I

felt driven to write a little bit about the awareness of deafness and hearing impairments upon reading the article about Virginie Lassilier in The Jakarta Post's Jan. 6 edition. Lassilier is helping the deaf with theater and raising awareness of the problems associated with being deaf in Yogyakarta.

It is such a pleasure to know that someone, a foreigner, cares so much about helping children and young adults that suffer from hearing impairments in Indonesia. Helping the deaf with theater is unique, reviving and extraordinary.

Deafness, unlike blindness, is an unseen disability. The general public is, therefore, largely ignorant of the hearing loss phenomenon.

Yet, deafness is the most prevalent sensory disability globally. The problem is disproportionately high in the Southeast Asia Region; every third deaf person in the world is from Southeast Asia.

The World Health Organization (WHO) estimates that every year about 38,000 deaf children are born in Southeast Asia.

This would mean that every day over 100 deaf infants are born in the region.

Despite being the most frequent sensory disability, deafness has received little attention in the health development agenda, including in Indonesia.

The consequence of this is the rapidly increasing burden of deafness. Deafness in infancy and childhood has an immense impact on communication, education, employment and quality of life in view of the years of deafness caused by hearing impairments in infancy and childhood.

The Indonesian population is estimated at 240 million and the estimated number of hearing impaired children, is over 2 million.

This figure, however, could be underestimated because, as in many developing countries, Indonesia (among other things) is lacking resources for diagnosis and rehabilitation for hearing impairment/deafness and the output of the available human resources such as audiometricians, teachers of the deaf and speech therapists is less than optimal because of a variety of reasons attributable to training, deployment and work environment.

Furthermore, the WHO protocol for population-based surveys in developing countries, does not adequately provide objective detection for children aged younger than five years.

The most important consequence of hearing loss in children is delayed speech and language development.

This delay can lead to social and emotional problems and the possibly of academic failure. The longer a child's hearing loss remains undetected and untreated the worse the outcome is likely to be.

In addition to its individual effects, hearing loss makes a large contribution to the burden of disease and it substantially affects social and economic development in communities and countries. Childhood deafness accounts for significant years of life lived with disability (YLD).

The WHO has used the Global Burden of Disease (GBD) to assess the impact of an illness or injury and hearing impairment is the 2nd leading cause of YLD and is the 15th leading contributor to GBD (2005).

The WHO has also estimated that two-thirds of those with severe-profound hearing loss live in developing countries.

The majority of hearing-impaired children found in hearing clinics and in schools for the deaf in Indonesia are severely or profoundly deaf and most of them live in poor socioeconomic conditions.

Hearing impairments in high-income countries have been shown to have a very large financial cost.

For example, in Australia, the real financial cost of hearing loss was US$11.75 billion in 2005 and this cost does not take into account the net cost of the loss of well-being (disease burden) associated with hearing loss, which is a further $11.3 billion. This is also likely in low- and middle-income countries.

Hearing impairment is, therefore, a cause and a consequence of poverty, especially in low- and middle-income countries.

There is little data available to document the impact on the poor, but it is evident that poor people who also suffer hearing loss are doubly disadvantaged.

One of the reasons why deafness receives little attention is due to a lack of evidence-based information and the general lack of awareness on the magnitude and consequences of deafness or hearing impairment in all parts of society.

Therefore, there is a lack of strong advocacy and a lack of political will to deal with it, which leads to a lack of resources and programs.