For children who have delays or disorders in developing speech and language critical to the learning process, early intervention is imperative. Yet for many, services are out of reach. All children, regardless of their families’ socio-economic status should be entitled to succeed in learning and success in life. The foundation for learning is the ability to use language. For those children who enter kindergarten unprepared to achieve academic success, the future is not bright. According to Catherine Snow, Graham professor of education at Harvard University, preschool programs focusing on building vocabulary are crucial for making up the deficit that children from low-income families already face. Children with the largest vocabularies in kindergarten still have the largest vocabularies six years later.

Language is the code we learn to communicate ideas. Speaking, listening, reading and writing are all forms of this code. An estimated 84% of incarcerated youth have communication disorders and 80% of adults in prison are functionally illiterate (Texas Medicine, June 2000). These problems stem from childhood. Early childhood programs for low-income families such as Head Start are grossly underfunded. Unfortunately, the effectiveness of various programs are so variable, it is hard to make a cogent argument for increased funding to all providers. One of the greatest challenges for our society is to implement consistently successful programs with demonstrable outcomes. Once this happens, it will be easier to convince our decision makers that an investment in these children is money well spent.

I was recently called an “audist” by a sign language interpreter on my staff, and believe me, it was not a compliment. Audism is a term used to describe attitudes and actions by people in the hearing world that oppress those who are Deaf. Audism, like racism…judges, labels and limits…The belief is that hearing people feel they are superior to Deaf because they can hear. It might be because I am Jewish but words that end in ISM such as anti-Semitism, racism, sexism and now AUDISM are words that are powerfully repugnant to me.

I told the interpreter that I wanted to share a story with her. A long time ago I had an assistant who I was very fond of, and she, me. One day an elderly Jewish lady, whom I’ll call Mrs. Goldstein, had an appoinment to purchase hearing aids. When she left without purchasing them, Katie, my assistant, asked “did Mrs. Goldstein try to Jew you down on the price?” What was so upsetting to me was that she had absolutely no idea that what she was saying was offensive, bigoted, insulting and just plain ignorant. I explained that to Katie and vowed to myself that I would help teach her the truth…it is the only way to combat prejudice.

I asked my staff person to help me in the same way. I am not an audist…but I may occasionally say things that might make it seem, out of ignorance that I am. Rather than make derogatory comments I asked her to take the time to educate me. I am very open to listening and learning.

When asked if she had a choice, if she would rather be deaf or blind, Helen Keller chose blindness. She answered “blindness separates you from things but deafness separates you from people”. Communication is the foundation of all human interactions. 30 million Americans, or 1 in 10 suffer from hearing loss yet only about 20% of those who could benefit from amplification choose to wear hearing aids. It is a statistic that has stymied me for many years. Most adults have hearing loss that occurs gradually over time. They don’t typically wake up one day and suddenly say “I don’t hear too well anymore”. In fact, the process occurs slowly over years. Many people aren’t even aware; family, co-workers or friends may be the first to realize what is happening. The TV may be a little louder, the person asks for repetitions, struggles in a crowd. The problem is, once made aware; resistance has historically been truly amazing. My grandmother, until nearly the age of 90 stated, “I don’t need a hearing aid…they are for old people”.

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In an ironic twist, the same person who helped me develop into a disruptive woman in healthcare has asked me to become a founding member of the Disruptive Women in Health Care blog. She is my big sister. When we were in high school, she had the coolest job ever; she was a “medical assistant” in the office of a local internist. He was a sole practitioner who believed in giving young women an opportunity to get experience in the medical field. Many of them have, in fact, gone on to careers in healthcare. Just before my junior year in high school, with my sister heading off to college, the baton was passed to me. After thoroughly prepping me for the interview (I can still count backwards from 100 in increments of 7 flawlessly and remember the spelling of such important words as phlegm and pneumonia), she was off and I was running.

Initially, my role was pretty basic. Interviewing the patients meant asking, “What is the reason for your visit?” to open and closing with, “Are there any other complaints or is there anything else you wish to speak to the Dr. about?” As I gained valuable experience, I was given more responsibility: setting up for and developing x-rays, performing EKGs, analyzing urine and stool samples and writing prescriptions. By the time I was mid-way through college, I had occasionally been given the opportunity to “assist.” That meant helping with pap smears, casting fractures, administering chemotherapy and suturing. Finally, throughout graduate school, I became known as the Medicare expert. The staff would save up hundreds of claims for me to complete when I came home for vacations and summers.

Can you imagine how simple things were then and how different they are now?  We had no computers; the forms were filled out using a pen. I knew what a LBBB was and why PVD was bad. My boss signed, by hand, each and every form I filled out. Although times were much more innocent in the late 1970s and early 1980s, I learned lifelong lessons in that office. I was the most comfortable audiology graduate student in my class when it came to interviewing patients. I wasn’t afraid of touching ear wax or giving difficult test results to families. I owe much of my success initially as an audiologist and currently in my role as Director of a clinic to my first employer, and of course, to my big sister.