Q&A | José Peres de Sousa, Ears, Nose, Throat specialist: Wellness may be the future of health-related tourism in Macau

Around six months after leaving Malo Clinic where he was clinical director, José Peres de Sousa started a practice in the FBC building. Interviewed by the Times, the ears, nose and throat specialist discusses issues such as the health consequences of excessive noise in work environments, abuse of headphones and poor air quality.

Macau Daily Times (MDT) – A local association conducted a survey recently interviewing 513 persons. They concluded that around 60 percent of local citizens admit to having hearing problems…

José Peres de Sousa (JPS) – It would be easier to assess if an official screening was made, and it is not difficult to implement such a screening to detect hearing problems. Nowadays, all newborns are screened for hearing problems. The idea of screening newborns for hearing problems was implemented in Portugal in the hospital where I worked – Dona Estefânia – and has since become common practice worldwide. In Portugal, we track around 95 percent of all newborns. We also practice screening in Macau. The process is very simple: a machine emits a sound inside the ear and the baby’s brain will react if the sound was heard. The machine will indicate if the sound wave has reached the brain. If the result is negative, it means that there may be a problem. […] The universal screening ensures that profoundly deaf children do not reach three or four years of age without detection. And that may mean the difference between having a normal life and a life that will be adversely affected. Detection of profound deafness at the moment of birth allows that person to receive an implant… We know that people who can’t listen can’t talk, and those who can’t talk find it hard to interact.

MDT – Is the above-mentioned 60 percent figure accurate in Macau?

JPS – Regarding the adult population, we can’t say there are 60 percent [with hearing problems] because a hearing screening has never been conducted. Two types of screenings could be conducted – one for people aged between 5 and 30 and other for people older than 50. Why? Because the types of deafness that appear in those age groups are different. Up to 40 years old there are problems related to the ossicular chain, meaning the transmission of the sound wave in the hearing channel. Even ear wax can cause deafness and then there are tympanic traumas and other pathologies that cause deafness in that age group. From 50 we have other type of deafness. We get older and the cells in the ear that receive the sound, transform them into electric waves and transmit them to the brain lose quality. The first frequencies to be lost are the acute frequencies. As a consequence, the person becomes unable to distinguish certain words.

MDT – There is the common perception that hearing loss is almost natural in elderly people. Is this correct?

JPS – Yes, the age of the cells causes that, and it also may cause eye problems. The loss of quality has two aspects: if it is in the cells, it can be corrected with a hearing aid, but if the problem is caused by nerve degeneration, it can’t. If a person with nerve degeneration uses a hearing aid, that person will only be able to hear noise. The hearing aid is good if the person who uses it is able to understand the words that are said.

MDT – In Macau, as elsewhere, we see many elderly people using hearing devices…

JPS – It is very common. I think the government has a policy of giving hearing aids to people, but many of those devices are quite basic. Nowadays, hearing aids can address [a much broader range of] problems. Even in cases of nerve degeneration there are big developments.

MDT – The respondents of the survey claimed that they lack knowledge about how to prevent hearing loss. Do you think that the Health Bureau  could do more in this regard?

JPS – There is no prevention. We know that hearing is sensitive to noise. People who work near machines that produce noise over 80 decibels are more prone to suffering gradual hearing loss. Here in Macau, not all construction workers use hearing protection, which is mandatory. […] In younger people, noise has a perverse effect. Apparently, nothing happens, but the habit of going to nightclubs with music above 120 decibels [is detrimental to their health]. Here in Macau, a person goes to a night club and the legs tremble from loud bass. Noise is the main cause for the early beginnings of hearing damage.

MDT – Nowadays, we increasingly see people using headphones connected to their mobile devices. Can the overuse of headphones cause hearing damage?

JPS – Yes. Some phones even indicate, when a headphone is linked, that the sound is too loud. If people listen to those devices for many hours with a sound level louder than 80 decibels, it will cause damage. It may not be permanent in early stages, but people will later experience hearing loss.

MDT – Do you get young people complaining of those symptoms here at your medical practice?

JPS – I see young people that come here with symptoms of hearing loss cause by headphones and from being exposed to very loud environments.

MDT – Due to increasing traffic and other factors, the air quality in Macau has decreased. Do you have the perception that there are more patients complaining of ear and nose allergies?

JPS – The air in Macau is not of good quality, particularly downtown. And the region is just a pawn in the middle of all the pollution sources that encircle us. This is a heavily industrialized area. The exposure to pollution has a similar effect to tobacco: it causes mucous rash. […] If the mucous is more reactive it causes diseases such rhinitis, sinusitis and bronchitis. A person with a healthy background resists more, but someone who is allergy prone will have trouble with this [Macau] pollution. And children are more sensitive, particularly if there is a family background of such ailments.

MDT – You are the former clinical director of Malo Clinic Macau, which opened at The Venetian Macao in 2009. How do you see Malo’s latest plans here, which include the opening of new clinics?

JPS – Health is a very specific business. Whether people know what they want to do or not. Since I left the board of directors of Malo – previously I was also the CEO of the company – I never felt that people were really interested in improving health care. Obviously, the financial situation was complicated, but we need to understand that investments in the health care sector only pay back after a while. And there is a crucial factor: If you want to attract people there, you need to have the best human resources. And you need to treat those human resources well, otherwise the quality of the service degrades and customers are drawn away fast. I left the post of clinical director six months ago for reasons due to what I feel is the responsibility of the clinical director, regarding everything that is going on at the clinic. I felt I lacked appropriate conditions to continue as clinic director, bearing in mind that the clinical director is responsible toward the Health Bureau and people in general. […] It stopped making sense for me, also because I couldn’t understand the CEO [who was from mainland China and didn’t speak English], and couldn’t speak with him.

MDT – Do you believe that Macau can become a health tourism center?

JPS – The health tourism in Macau is not the same as in Singapore, Taiwan, Hong Kong or Thailand. Here it is possible to have a good check up, but specialized doctors are needed. Macau could become a major health tourism center in terms of dentistry – and when Dr Malo arrived in Macau it was a big evolution compared with what we had here before, but that was before he liquidated his own company.

MDT – What does the government need to do to turn the region into a health tourism center?

JPS – The government made a bet on our clinic [Malo Clinic] because it was innovative within this part of Asia. The relationship between medical spa and casino was a win-win situation. But, as I always told Dr Malo, dentistry should be the support while the hospital grew. Here in Macau, the only place with conditions to implement a concept linked to health tourism – namely wellness, which is something that hospitals can’t provide – is what is installed at the [Malo Clinic] Venetian. But a lot of investment is needed. The spa must be transformed, because that classical concept of spa, with massages, is outdated. There are many other things in a medical spa.