Restoring hearing in American Samoa Expanded from the print edition
In August 2015, I travelled to American Samoa with Richard Wagner, MD, of Global ENT Outreach (GEO). American Samoa is a group of six Polynesian islands in the South Pacific and is the United States’ southernmost territory.
By Robert M. Brody, MD, University of Pennsylvania, Humanitarian Efforts Resident Travel Grantee
In August 2015, I traveled to American Samoa with Richard Wagner, MD, of Global ENT Outreach (GEO). American Samoa is a group of six Polynesian islands in the South Pacific and is the United States’ southernmost territory. It has a population of 60,000 people who all obtain medical care from Lyndon B. Johnson Tropical Medical Center, the islands’ only medical facility, which is located in Pago Pago. The hospital has an ENT clinic, an audiology technician, and an ENT physician who provides screening and medical care; however, there is no full-time staff to provide surgical services to the population.
With a high incidence of hearing loss and a high prevalence of diabetes, 6 percent to 10 percent of American Samoa’s population suffers from some form of otologic disorder. The clinic sees all ENT consultations for the entire population and is able to triage cases such that surgical services can be provided once to twice yearly during planned visits by GEO.
During our time in American Samoa, we performed 20 otologic cases including tympanomastoidectomy for cholesteatoma, stapedectomy and ossicular chain reconstruction, and tympanoplasty for persistent tympanic membrane perforations with associated hearing loss. Aside from establishing safe ears in our patients with cholesteatoma, it was a pleasure to restore hearing and quality of life to our patients who had been suffering from conductive hearing loss. Some of these patients had suffered from hearing loss for decades, since childhood, due to poor access to care.
In addition to otologic services, there is a great need for surgical expertise related to other areas of the head and neck in American Samoa. We identified an 11-year old child suffering from a second branchial cleft fistula and excised his tract during our trip.
Tracheotomy placement as well as postoperative care and teaching were provided for an infant as well as multiple adult patients. Parotidectomy was performed for a large parotid mass consistent with a pleomorphic adenoma. Functional endoscopic sinus surgery was performed for one patient with complete nasal obstruction due to nasal polyposis. An urgent incision and drainage of a rapidly progressive facial cellulitis with resultant abscess formation was performed as well in a diabetic gentleman. With daily packing changes, appropriate blood sugar control, and appropriate antibiotic therapy, we saw his infection resolve over the ensuing 10 days.
It was a privilege to spend two weeks training with Dr. Wagner and an honor to provide such necessary care to the people of American Samoa. It was humbling to work with such autonomy surrounded by the amazing physicians and staff at LBJ Tropical Medical Center. I am deeply grateful to the AAO-HNSF Humanitarian Efforts Committee and Synthes International for supporting my efforts with GEO. I look forward to participating in future humanitarian endeavors in conjunction with the AAO-HNSF.