Heeding the Call to Heal

Dr. Susan Emmett, who is Hutchison’s Distinguished Alumna for 2020, is working to change disparities for those experiencing hearing loss in areas where there is limited access to ear and hearing care. Together with colleagues from around the world, they are striving to create equity in hearing care.
In rural Alaska, Dr. Susan Emmett ’01 was examining a three-year-old boy named Anuk. His parents brought him to the clinic because he didn’t seem to speak as much compared to his brothers. Emmett, an otolaryngologist, ear surgeon, researcher, and professor at Duke University School of Medicine, learned that Anuk had suffered from ear infections since he was about four months old. Several rounds of ear infections without proper treatment left him with significant hearing loss.

Without treatment, Emmet knew the possible outcomes: Anuk’s speech could lag behind, he would likely do worse in school, his job prospects could be limited, and he might experience social isolation.

Unfortunately, hearing loss statistics are grim. Anuk is one of an estimated 1.3 billion people living with hearing loss globally. Over 80 percent of those affected reside in low- and middle-income countries, where there is limited access to ear and hearing care.

Dr. Emmett, who is Hutchison’s Distinguished Alumna for 2020, is working to change these disparities. Together with colleagues from around the world, they are striving to create equity in hearing care.

HOW DID SHE GET HERE?
Seven years after graduating from Hutchison as valedictorian of the Class of 2001, Susan Emmett was living in East Africa, working in Moshi, Tanzania, at the base of Mount Kilimanjaro.

Emmett was in her third year of medical school at Duke University. She was one of 65 medical students nationwide and the only student in global health to receive the prestigious Howard Hughes Medical Institute fellowship that funded her research for a year. She completed her undergraduate work at Princeton University in molecular biology and in the School of Public and International Affairs. Building on her interest in policy fostered at Princeton, Emmett’s research in Tanzania was looking at the intersection of health policy and science in global health.

During that year, Emmett observed something that wasn’t getting a lot of attention. “There were many children with hearing loss, and it wasn’t being addressed or even talked about because there were other issues that were taking priority.”

Noticing that deficit turned out to be a transformative experience, because up until that point, Emmett hadn’t decided on a medical specialty. She began to think otolaryngology, a specialty that focuses on medical and surgical management of disorders of the ear, nose, and throat, was the path she would take. “I was excited about working with patients to restore hearing and change their quality of life. No one was doing global health research in otolaryngology at that point. Until I spent that year in Tanzania, I wasn’t sure how otolaryngology would fit with my interests in global health and policy work. I saw a need and decided to do what I loved.”

Emmett’s focus on hearing loss in children has turned out to be her life’s work so far. She was selected for a seven-year otolaryngology-head and neck surgery residency at Johns Hopkins, the top otolaryngology program in the country. While at Hopkins, she also completed a postdoctoral research fellowship and master’s in public health. Dr. Emmett now practices as a surgeon and professor at Duke, where she works with colleagues around the world to conduct research on hearing health disparities globally.

“I was mentored by some incredible public health researchers who taught me the nuts and bolts of how to do large public health intervention trials and field studies. It was combining two areas of expertise, surgery and public health research, that set me up for the career that I’m in now. It’s exciting to be filling a need that hasn’t been addressed before.”

KEEPING A WIDE FOCUS
For many people, the grueling years of medical school and hectic, sleep-deprived residencies required to become a doctor or a surgeon are onerous enough. Once doctors start practicing, their hours are filled quickly with treating patients and performing surgeries. Most don’t have the time or the bandwidth to tackle a global health problem or advocate for health policy.

Emmett was determined to take it all on. Her passion for policy work was nurtured by relationships with two important mentors while at Princeton. During her summers, she worked for Dr. Lana Skirboll, a longtime director of science policy for the National Institutes of Health. “I learned a lot about what it meant to have a career in policy and how to be a scientist and a public servant from her,” she said. She still talks with Skirboll regularly. Emmett also had the opportunity to be mentored by Princeton President Shirley Tilghman, an accomplished molecular biologist who became the university president during Emmett’s freshman year. Emmett got to know President Tilghman when she taught one of Emmett’s classes. Tilghman later served as her senior thesis advisor, a yearlong scholarly endeavor for which Emmett was awarded the Molecular Biology Senior Thesis Prize at at Princeton’s graduation.

“I never planned to become a scientist working in a lab,” Emmett explained. “I was interested in the intersections of how we explain science effectively to the public, how we make decisions that guide how healthcare is delivered in the future, and how scientific evidence is implemented to improve health. The goal is to do that in a way that the public understands and appreciates.”

THE PREVALENCE OF HEARING LOSS
“The global burden of hearing loss is tremendous,” Emmett stressed.

It bears repeating: an estimated 1.3 billion people suffer from hearing loss and the majority live in countries or communities where treatment is either scarce or almost non-existent. The World Health Organization estimates that up to 60 percent of childhood hearing loss could be prevented in these countries with better access to care or other preventative services like vaccinations.

Emmett has spent significant time in rural Alaska, and, as with Anuk, the vast majority of hearing loss in children there is from ear infections. “Up to 75 percent of children have had at least one ear infection before their first birthday in Alaska, and the prevalence of hearing loss is anywhere from six to nine times higher in that state than it is in the general U.S. population. We’re trying to understand what factors are creating this and why ear infections are happening so much more frequently there.” Her research has also taken her to Nepal and Bangladesh in South Asia.

Knowing a root cause of hearing loss is helpful, but Emmett cautions that hearing loss can happen even when there is good access to care. “That’s one of the complexities of this. Even if we develop the best systems in the world to make sure that every child has access to care, it doesn’t mean that we’ll completely change this problem. But it will put us a lot farther down the path of addressing these disparities.

“The focus of my research now is trying to understand why hearing loss is so much more common in low resource settings and what can be done about it,” Emmett explained. “How do we better identify individuals affected by hearing loss and ensure they receive the care they need, no matter how remote their community?”

TACKLING HEARING LOSS GLOBALLY AND EQUITABLY
In Alaska, mobile screening and telemedicine technologies are being implemented successfully and used more frequently because of the remoteness of some areas. With telemedicine, patients can be connected to specialists who are thousands of miles away. Emmett began to see that the work she and her team were doing in Alaska could be applied around the globe, which was always her goal.

In 2018, Emmett launched the Global Hearing Loss Evaluation, Advocacy, and Research (HEAR) Collaborative. It is the first international research network dedicated to reducing disparities in hearing loss.

“We now have 28 countries involved,” Emmett said. “This is a network of surgeons, audiologists, and speech language pathologists who all work on hearing loss in their own countries. We have come together to try to address how we best treat patients with hearing loss in low resource settings and how we address challenges with access to care. We’re asking, ‘What’s making hearing loss so common in these environments? How do we prevent it in the first place?’

“A lot of my focus now is on building collaborations and developing research projects with a few of the sites and also big projects that cover many countries at one time.”

One of the challenges Emmett and her colleagues face, she said, is that hearing loss is not yet a well-accepted concern within the public health realm. “We’ve got smart and dedicated people working on this issue, but it doesn’t always get the attention from funders and from policy makers that it needs and deserves.

“Transformative change doesn’t happen overnight, even if you see it coming in the future. It takes perseverance and really sticking with the work that you’re doing and knowing that changes will come, but they might not happen tomorrow.”

WHEN TED CAME TO TOWN
How do you stand out in a world crowded with people and organizations trying to advance their cause for making the world a more equitable place?

Even though Emmett’s former college roommate lives at the southern tip of Argentina, they have seen each other every year since they graduated. Her friend had been nudging Emmett for years to apply to become a TED Fellow. That’s the TED of the ubiquitous TED Talks and TED Conferences, the media organization that posts talks online for free distribution under the slogan “ideas worth spreading.”

TED looks for individuals who are early in their careers, but who have visionary plans and are destined to be change makers. Their goal, ultimately, is to get good ideas out into the world. For the person giving the talk, the exposure can be a great boost in terms of publicity, as well as mentoring and guidance.

At first, Emmett brushed off her friend’s encouragement, thinking no one would care about the work she was doing. Then she found out that the TED Global Conference for 2017 was going to be held in … wait for it … Arusha, Tanzania.

“It had been 10 years since I had been there,” Emmett recalled. “I was excited about the possibility of going back, and particularly in a way that would help to launch and publicize the work that I’ve been doing that essentially originated
from that place.”

Emmett applied, but the process was intense. She recalled being interviewed at 4 am on a snowy morning in Alaska. She was interviewed virtually by seven people, all of whom could see her, but she couldn’t see them. She spoke about her work in Alaska and her commitment to addressing disparities in global hearing health. Soon, she was selected as a TED fellow. She spent nearly four months working with TED staff to prepare the talk she would give in Tanzania. After all, talks can eventually be viewed by millions of people around the world.

“It was an amazing year,” she said. “I met incredible people from all over the world working in all kinds of different fields, and I saw the transformative work that they were doing. We were all building off of each other. It was one of the most remarkable experiences I’ve ever had.”

Although the fellowship lasts for one year, you’re a TED Fellow for life. Emmett said she has benefited from the executive coaching and support of the program.

COLLABORATION IS KEY
In addition to seeing patients, performing surgery, teaching and mentoring students, and trips to field sites to oversee research, Emmett is knee deep in policy work. She is working as a consultant for the World Health Organization to create the first-ever world report on hearing, which will gather evidence to share with ministries of health around the world about how to improve access to hearing care. She serves as the director of innovations in service delivery for the Lancet Commission on Hearing Loss, another international initiative to address hearing loss disparities.

If you ask her if it’s too much work, she simply shrugs it off, saying that the key is collaboration. “It’s about building on existing relationships and networks and empowering colleagues to be able to work on issues and answer questions scientifically that none of us would be able to answer if we worked in isolation. We can accomplish so much more by working together instead of all working individually in our own hospitals or regions or countries. If we can work across countries and across cultures, we can create transformative change in a way that is impossible otherwise.”

Like most people have experienced, the pandemic has had its impact, but she’s still working as hard as ever remotely. “We were fortunate that the randomized trial I’d been running in rural Alaska was wrapping up before COVID-19 hit the U.S. in the spring. We’ve been doing data analysis and data cleaning and preparing our results, and that can be done remotely. I spend a lot of time on Zoom at odd times of day.”

TO THINK IT STARTED AT HUTCHISON
“Vicky Fisher was a longtime math teacher at Hutchison,” Emmett recalled. “We became close, but she passed away when I was a sophomore in college. She was an inspiration to me with all that she accomplished in her life. She believed in me and was certain that I could go on to change the world. She embodied the lessons that I gained at Hutchison of being able to move forward and accomplish my dreams in an unencumbered way. I still think about her almost every day.”

“Hutchison does an incredible job empowering young women to reach their full potential and to not feel constrained by limitations that society might otherwise impose.”
She added, “It never crossed my mind that I wouldn’t be able to accomplish something because I am a woman, and so I’ve carried that forward throughout my career. It’s an amazing gift that I received from my education at Hutchison.”

How would she advise a Hutchison girl? “I would say go for your dreams. Find what it is that you absolutely love and how you can make the world a better place, and then go do it. It’s important to keep the 30,000-foot view in mind and know where you’re trying to go. Help inspire those around you on how we can get there and how we can work together to get there. It’s a matter of perspective, grit, and perseverance. You have to be willing to work hard for things you believe in, even if there isn’t instant gratification.

“I love what I do. All of this hard work has put me in a place where I can build teams and dream about how we can really make the world a better place, improving access to care for the most disadvantaged.”
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