Combined on-site and tele-education to develop a locally led audiometry service in Cambodia and Bangladesh


  • Dr Kelley Graydon University of Melbourne, Australia
  • Professor Mahmood F. Bhutta Department of Global Health and Infection Brighton & Sussex Medical School, UK
  • Dr Julien Zanin University of Melbourne, Australia
  • Manuel Loureiro University Hospitals Sussex, UK
  • Asalin M. Esha Humanitarian Crisis Management Program, Bangladesh
  • Dr Touch Sokdavy Kien Khleang Rehabilitation Centre, Cambodia
  • Dr Christopher J Waterworth University of Melbourne, Australia



tele-education, developing country, audiology


There is a scarcity of audiological training programs in low-and middle-income settings. We aimed to co-develop an audiology training program combining on-site and tele-education at two locations: a charity hospital in Cambodia and a government hospital in Bangladesh. A novel program was designed to train local staff in pure tone audiometry which forms the basis of hearing assessment in adults. Prior to training, there were no in-house audiology services for patients. A combined short bespoke in-country training program, followed by ongoing support through remote live education enabled an audiometry set up. The model also consisted of continuing quality assurance during audiological assessments via an internet platform. The programs have allowed for successful training of seven local health care workers in Cambodia and two in Bangladesh, providing accurate hearing testing of adult patients, with associated streamlining of patient referral pathways. Trainee performance in both contexts has been positive. In Cambodia, trainees exhibit highly proficient audiological skills and assess over 1000 patients annually. In Bangladesh, trainees have gained competency in hearing screening. On-site training followed by remote support allowed for a low-cost model for audiological training. Critical to success was the motivation, trust and engagement of local staff, availability of equipment, and flexibility in teaching style. The program has proven a model of training health care workers in hearing assessments. An additional outcome of this cross-cultural collaboration has been the internationalisation of higher education at home.


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Author Biographies

  • Dr Kelley Graydon, University of Melbourne, Australia

    Dr. Kelley Graydon holds a PhD from The University of Melbourne and is Audiology Course Coordinator and a Senior Lecturer in the Department of Audiology and Speech Pathology. Dr. Graydon is also Director of Learning and Teaching for the School of Health Sciences. Her areas of interest and research include teleaudiology, global audiology and school hearing assessments and screening. 

  • Professor Mahmood F. Bhutta , Department of Global Health and Infection Brighton & Sussex Medical School, UK

    Mahmood is the inaugural Chair in ENT Surgery and Professor of Sustainable Healthcare at Brighton and Sussex Medical School (UK).  He has an interest in health systems research, and serves as honorary consultant to the WHO Programme for the Prevention of Deafness and Hearing Loss.

  • Dr Julien Zanin , University of Melbourne, Australia

    Dr Julien Zanin is a senior audiologist at the Melbourne Hearing Care Clinic and an early career researcher within the Department of Audiology and Speech Pathology. Dr Zanin has been working at the University of Melbourne for 8 years and has extensive experience in the provision of hearing rehabilitation services to his clients. Julien holds a Doctor of Philosophy (PhD) from The University of Melbourne, which explored the use of novel neuroimaging techniques to investigate changes within the hearing pathways. The findings from his work have been published in leading journals in his field. In addition to his clinical and research roles, Dr Zanin is also lecturer and subject coordinator for the Master of Clinical Audiology course at the University of Melbourne.

  • Manuel Loureiro, University Hospitals Sussex, UK

    Manuel Loureiro is an Audiologist with over 10 years experience based in Brighton, United Kingdom, where he serves as Head of Audiology at University Hospitals Sussex NHS Foundation Trust. A BSc and MSc in Audiology, Manuel also holds PGDip and certificates in Healthcare Leadership and Management. Manuel is a Senior Fellow of the British Society of Audiology and vice-chair of this body's Bone Conduction and Middle Ear Devices Special Interest Group. With a special interest in auditory implants, Manuel has balanced clinical practice with research in the fields of auditory implants and teaching in low- and middle-income countries."

  • Asalin M. Esha , Humanitarian Crisis Management Program, Bangladesh

    After completing my bachelor's degree and 1 year internship from Dhaka University, Bangladesh, I started working with a nongovernment organisation at the Rohingya refugee camp in Cox’s Bazar, Bangladesh. For the last 2.5 years I am continuing my humanitarian support in the camp as a medical officer as well as expanding my skills in research

  • Dr Touch Sokdavy, Kien Khleang Rehabilitation Centre, Cambodia

    Dr. Touch Sokdavy, is the head of the ENT team at the CSC. The ENT team was founded in 2014, and, through training from visiting experts from around the world, they have rapidly expanded the scope of surgeries they can perform. Dr. Davy completed her medical degree at the Faculty of Medicine and received a scholarship to complete her ENT specialization at the University of Health Sciences. Dr. Davy spoke at the Coalition for Global Hearing Health in Manila, performed an observation at Tan Tack Song Hospital in Singapore, and was a keynote speaker at a Global Hearing Conference in Australia. Her interests are improving access to ear and hearing care through training, education, advocacy, and research.   

  • Dr Christopher J Waterworth , University of Melbourne, Australia

    Dr Christopher J Waterworth, Lecturer and Researcher at Melbourne School of Health Sciences and Technical Advisor at the Nossal Institute for Global Health, University of Melbourne, is dedicated to academia and improving healthcare access in low resource settings. He has over 25 years experience as a practicing clinical audiologist. His current research interests lie in addressing health systems strengthening, disability inclusion, primary care integration of rehabilitation, and digital tool evaluation. His PhD explored ear and hearing care in Cambodia, establishing him as a leading researcher in the field. He serves on the Graeme Clark Foundation and the Executive Board of the Global OHNS Initiative.




How to Cite

Combined on-site and tele-education to develop a locally led audiometry service in Cambodia and Bangladesh. (2024). Journal of University Teaching and Learning Practice, 21(04).