~ - -- - --- - -" - - - - - - --

Intercultural Communications and Conductive Hearing Loss

Damien Howard

Dr Damien Howard is an Australian psychologist and educatorwith a research interest in the social outcomes of middle eardisease, especially among Aboriginal people. He lives in theNorthem Territory of Australia where 30 per cent of the populationis Aboriginal, many of whom live in remote communities inextreme poverty and where middle ear disease is endemic.He has worked in these communities as well as more urbancontexts as a teacher, psychologist, cross-cultural consultantand researcher. A number of research reports and resourcesdeveloped by him are available at www.eartroub/es.com.

IntroductionCultural and linguistic differences are critical factors

to consider in intercultural communication. However,the widespread hearing loss that is known to exist inAboriginal communities can also have a significant andadverse impact on communication, especially intercultural

communication. Children who grow up in poverty,who live in crowded housing, and who experience poornutrition and inadequate health care, are prone to repeatedsevere episodes of middle ear disease (otitis media).These episodes can often cause conductive hearing loss(Bowd, 2005; COULOS.Mctcalf& Murray, 2001).

AeknQ~/~diment~ The author would /ike to thank Sheri Loch-nar an a anne iffars for their assistance in proof readingand editing this arlie/e, as well as the two anonymous reviewersfor their suggestions for its improvement.

Questions or correspondence concerning this article may beaddressed to.

Dr. Demien Howard,Phoeni}( ConsultingDarwin AustraliaPO Box 793, NightelfffDarwin, Northern Territory Australia 0814Fax: +61889309003Phone: 61889484444damien@ohoenixeonsultinq.com.au

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---- ---------AbstractVVidespread conductive hearing loss among Aboriginal peoplesin first world nations has a significant, although largely invisibleimpact on intercultural communication. Poor acoustics andcultural differences in communication styles compound theeffect of widespread hearing loss among Aboriginal peoples.This article considers Australian research that has investigatedhow conductive hearing loss can impact on interculturalcommunication in schools and in the criminal justice system, aswell as communication processes within Aboriginal families. Anunderstanding of these issues can facilitate the developmentof innovative interventions that can help address Aboriginaldisadvantage, especially within mainstream institutions.

In Canada ..otitis media is endemic among InuitFirst Nation and Metis children in northern Canada. withprevalence rates as high as 40 times thai found ill theurban south. Conductive hearing [ass among childrenmay affect as many' as two-thirds of Aboriginal childrenin northern Canada (Bowd, 2005). In Australia. as manyas 80 per ceru of the Aboriginal children in remotecommunities have some degree of conductive hearing loss(Couzos, Mdcalf& Murray, 2001).

Different types of hearing lossWhen thinking about hearing loss people generally

think of those who are 'deaf', that is those who havesevere to profound levels of permanent hearing loss.However, there are a far greater number of people whohave less severe and sometimes fluctuating levels of oftenunidentified hearing loss. This is especially true amongstchildren.

People \1,11\0arc pre-lingually deafIthat is, profoundlydeaf before developing oral language) are noticeable

because of their manner of speech and/or because theyrely on sign language and lip reading for communication.lu contrast. people: with slight, mild and moderate hearing

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loss arc less noticeable. They usc spoken language astheir primary means of communication and their abilitvto listen and hear may be adversely affected in only .some situations. Nevertheless, mild to moderate levels ofhearing loss can sti II have significant social. educationaland occupational implications.

Conductive hearing loss, otitis media and'listening problems'

'Conductive hearing loss' is hearing loss caused byproblems that affect the transmission ofsound impulsesbefore they enter the inner ear. The term refers to the waysound is transmitted by mechanical conduction throughthe vibration of the eardrum (tympanic membrane). alongthe small bones in the middle ear. and then through theprcssuriscd air in the middle ear. Conductive hearing lossamong children is most often the result ofinfection iOnthemiddle ear - otitis media.

The infection causes a build up of1luid in themiddle ear. The pressure exerted by this fluid can buildup to the point where the eardrum bursts, or perforates.The fluid build up and eardrum perforations inhibit thetransmission or conduction of sound through the ear. Inmost developed communities otitis media is a commonbut. short-term childhood illness that is resolved bv thetime children begin school (Bluestone. 1998). Ho~\'ever,in communities where children grow up in overcrowdedhousing, have poor nutrition and limited access to healthcare, middle ear disease is more prevalent and moresevere (Couzos, Metcalf & Murray. 2001). Children fromthese communities often experience mild to moderatefluctuating conductive hearing loss during their schoolyears.

Aboriginal Australians, Canadians and Americans(\VHO, 1996). and Pacific Island and Maori childrenin New Zealand (Greville, 20tH) have a known higherprevalence of middle car disease and associatedconductive hearing loss than other population groupsin those countries. It has been estimated that Aboriginalchildren in Australia experience middle ear disease andrelated hearing: loss throughout their childhood for anaverage of two and a half years, while the average forchildren in the mainstream Australian community is justthree months (Couzos, Metcalf & Murray. 2001).

Childhood middle car disease also contributes toa secondary condition - problems with the processingof auditory information. The persistent partial sensorydeprivation that results from the conductive hearingloss associated with middle ear disease can inhibit thedevelopment of the neurological abilities needed toprocess sounds (Hogan & Moore. 2003). This can leadto an ongoing auditory processing problem, which is

© Damien Howard

sometimes referred to as a central auditory processingdisorder. While about 10 per cent of' people in the generalcommunity are affected by auditory processing problems,one Australian study found that 38 per cent or a group ofAboriginal secondary students showed signs of auditoryprocessing problems (Yonovitz & Yrmovitz, 2000).

'Listening problems" arc especially evident in noisysituations and are related to a combination of conductivehearing loss and auditory processing problems. both ofwhich are caused by past or current middle ear disease.For the sake of descriptive simplicity in this article. thiscombination of problems is termed 'conductive hearingloss' or 'hearing loss'

Conductive hearing loss is widespread amongAboriginal adults as well as among Aboriginal children.While intermittent conductive hearing loss is mostcommon among children, many Aboriginal adults havesome degree of ongoing conductive hearing loss as aresult of significant uncorrected damage to the middleear caused by repeated infections during childhood.In Canada it is estimated that 44 percent of Inuit. and39 percent of First Nations adults living in reserves orsettlements have hearing loss (Bowd, 2005). For remoteAustralian communities, studies have found 50 percent ofIndigenous tertiary students (Lay, 1990) and 60 per centof a group ofAhoriginal workers have some degree ofhearing loss (Howard, 2007a).

III developed Western countries with Aboriginalminorities (Canada, Australia, New Zealand) research inthe area has mostly been restricted to studies of the healthaspects of ear disease among Aboriginal peoples (Bawd,2005; Couzos, Metcalf & Murray, 2001). However. inAustralia there is also a small body of research on theeffect of conductive hearing: loss on educational and socialoutcomes of car disease among Aboriginal people. This isdescribed in the following sections.

Intercultural Communications in Classrooms'All of the kids with that ear problem. thev re

fighting or bullying the other kids fat school](Australian Aboriginal Health Worker)

In intercultural classroom settings! AustralianAboriginal students with conductivehearing loss havebeen found to participate less than other students in thehighly verbal Australian teaching processes. Studies haveshowed that they contribute little to class discussions andarc less likely to answer questions. Often they arc also thestudents who are most disruptive in class (Howard, 2004);and they tend to be less academically successful at school(Yonovitz & Yonovitz, 20(0). In part. this is becausepersistent conductive bearing loss makes it more difficultfor the affected Aboriginal children to acquire languageskills. especially when learning English as a second or

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Intercultural Communications and Conductive Hearing Loss

third language (Jacobs. 1988; Yonovitz & Yonovitz. 2000;Howard. 2007a). However. their classroom and languagebased learning difficulties are also related to aspects oftheclassroom environment.

Classroom based research in Australia points 10 anumber of mediating factors that influence the extent towhich adverse communication and social outcomes resultfrom conductive hearing loss among Aboriginal children(Howard. 2004: Howard, 2006a). These factors arc:

The cultural context of the classroom;

The teachers' perceptions of and responses to thebehaviour of Aboriginal children with conductivehearing loss; and

The levels of background noise in schools.

Classroom cultural context and hearing lossIn Australia, most Aboriginal children arc taught in

standard Australian English by a non-Aboriginal teacher.In this setting certain factors appear to compound thedifficulties associated with hearing loss for Aboriginalchildren (Howard, 2006a).

They face culturally unfamiliar and highly verbalteaching styles that require students to learn fromlistening to teachers and peers in an artificialclassroom environment;

Their classrooms are often noisy and seldom haveadequate acoustics for Aboriginal children withhearing: loss.The standard classroom approach to teaching and

learning differs markedly from the traditional styles ofeducation found in many Aboriginal cultures, wherelearning occurs in small groups or 'one-to-one' and in reallife contexts (Harris. 1980: Erickson & Mohan. 1981).These more informal styles of education have manyadvantages for children with mild to moderate hearingloss.

Firstly, reallife contexts provide children withmulti-sensory learning cues ~ they can observe tasksas they are demonstrated, so they do not have to relyon mainly spoken explanations;

Secondly. the levels of background noise in one-to-one or small group instruction in real life settings arcoften lower than they are in classrooms.

Moreover. it is easier for children to understandsomeone who is known, speaking a familiar language,and who is able to talk about topics within the context ofa familiar cultural framework. These 'familiar" supportsfor communication and learning become critical whenconductive hearing loss reduces the information that isotherwise available from listening.

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The evidence from Australia suggests thai ifAboriginal students are taught in the language with whichthey arc most familiar. in a wholly Aboriginal classgroup, by a teacher from the same cultural group, thefisk of the adverse communication and social outcomesfor the children with conductive hearing loss appearsto be minimized (Lowell, 1994; Massie, 1999; Howard2004). When teachers are from their own culture, childrencan learn within a framework of cultural and linguistic'familiarity' that makes it easier for them to understandwhat is said. 'familiarity' with the person, language andculture helps children to 'fill in the gaps' that result fromdiminished auditory input. Without such non-auditorysupports and aids to understanding, Aboriginal peoplewith hearing loss (adults as well as children) can findspeech difficult to comprehend. When they do this can i.nturn karl to fear of being 'shamed' ~because they havenot understood - and the resulting anxiety can compoundthe difficulties \vith understanding. The problem becomesa cyclical and negatively reinforcing one, and one that,for Aboriginal children with conductive hearing loss,can limit their ability ro learn and to develop essentialunderstandings of culturally unfamiliar 'world views'.

Condnctive Hearing Loss and 'Worldviews'A shared 'worldvicw" is important for successful

inter-cultural communication. Shared 'worldviews"develop as the result of a series of successful cross-cultural negotiations over time (Lowell et al.. 2004).However, people with conductive hearing loss andwho come from minority cultures are less likely tobe able to successfully participate in the interchangesand negotiations that are needed to arrive at a shared'wotldvicw' (Howard, 2006b).

Firstly, when people with conductive hearing lossdo engage in intercultural communication. they arcoften unable to do so as successfully as those who canhear well. They may misunderstand what is said. Theyarc often slower to learn concepts. They may distract1:1 group with "offtopic' interjections, or they may justmaintain a perplexed silence (Howard, 2006a). Secondly,Aboriginal people with conductive hearing loss oftenseek to cope with their communication difficulties byavoiding or minimizing their involvement in interculturalcommunication. In the case of Aboriginal children withconductive hearing loss in Australia the)' arc absent tromschool more often than others (NACCHO, 2(03). Whenthey are at school they are more likely to try to avoidengagement with their teachers and involvement in manyclassroom activities (Howard, 1994.20(4).

Many Aboriginal adults with hearing loss employ theslime tactics - absence or avoidance.

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"!IrY to have tiuta 10do with white people"(Aboriginal Health n"c)rker with. hearing toss).

By avoiding or minimizing their involvement inintercultural communication. Aboriginal people withhearing loss are dealing with the anxiety they mayotherwise experience during intercultural communication,where successful communication depends on levels ofauditory/verbal skill they do not have. However, if theyarc familiar with the people and social processes involved.this can help to minimize their anxiety, notwithstandingany hearing loss. Conversely, communication withunfamiliar people in the context of unfamiliar socialprocesses compounds the communication difficulties thatresult from hearing loss. For example. school children withhearing loss often have more difficulty when dealing with atemporary teacher tan un Iami liar person) and exhibit moresignificant behaviour problems when they arc participatingin school excursions (involves unfamiliar social process).

Over lime, their adverse experiences and negativeresponse patterns have a cumulative result. To beginwith, they experience basic communication difficulties.They have difficulty hearing-what-is-said. because oftheir hearing loss. This, in turn, can lead to difficultywith understanding-what-is-hem·J, because they have notacquired the familiarity with Western 'worldviews" thatwould help them to understand-what-is-said. The problemcompounds first in childhood and then into adulthood;many people with conductive hearing loss seek to avoidor minimize the risks of intercultural communication_ anxiety, communicative failure and "shame'. As aresult those with conductive hearing loss develop lessfamiliarity with Western ways of doing things than doother members of their group.

The effects of this disengagement can be seen inthe C0111mentfrom a teacher when told which of theAboriginal children in her class had been identified ashaving conductive hearing loss. She said that she hadthought her difficulties in communicating \...-ith andrelating to these students had arisen because the)' were"more Aboriginal" than other students. This comment isindicative of the way in which hearing loss can obstructthe development of shared 'worldviews". It also servesto show how a focus on 'cultural differences.' as anexplanation for intercultural communication difficulties,can obscure recognition ofthe contribution tI131conductive hearing loss on-en makes to these difficulties.

Relationships with TeachersThe \HI)' teachers view children's classroom

behaviours (which may be related to a hearing loss)and the 'way teachers respond to these behaviours arcmediating factors in the disadvantage experienced byAboriginal children with conductive hearing loss.

© Damien Howard

For Aboriginal students, their relationships with theirteachers arc a key factor in their success at school (Malin.1990). Some students with conductive hearing Jossactively avoid engagement with teachers, misunderstandwhat is said, fail to complete work, are disruptive inclass and tease their peers. The teachers often See thesetypes of classroom behaviour as a function of poormotivation, limited ability or overt defiance. In one study,the Aboriginal students that nun-Aboriginal teachers saidthey had most difficulty relating to were the ones whowere found to have conductive hearing loss (Howard,2006a). However, when teachers know which childrenhave conductive hearing loss and understand how certainclassroom responses are shaped by conductive hearingloss. as well as how to communicate better with thesestudents, then the students' engagement in learning aswelt as their relationships with their teachers improves.At the same time. the amount of antisocial behaviordecreases (Howard, 2006a; "Hookey, 2007).

Background noiseBackground noise can significantly increase

communication difficulties for people with conductivehearing loss. Although people with mild to moderate hearingloss may cope when listening ill a quiet environment, theyexperience difficulties as the background noise level rises(Whitlock & Dodd, 2003; Finitzo-Hieber & Tillman.19781 School environments are often noisy becauseof the activity and talk among groups of childrencongregated in confined and often acoustically poorclassrooms (Wilson et <II., 2(02). In these situations,Aboriginal children with conductive hearing. lossexperience learning difficulties and display lower levelsof achievement (Yonovitz & Yonovitz, 2000; Howard,2004) as well as poor social and emotional outcomes andhigher levels of antisocial behaviour (Zubrick et al, 2004:Howard." 20(4).

Thus, the evidence from research in schools. froman Australian perspective, serves to confirm that theconsequences of schooling for Aboriginal children withconductive hearing loss are significantly mediated bycultural context, non-Aboriginal teachers' perceptionsof and responses to student behaviour, and noise levelsin classrooms. These factors interact synergisticallywith conductive hearing loss to determine the level ofdisadvantage that can be associated with conductivehearing loss. The same' factors also influence outcomeswhen Aboriginal people become involved with thecriminal justice system.

The criminal jnstice systemIn Australia and New Zealand, there is evidence that

a higher proportion of Aboriginal prison inmates have

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Intercultural Communications and Conductive Hearing Loss

some degree or hearing loss when compared with thegeneral incidence of conductive hearing Joss in the totalAboriginal population (Bowers, 1986: Murray & La Page,2004). This suggests that:

Involvement in {he crmunal jusuce system maybe the ClUJ product ofa cumulative link wherebyhearing-related soda! problems contribute 10 loweducauonal stondards. unemployment, alcoholand substance abuse. these being the moreobvious antecedents ofcosuaci with the criminaljustice system (Howard et al., 199 I. P 9)

And here. as in schools, difficulties with interculturalcommunication processes, the perceptions and responsesof non-Aboriginal stair and background noise levels, incombination with conductive hearing toss. can and dolead to significant communication problems.

Linguistic and cultural differences are frequentlypresumed to be the reason why an Aboriginal witnessmay misinterpret a question. give an inexplicable answer,remain silent in response to a question or ask for aquestion to be repeated. The potential contribution ofconductive hearing loss to a break down of commun-ication is generally not considered. However. it isprobable that the distinctive demeanor of many AustralianAboriginal people in court is related to their hearingloss. Where this is the case there is a very real dangerthat the court-room demeanour of Aboriginal people (notanswering questions, avoiding eye contact. turning awayfrom people who try to communicate with them) maybe being interpreted as indicative of guilt, defiance orcontempt (,..toward, 2006c).

COHrt processes art largely an artifact of 'Western'culture. The social processes arc structured and highlyformal and the language used is often obscure, even tonative English speakers. Yet Aboriginal people can bedisadvantaged if they do not participate fully in courtprocesses that involve archaic examples of 'Western-social etiquette and a specialized English vocabulary.An anthropologist made the following comment afterobserving Aboriginal defendants in court proceedings:

(The) nwst/i'equent response is to withdrawfrom the sttuatton, mentally, emouonatty andvisually. One magistrate in a country towncomplained to me that "Abortgtnes in thedock are always gazing OUi of the Window, orlooking down and either iglloring questions ormumbling inaudible answers "(Howard e{ at,1991, p 10).

Also, as is the case between a student and his/herteacher, conductive hearing loss can jeopardise thebuilding of rapport and quality communicaiion betweena client and his/her legal counsel. Yet a good relationshipbenvcen thcm is critical to cO'ectivc represcntation withinthe criminal justice system.

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One Ahoriginal mall with hearing lossrelated that, years earlier. feeling confusedand embarrassed ahout his hearing-relaredcommunication dtfficutttes. he pleaded guilty toif charge a/which he believed he was innocent.He thought it would be easier to plead guiltythan to try to explain (through his lawyer) hisinnocence in court. He subsequently spent sixmonths in prison (Howord et cd.. 1??J,p If)

The following anecdotes arc indicative of ways inwhich communication elsewhere in the criminal justicesystem can also be adversely affected by conductivehearing loss. with perverse consequences.

A defendant with hearing I08s 11·'(1S crash weldedwhen being transported from court when he didnot obey a verbal order to stop, that he did nothear

/~ffer sentencing. 11 defendant with hearing losswas placed in an unfamiliar room to be toldwhat his sentence meant. His usual lawyer wasnot available because of of her commitments, soanother unfcuniliar lawyer fried to explain thesentence. However. the mall became wild and'trashedthe room when the new lwryer triedto explain the court outcome. He only calmeddown whenfcnntliar stafffrom [he detentioncel1lre arrived

Along term feud developed between (/ hearingimpaired prisoner and another prisoner aftera hearing related misunderstanding during agame of cricket ill prison (Howard, 2006c, p 9j.

In the criminal justice system, background noise alsoplays an important role ill communication problems forpeople with conductive hearing loss. A group of prisonstaff linked the places and times when it was noisiestwith the incidence of most arguments between inmates.They also noted that the number offights reduced whenthe public phones used by inmates were enclosed tobetter sound proof them. because people using the phonesexperienced less frustration as a result of noise intrusion(personal communication. 20(6).

There is also evidence that hearing loss can inhibit notonly imercultural commuuication but also communicationbetween Aboriginal people.

Family lifeResearch into the influencc of conductive hearing

loss \vithin families indicates ihat conductive hearing losscan have'ill impact on communication bet\veen peoplefrom the same cultural background. One sma!! qualitativestudy ~Howard & Hampton. 2006) supports the view thatconduct!v.:: hearing loss can have a negative effect onfamily life.

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Half the kids gertioggtngs [beatings] becausethey [thefamity] think theyre [the children]ignoring Them. I sec parents giving kids withhearing loss a flogging when they [the children]have not understood - f see that all the lime,everywhere .:

They are cheeky __you set' a kid [who hasmiddle ear disease} throwing rocks at Mumand swearing and demanding something. andusually most limes they wttt give it to themto shut them lip {Aboriginal Health Workers-Howard & Hampton, 2006, p2j

There is also evidence of the adverse effects thata child with conductive hearing loss can have on otherfamily members. -

lfelt depressed andfrustrated because f didn'tknow what was going on J was blaming myselfI thought if was my fault and I was a badmother: lfett like I was letting her down. l wasfrying to figure Oil! what 10do, The behaviourproblem came at school. The}' never suggestedanything and it was depressing nOl knowingwhat to do. but if wus getting me down andif was the stress levels. J was gruwling her andyelling. l was pushing her awav because I didn tknow how 10 dcat with it. It made us grow apan.I did not want 10 he around her. I didn 't wall! todeal with it I didn [ know how to deal with it.II realty stresses me. Other people [people inthefamity} scatter co= I am going o/Tnty headyelling at her (AhJlher a(child with conductivehearing loss - Howard & Hampton, 2006. p3)

Tn homes. just as in schools, antisocial behaviorassociated with conductive hearing loss can be mediatedby background noise. Disputes and arguments involvingpeople with hearing loss typically arise in noisy socialgatherings. espedaHy ,,"'hen alcohol is involved. Some-times other family members experience frustration andanger because of their family member's hearing relatcdcommunication difficulties. The follmving short casestudies describt; hm\! this can happen and how dire theconsequences ean he for a family.

One woman with hearing loss accused herhusband oj 'mumbling "when she could notIIfldei's[(lnd him at a time l!'i1en them was fots ofnoise at home hecause afmany visitors stayifl,;;She got angry with him and threw something athim, he responded by hirting hef; ll'hich led tohis arrest andjail (Howard, 2007b, pJ)

A young husband with hearillg loss describedhow the birlh of(l lIew baby made if harderfor him to hem: Communication demands Oil

him were greater because his wi!!:! wantedmore support/rom him 10 look alter Iheir newhaby. but she gOT angry when he had troubleunderstanding her above the baby:~ crying

© Damien Howard

On one occasion he had 10 go to hospital aftershe became angry and hit him. She had askedhim to get something from the shop hut hehad misunderstood what she said and boughtthe wrong thing with the last 0/ their money(Howard. 20076. plj

There is also some evidence, from studies of non-Aboriginal children. that conductive hearing loss caninfluence family Iit~in other important wa).;. Childrenwith conductive hearing loss may instigate familialinteractions less often than children who can hear well.and may also be Jess responsive to their parents (Roberts,Burchinal & Clarke-Klein. 1(95). This results in adiminished quantity and quality of social interactionbetween affected children and caregivers (Hoff-Ginsberg,1990; Vibbert & Bornstein, 1989). Mothers with a childwho had experienced chronic middle car disease weremore likely to be depressed and to feci that they were lessadequate as parents than other mothers (Forgays, Hasazi& Wasserman, 1992). Some non-Aboriginal Australianmothers also reported that they found it more difficult tofeel close to a child with conductive hearing loss (DorothyMoore. personal communication, 1992). - .

Other studies among non-Aboriginal children havebeen less supportive of the long-term effects of earlyconductive hearing loss (Bowd, 2005). However. itshould be remembered that these studies were carriedout in non-Aboriginal communities where less seven::middle ear disease affects t'flr fewt;r children. and feweradults have permanent hearing problems. These nOI1-

Aboriginal communities also fact; far ~e\verother typesof social disadvanlui!e than is often the case ill Aborieinalcommunities, and th~y do not face the challenges -involved in being a cultural minority. As <1 result. theadverse consequences of conductive hearing loss arelikely to be more muted than they are in Aboriginalcommunities (Nicnhuys. 1992; Ho" ...ard, 2006h). Thismeans research outcomes involvin2 non-Aboriginalgroups should not be used as a basis for policy ~mdpractices applied in Aboriginal communities,

The Implications for Welfare AgenciesThere has been no forma! resl!arch into hearinlZ:loss

among Aboriginal welf~lrc clients. This is despite tllerebeing both disproportionate numbers of Aboriginal peoplewho have hearing loss (Bowd. 2005. Com',os, MctcalL& ivlurray, 200 I) as weB as an over representation ofAboriginal people involved wilb welfare ser"'ict;s (Wicnet a1, 2007, Trewin & Madden, 2005). There are also clearlinks between hearing loss and issues associated withinvolvement with ,."drare services. We have seen earlierhow widespread hearing loss can influence Aboriginalfamily life (Howard & Hamptoll, 2006). Then:: are also

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Intercultural Communications and Conductive Hearing Loss

indications that Australian Aboriginal children with ahistory of ear disease are more likely to be involved insubstance abuse (LO\....ell. 1994). We know too that nonAboriginal children with hearing loss arc more likely toexperience sexual abuse than non Aboriginal children(Sullivan. Brookhouscr, & Scanlan, 2000).

Informed speculation would suggest that many, ifnotmost. ofAboriginaJ welfare clients in Australia, Canadaand New Zealand have some degree of hearing loss asa consequence of endemic childhood ear disease. Asoutlined earlier most of the Australian Aboriginal childrenwho have behaviour problems at school have hearing Joss,as do the majority Aboriginal adults who become prisoninmates in Australia. Many of these children and adultswill be involved with welfare agencies at some point.

Widespread Aboriginal hearing loss has a number ofpractical implications for welfare agencies. These includethe importance of determining if Aboriginal clients havebearing loss, plus ensuring caseworkers and, as much asis possible, family, carers and educators know and useeffective communication strategies with welfare clientswho have hearing loss. These clients also need to haveaccess to health services to treat any active ear diseaseor have surgery to repair damage to ear drums. ifthis isneeded. Further. formal research of this significant issueamong Aboriginal welfare clients is urgently needed

These matters are not easily addressed as theinformation and/or infrastructure needed to do so ismostly no! readily available. For example, Aboriginalchildren on reserves in Canada and in remote commun-ities in Australia have the worst ear health in theirrespective nations. as well as very limited access to healthservices. A Canadian reviewer of this article pointed outthat many children living on reserves can only accessadequate ear health services when they arc taken intocare (Shangrcaux and Blackstock. 2004). Nevertheless,the awareness that conductive hearing loss has importantcommunication and social outcomes for many Aboriginalpeople who arc involved with welfare agencies is animportant first step on what will be a long journey.

DiscussionDrawing on research carried our in Australia. this

article has outlined the significance of conductivehearing loss in both intercultural and also potentially insame-culture communication. Attempts to address thehealth aspects of middle ear disease in Australia over thelast thirty years have had limited success (Bowd, 2005;Morris el al.. 2007). In isolation. however. and withoutconsideration of the social and educational consequencesof conductive hearing loss for Aboriginal children andadults, such health initiatives are likely to haw a limited

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effect on the cycle of poverty and the way it can unfoldfor Aboriginal people affected by conductive hearingloss and its consequences; poverty contributes to a higherincidence of middle ear disease among children, whichresults in conductive hearing loss. which leads on to poorsocial, educational and employment outcomes. whichperpetuate poverty.

Middle car disease is an important health issue,but there is also a need for a greater focus on thecommunicative and social consequences of Aboriginalhearing loss. It is a problem whose impact is seldom fullyappreciated or addressed.

Widespread Aboriginal hearing loss acts as a directbarrier to cornrnunication. It also contributes indirectlyto the linguistic and cultural barriers that constrainintercultural communication. These barriers can havea negative impact on social and emotional wellbeing,educational opportunity and access to almost all serviceswhere access depends on effective communication.Many of the problems that arise arc not caused solely asa result of conductive hearing loss. They arise becausecommunication is impeded by the interaction of noisyenvironments and culturally unfamiliar communicationprocesses with widespread hearing. loss. From what wepresently know, to successfully overcome these barriers,three things are important: knowing which people dohave conductive hearing loss, improving environmentalacoustics by limiting. background noise levels. andadopting more effective communication processes,including culturally based communication strategies.

What does this mean iu practical terms?1. Access to audiological services for hearing tests is

often problematic, especially in remote areas, but'easy-to-use' hearing screening strategies can help toidentify probable hearing loss (Howard, 1993).

2. There arc a number of ways to acoustically improvean environment. ln schools sound field amplificationwhere lite teachers voice is amplified to the wholeclass is beneficial as is adapting buildings to preventnoise intrusion and limit reverberation (echo) inrooms (Wilson et al.. 2002). One inexpensiveintervention is simply to minimize background noiselevels during communication. All too often, non-Aboriginal professionals with good hearing. decidewhether or not an acoustic environment is adequatefor communication with Aboriginal people who haveconductive hearing loss that the professional does notknow or think about. Communication outcomes canbe significantly improved ifpeople are aware thatthcy may be talking with people who quite possiblyhave conductive hearing loss, and if they take steps to

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minimise background noise levels (Howard, 2006a).

3. Communication problems that arise because ofunfamiliar cultural communication strategies anddiffering 'world views' can be addressed through theinvolvement of Aboriginal staff in service provisionand as communication brokers, as wei! as training allstaff! in effective communication strategies for peoplewith hearing loss (Howard. 2007a} These strategiesinclude using visual cues during verbal explanations.selectively using amplification devices, spendingmore time on 'communication' and being careful notto make inappropriate judgments about capacity ormotivation on the basis of people's comruunicaticndifficulties (SIjC w\vw.emtroublcs.com for moreinformation).

Fhis is not to suggest that we already know enoughabout these issues to be certain about how best [0

address them. There is a need for more research into theconsequences ofwidespread conductive hearing lossamongAboriginal people - children and adults, and waysof addressing this problem. In the field of education,there have been a few in depth studies. In the criminaljustice and the welfare sectors. as well as in othercontexts, there is much more work to be done. Withouta fuller understanding or the long term and 'life cycle'consequences of conductive bearing loss, in interactionwith other environmental and cultural factors, it willbe difficult to fully assess and effectively address theproblems arising from childhood middle ear disease.Nevertheless, the results ofthe work in Australia do point10 steps that can be taken now 10 minimize some of theconsequences of conductive hearing loss for individuals,their families and their communities.

There is a parallel in the disadvantage I~lced by theAboriginal peoples of Call ada, Australia, New Zealand.because of the role that conductive hearing loss play·sin the perpetlmtion of the cycle of poverty lhat affectsAborigin<ll minorir.ies in first \vorJd nations. further,it h<ls been estimated that a third of the popUlations indeveloping countries experience hearing loss because ofchildhood ear disease that is rdated to poverty (Berman,1995), This mCDns there are at least a billion PI.;Opie worldwide who can be assisted by a better understanding ofthese issues.

Endnotes1. Classes of Aboriginal students taught by a non-Aboriginalteacher who speaks standard Australian English.

2. \/Vtlile Aboriginal people can often communicate effectivelywith Aboriginal people with hearing loss, they are often unawareof their own or others' hearing loss. \l\lhen they become aware ofthese issues they can use their communication skills even more

effectively.

© Damien Howard

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© Damien Howard 105