NACCHO Aboriginal Health News: Indigenous ear surgeon Dr Kelvin Kong closing the gap

 

ears

Dr Kelvin Kong, one of three Indigenous surgeons, is excited about the RACS’s decision to sign off on a strategic plan to develop the Indigenous health workforce. It has taken six years of consultation. ‘‘One of the most conservative institutions in Australia, which hasn’t had an Indigenous health policy, finally does,’’ he says, beaming. ‘‘Part of the focus is to increase the number of ATSI [Aboriginal and Torres Strait Islander] surgeons, as well as increasing the awareness of Aboriginal health in the college. Indigenous health hasn’t been in the curriculum for ENT training even though ear disease is so widespread.’’

NH 2

Photo above :Ear, nose and throat specialist Kelvin Kong, from Newcastle, regularly conducts clinics in Broome to tackle the devastating impact of ear disease among Indigenous children. Picture: Simone De Peak 

Published in the Newcastle Herald : By ROSEMARIE MILSOM

WHEN two brothers walk into a starkly lit room at the rear of Broome Hospital on a Tuesday morning, the confronting extent of ear disease among Aboriginal children becomes apparent. Both boys have rats’ tails – 13-year-old Quentin Turner’s is an uncoiled spring while five-year-old Leithan’s is straight – but that is not all they have in common.

Dr Kelvin Kong, an ear, nose and throat (ENT) specialist, scans their medical records while the boys sit quietly with their mother Juelene, Leithan burrowing shyly into her chest. Quentin’s folder is five centimetres thick.

It is the second week of Kong’s 10-day visit to the hospital, which services a vast, sparsely populated expanse of Western Australia. Of the 24,000 people treated in the emergency department each year, 60 per cent are Indigenous. In the ENT clinic overseen by Kong, the majority of patients are children and the doctor’s easygoing manner puts the littlies – and their parents – at ease. ‘‘Holy dooley’’ and ‘‘cool bananas’’ are not typical phrases used by surgeons, but Kong, who has a playful streak, is anything but typical.

Quentin’s multiple hospital visits began when he was a baby with recurrent middle ear infections, known medically as otitis media. Before he started school, his eardrums ruptured because of the build-up of fluid in the middle ear. Illuminated by the tip of an endoscope, a healthy ear drum appears as a taut, opaque membrane stretched across the ear canal. ‘‘It’s like a trampoline,’’ explains Kong. ‘‘It wobbles and moves the three inner ear bones, which then send sound to the brain in the form of electrical impulses.’’

‘‘In a community in central Australia I visited, the health worker was baffled by a patient, a little girl. She called me over to have a look and it was a normal, healthy ear drum. She’d never seen one before.’’ – DR KELVIN KONG

Among Indigenous children in remote areas, an intact ear drum is rare and poor hearing is widespread. Recurrent infection leads to persistent ear discharge and perforated ear drums in 40 per cent of these children before 18 months of age. Indigenous children tend to suffer from infection more frequently and severely, and with more serious complications, than non-Indigenous children. During Kong’s clinics, all the Indigenous children have one or more perforated ear drums, but some have no ear drums at all.

Quentin’s ear troubles did not end with otitis media. He endured mastoiditis, a bacterial infection in the mastoid bone, which sits behind the ear and consists of air spaces that help drain the middle ear. This in turn formed an abscess and led to surgery. ‘‘There is hearing loss with every step,’’ says Kong.

Today, he has a runny left ear, a symptom of infection that is so common among Indigenous kids it is regarded as abnormal not to have cotton wool stuffed in your ears. From an early age, children are schooled in the practice of making ‘‘tissue spears’’ to soak up water after swimming and discharge caused by infection. At some schools  classrooms are wired for sound and teachers use microphones.

Kong administers antibacterial drops to Quentin’s ear, encouraging him to tilt his head and rub the area, and then addresses the far more significant issue: at 13, Quentin is deaf. There is no hint of emotion as Kong phones a contact at Hearing Australia to ensure a hearing aid has been arranged and can be installed during the organisation’s next visit to Broome.

‘‘OK, Mr,’’ says Kong, looking directly at the teenager so he can read his lips. ‘‘You need to go and buy yourself a cool cap. Choose whatever you like, but make sure it fits tightly around here,’’ he explains, circling both temples with his hands. Instead of the embarrassment of a traditional aid, a subtle device will be installed in the cap which Quentin will have to wear in the classroom.

It is a sad outcome, though not unexpected.

Leithan’s hearing loss is not as severe, though his right ear drum is perforated. Newcastle audiologist Jacinda Burgess who is also visiting Broome – as is anaesthetist Michel Hoppinghaus – shows Kong the results of the five-year-old’s hearing test. ‘‘The left ear is borderline normal and the right is just below normal,’’ she says. ‘‘His teacher needs to be aware and he has to sit at the front of the classroom. Hopefully she can help tune him in if he tunes out.’’

After the family leaves with plans for an afternoon fishing trip north of Broome – Juelene tells me that the best way to prepare dugong is in a slow cooker – Kong reflects on the boys’ predicament. ‘‘If you visit them in 10 years’ time, they’ll probably be living very different lives. Quentin’s future is in jeopardy. He has missed out on a lot of his education because he hasn’t been able to hear properly.

‘‘His employment prospects are poor; he won’t be able to get a job in the mines. It will be easy for him to become socially isolated and it’s not surprising that hearing problems lead to relationship breakdown, alcohol and drug issues. The impact happens on a lot of levels.’’

YOU know you are a long way from home when the overnight temperature doesn’t dip below 28 degrees and the morning radio weather report includes Christmas Island. Broome is the main tourism and transport hub in the Kimberley region. Its population of 15,000 swells to more than 40,000 during the peak tourism period between June and September. This time of year is quiet even though school holidays are in full swing.

As you fly in to the historic pearling town, which is a long way from anywhere, the first thing that you notice is the Mars-red soil that forms a bold fringe along the tarred roads and contrasts with the stunning turquoise of the tepid Indian Ocean. There are no hills or tall buildings; this is cyclone territory and even tall trees are kept to a minimum.

On the section of Robinson Street where Broome Hospital is located, there is a row of magnificent ghost gums. In the peachy post-dawn light, the scene evokes the pastel tones of a Namatjira painting, but by mid-morning the trunks appear to glow under the harsh glare of a tropical sun.

When  Herald photographer Simone De Peak and I arrive, Dr Kong is in the midst of a schedule that includes consultations, surgery and follow-up appointments. The most common procedures are ear drum grafts, tonsillectomies and the insertion of grommets to enable air to enter the middle ear and fluid to drain. The 40-year-old makes the most of his visit and uses his larrikin charm to persuade theatre staff to squeeze in additional patients: the next ENT surgical list isn’t until November.

Kong leaves his New Lambton Heights rooms and heads to remote Australia at least three times a year for stints lasting from one to three weeks. Specialists from Sydney, Melbourne and Perth also rotate through Broome and other remote communities in a practice largely attributed to respected Perth ENT specialist Professor Harvey Coates. Kong regards Coates, who has been working in remote communities for 35 years, as a mentor. The 70-year-old has watched hearing disease destroy the lives of countless youth.

‘‘The average Aboriginal child, more so in the bush than the city, has hearing loss for 32 months of their first five years compared to three months for a non-Aboriginal child,’’ he explains down the line from Perth. ‘‘This translates to truancy, poor speech and performance at school. It affects self-esteem and behaviour, especially given some of these kids have English as a second or third language.

‘‘On one hand you can say we have the worst ear disease in an Indigenous population of any country in the world,’’ he adds. ‘‘Having said that, chronic ear disease, which is a sign of poverty, is slowly improving with improvements in all the social determinants of ill health such as access to running water, adequate housing and food, attention to hygiene, and access to medical care. There’s not one predominant cause.’’

Edie Wright, who accompanies her nine-year-old granddaughter Kimberley to Dr Kong’s clinic, has experienced the impact of ear disease at home and work. As the regional consultant for Aboriginal education, the 62-year-old describes otitis media as a ‘‘disease of poverty’’. ‘‘It’s also a silent disease,’’ she says. ‘‘Kids get used to the discomfort and while their behaviour might worsen, they don’t complain.’’

Wright was a principal at a remote community school in Wangkatjungka, 130 kilometres south-east of Fitzroy Crossing, between 1999 and 2003. She was overwhelmed by the extent of hearing problems among her students and implemented the ‘‘BBC’’ program. Each morning, the kids would ‘‘breathe, blow and cough’’ and complete a set of exercises to enable postural drainage. ‘‘We reduced our ENT referrals by 70 per cent,’’ she says.

Addressing ear disease is not necessarily as simple as that, she continues. ‘‘Poverty, unemployment, malnutrition, physical and sexual abuse, police intervention – there’s a range of stressors these families face. When you’re in an remote community and a kid has a perforated ear drum and there’s no community health nurse on site, mother can’t get into town because she doesn’t have access to a car and has five other kids to look after … you know, in terms of the list of priorities, a runny ear isn’t so important.’’

Ear disease is not confined to Indigenous communities in far-flung parts of the country: Kong also treats Indigenous patients in Newcastle, Forster, and Taree. ‘‘Urban rates [of ear disease] are not as high, but they are still three to four times higher than in the non-Indigenous population,’’ he says. ‘‘Newcastle being a good example.’’

As a young doctor following in the footsteps of his older twin sisters, Marilyn and Marlene,the first Indigenous women to graduate with a bachelor of medicine from the University of Sydney, an earnest Kong was deeply affected by one particular patient. ‘‘A guy came in who was 40 and he typifies all that’s wrong with ear health. He had what he described as noises in his ears and when we had a look there were maggots in there.

‘‘This was in Newcastle, this wasn’t remote Australia. I looked at his [medical] notes because it’s very distressing to think about how this happened. When he was six years old he’d gone to emergency with discharge in his ears, then had a follow-up at an ENT clinic, but back again a few months later. Page after page of notes.

‘‘It’s no surprise that as a consequence he couldn’t read or write, was unemployed, in and out of prison. I thought, if I’d met this man when he was four years old, could I have changed those outcomes?’’

KONG has a dizzying schedule. Like most high achievers, he crams as much as he can into a day while wishing he could stretch time (he favours slip-on shoes so he doesn’t have to waste precious minutes tying laces).

His impressive CV runs to 20 pages. He works between Newcastle Private and John Hunter hospitals, teaches, mentors Indigenous medical students, is a board member of the National Centre for Indigenous Excellence, and as previously mentioned chairs the RACS’s Indigenous health committee. He is also involved in essential ear disease research and was in Darwin this week for the official launch of the Centre of Research Excellence in Ear and Hearing Health of Aboriginal and Torres Strait Islander Children, which will be led by Menzies School of Health Research fellow Professor Amanda Leach.

Kong, one of three Indigenous surgeons, is excited about the RACS’s decision to sign off on a strategic plan to develop the Indigenous health workforce. It has taken six years of consultation. ‘‘One of the most conservative institutions in Australia, which hasn’t had an Indigenous health policy, finally does,’’ he says, beaming. ‘‘Part of the focus is to increase the number of ATSI [Aboriginal and Torres Strait Islander] surgeons, as well as increasing the awareness of Aboriginal health in the college. Indigenous health hasn’t been in the curriculum for ENT training even though ear disease is so widespread.’’

Kong’s operating theatre is always filled with music. He has a penchant for rap and hip-hop, and if there are young staff rostered on it is not unusual to hear Kanye West blaring. He happily tones it down with Sinatra for an older team. (When I accompanied my four-year-old daughter into theatre for her tonsillectomy in December, he quickly changed the hip-hop track to the ubiquitous theme song from the animated movie Frozen – much to her delight.)

‘‘In the household I grew up in there were people coming and going all the time,’’ he says of the family’s modest two-bedroom Shoal Bay home, which accommodated the three kids and their mother, community nurse Grace Kinsella. His parents met in Sydney but separated when the children were young. His Chinese father, Dr Kong Cheok Seng, lives in Malaysia.

‘‘There wasn’t really such a thing as sleeping arrangements; it wasn’t a nuclear family,’’ Kong continues. ‘‘My mother had a sister who passed young and she had young kids so they’d stay over a lot; other cousins would too. You’re head to toe on the mattress … head to toe and head to toe,’’ he laughs, ‘‘and you’re fighting over space. The only thing you could do to get any study done was put your headphones on. I actually concentrate super well with music.’’

Kong speaks fondly of the women in his life. His maternal grandmother, Gwen Russell, who died in 2010, was born in Kempsey and grew up in an Aboriginal mission. Her mother Jessie was a Worimi woman and her father Clem was the eldest of the famous boxing Sands brothers.

It was Gwen who pulled a cocky Kong aside after he failed a number of first-year subjects at the University of NSW. The talented rugby union player had opted to study in Sydney to ‘‘chase football dreams’’ with Randwick. It all went to his head. ‘‘She gave me the biggest dressing down,’’ he remembers, smiling. ‘‘She said, ‘These footballers come and go, you’ve got bigger things to do. You need to give back to the community’. I was crying and upset, but it made me stop and think and things turned ’round.’’

His mother was the eldest of 12 children and grew up in a simple tin dwelling at Soldiers Point (the family later moved around Port Stephens). She reinforced the importance of education. Kong’s sisters helped him through the gruelling years of medicine and when he became an RACS fellow in 2006, the three siblings represented 20 per cent of Indigenous specialists in Australia.

Since then he has dined with governors-general, prime ministers and visiting royalty – he warmed to Prince Charles but found Princess Mary aloof – and become the poster boy for Indigenous success. He is in the midst of selling his expansive Hamilton South home which is filled with Indigenous art. He drives a Prado and has a penchant for brightly coloured designer label shirts. ‘‘I think I’ve been extremely lucky,’’ Kong says, ‘‘and extremely blessed with the opportunities I’ve been given and because of that I think I have to be mindful about giving back.’’

Does he ever feel uncomfortable about the trappings of success given the plight of so many within the Indigenous community? ‘‘Anita [Heiss, an Indigenous writer], who’s a good friend, likes rocking up in a flashy sports car to schools,’’ he says. ‘‘Among some people in the community it can be a badge of honour being poor, but she wants kids to see that there’s no reason why they can’t be successful. I’ve worked hard and I have a beautiful home, I eat well, and I’m able to help my family.’’ (Kong and his sisters paid for a lovely home to be built for their mother on the same site as the two-bedroom fibro house that they grew up in.)

In 2008, Kong was appointed to the 10-person steering committee for then prime minister Kevin Rudd’s ambitious Australia 2020 summit amid controversy about the lack of women representatives. When he stepped down citing ‘‘family illness’’, commentators suggested it was to enable a woman to take his place. The sad reality was that his wife Sarah, who was diagnosed with breast cancer a couple of months after their 2002 wedding, had been told by specialists that the disease had spread to her brain. The couple had hoped she would make it to her 40th birthday, but Sarah died in April 2011 after Kong threw her a surprise party. She was 38.

When Sarah, a nurse, was first diagnosed, Kong contemplated stopping his specialist training, but a senior colleague encouraged him to continue. One of his biggest faults, he admits, is becoming too obsessed with work. ‘‘I always worry, particularly after Sarah died, about how involved I get with work.’’ As Kong speaks, his ever-present smile disappears momentarily. ‘‘I worry it takes away from family time. I took holidays around Sarah’s treatments and work was as flexible as it could be. About 80 per cent of my colleagues were supportive. I had some amazing times with Sarah, but I always wonder if I should have spent that extra time with her rather than at work.’’

The grief that crushed him after his wife’s death forced him to take time out. He became ‘‘dishevelled’’, grew a beard for the first time, and wondered how the world could keep turning in spite of his loss. ‘‘As a medico it was very humbling to go through that experience,’’ he says. ‘‘We were told Sarah would only live six months, but we got eight years. You can’t underestimate hope.’’

Kong has a child’s drawing on his office wall that reminds him of that time in his life. ‘‘I still had a beard when I came back to work and there was a little girl who drew me with the beard,’’ he remembers. ‘‘After her operation when she came back for a follow-up appointment, I’d cleaned myself up and shaved off the beard.’’ She started crying when she saw him. ‘Where’s Dr Kong? I want Dr Kong’.’’ He laughs. ‘‘I realised everything was going to be all right.’’

He buried himself in work and accepted he would probably not have his own children; he could not imagine falling in love again. ‘‘I thought, I’m lucky because I have a big family and wonderful kids I get to see at work. It was a way of making the most of not becoming a father.’’

As we chat over coffee – he is predictably addicted to the stuff – he checks his phone. A lot can change in four years. Kong is now engaged to Kiara Mitchell, a nurse at John Hunter Hospital, and they are expecting a baby in September. He is waiting for a message from her.

No one is more blissfully surprised about the turn of events than Kong. ‘‘Looking back, Sarah’s death made me realise that you have to grab life,’’ he says. ‘‘I’m trying really hard to make time for Kiara and get more balance. I’ve thought about kicking back to part-time when the baby arrives [pause]… but I’d probably drive everyone mad,’’ he laughs.

DR James Fitzpatrick is on the phone from Fitzroy Crossing, a small town 400 kilometres east of Broome. A seven-year-old girl has presented at the polyclinic with something lodged in her right ear canal. The ear is weeping. It is not uncommon for Indigenous kids to stick objects in their ears because of the irritation caused by constant infection. The girl, Alice Gardiner, will likely need to be anaesthetised so the object can be removed and the polyclinic can’t carry out the procedure.  ‘‘Happy to help,’’ offers Kong. ‘‘When can she come in?’’

I ask Kong what would happen if he wasn’t in town? ‘‘She would have to put up with it until the next team arrives, or she’d have to go to Perth.’’

An exhausted Alice arrives the next day with Priscilla, her aunt, after travelling through the early hours of the morning on a Greyhound bus. Her dark hair with its sun-bleached tips is dishevelled and she is wearing a bright pink tracksuit and sandals. She sits on the floor of the consultation room and plays with a plastic toy shaped like a turtle. She does not make a sound.

Kong asks her to climb on to a seat and as he gently explores her ear with a fine curette it quickly becomes clear that Alice will be heading to theatre.

‘‘Sleep doctor’’ Michel Hoppinghaus tells her about the special wind, the ‘‘laughing wind’’ that will help her rest during the procedure. He turns to her aunt. ‘‘It’s very safe; she’s fit and well. It was probably more dangerous coming here in the bus,’’ he jokes.

‘‘I think I’ve been extremely lucky, and extremely blessed with the opportunities I’ve been given and because of that I think I have to be mindful about giving back.’’ – DR KELVIN KONG

The theatre nurses talk soothingly to Alice, covering her with a green blanket. She looks like she will fall asleep before she has any anaesthetic. Kids with recurrent ear problems are plagued by poor sleep and no one knows how long the object has been lodged in her ear.

When Hoppinghaus attempts to place the mask on Alice’s face, she flails, terrified, and resists with every bit of energy she has left.

When she succumbs, her head turned to the left, Kong cautiously removes a small bead from deep within her ear. ‘‘The poor thing,’’ he says quietly, placing the bead in a plastic container.

The bright light reveals a gaping hole in her ear drum that will require another operation. It is an unremarkable outcome.

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