LTF. In clinical shorthand, it means Lost To Follow Up — a patient who slips through the cracks, unreached, untracked, unserved. In the world of newborn hearing screenings, it describes something more quietly devastating: a Deaf child whose hearing loss goes undetected at birth, sent home into a world of sound they cannot access.
It begins in the first hours of life.
Most hospitals in the United States conduct auditory screenings on newborns before discharge. If hearing loss is detected, a network of public and private resources stands ready — audiologists, early intervention specialists, educational supports, and access to visual languages like American Sign Language (ASL). The system is imperfect, but the infrastructure exists.
A gap that begins at birth
In the Dominican Republic and Nicaragua, that infrastructure largely does not. Detection is inconsistent. Rural communities — where most births happen at home — fall further outside the reach of any formal support. When hearing loss goes undetected, it doesn’t simply mean a child misses sound. It means they miss language. And when a child misses language in those first critical years of development, the consequences ripple across an entire life.
Deaf babies require exposure to both oral and visual language from birth to achieve the cognitive milestones of their hearing peers. Most Deaf children are born to hearing parents — parents who may not know ASL, who may not even know their child is Deaf for months or even years. In the United States, policy and programs exist to begin bridging that gap. In countries like the Dominican Republic and Nicaragua, they largely don’t.
As I begin my own journey with the Deaf World, I have the opportunity to meet young people who are deaf — brilliant, resilient and curious — who have spent much of their lives Lost To Follow Up. They stand before me and I find myself wondering: what paths has this person taken to arrive in this moment with me? How do they see me when I show up? What do they believe is possible? The public, too often, has reached its own conclusions — that they are slow, or less. They are neither. They are people who were born into a world that didn’t know how to receive them.
Language is the architecture of thought
Language is not just communication. It is the architecture of thought itself — the vehicle of our own internal narrative.
It is how we imagine possibilities, how we justify decisions, how we talk ourselves into or out of the life in front of us. Before we ever speak a word aloud, language is already at work inside us, quietly shaping who we think we are and what we believe we can do.
Which raises a question when I sit with it long enough: if language is where our internal narrative lives — if it is the medium through which we understand ourselves — then what happens to a person who never receives it?
I think about this through the lens of my own story, because language is precisely what changed my life.
A question in a second-hand store
In 1998, I was in my early twenties and “a bit adrift,” you could say. A friend I’d met in high school Spanish class called with the idea of a road trip through Mexico and Central America. I said yes — and that yes, I realize now, was the product of my self-confidence, the support of my family and friends, and my belief in possibility — privilege nurtured by access inherited from where I was born. Privilege that afforded me many opportunities, including the early exposure to other cultures and learning basic Spanish in high school and college.
Which brings us to the road trip. We ended up in San Juan del Sur, Nicaragua. And there, in a second-hand clothing store, I met a woman named Doña Nidia.
She asked me questions — the kind of direct, generous questions that Nicaraguans ask strangers: Who are you? Where are you from? What are you doing here? My Spanish was choppy, full of gaps. But it was enough. Enough for her to understand that I was curious, that I was interested in more than just cheap shirts. I wasn’t just passing through. She told me she wanted to introduce me to her son Roger. He liked basketball too.
That afternoon, Roger took me to the court where the guys played after work. I met Julio, Carlos, Marlon, Danilo. They looked at me the same way as Doña Nidia — asked me similar questions. We talked over beers that night, and over the next week, they invited me into their homes, and something shifted. I understood, for the first time in a long time, that I was exactly where I was supposed to be.
Those friendships became the foundation of Comunidad Connect. The relationships built in San Juan del Sur seeded everything that followed — in Nicaragua, in the Dominican Republic, and eventually in thousands of lives that were changed not because of any grand plan, but because a woman in a second-hand clothing store asked me some questions, and I had just enough language to answer.
Where would I be — where would any of us be — if I hadn’t?
Two decades of relationships
Comunidad Connect has now been part of communities in Nicaragua, the Dominican Republic, and the United States for over two decades. Over that time, these relationships have produced outcomes that speak for themselves: 7,500 people with access to clean water, 250 families with new homes, 3,000 women and children receiving quality healthcare, 1,000 people with safe sanitation, 1,000 children in organized sports, and 2,000 students and faculty who have traveled abroad to learn and serve.
Every one of those outcomes passed through language — through conversations that nurtured friendships, that developed trust, that became partnerships, that became staff, board members, community partners, beneficiaries, and donors. Along this slow and deliberate work of being understood across different cultures, language was the conduit and the key to it all.
So, what about the members of our community who were never given language in the first place…?
The community never given language
In Puerto Plata, we work directly with the Escuela Nacional para Los Sordos — the School for the Deaf — managed by the Dominican Republic’s Ministry of Education. We have a growing collaborative relationship with ANSORDO, the National Association of the Deaf, and with the Ministry itself. These partners are helping us understand, slowly and with great humility, that the Deaf community in the Dominican Republic is a community of people with enormous capacity and very few doors.
We are beginning to ask: what if we could help open them?
What if we advocated for policy requiring early hearing detection at birth?
What if we helped build access to quality early Deaf childhood education — meeting Deaf children in visual language, from the very beginning?
What if we supported hearing parents with the tools and knowledge to raise Deaf children who thrive?
What if we brought a positive, affirming public narrative to communities where Deaf individuals are more often hidden than celebrated?
What if we bridged Deaf individuals and their families to healthcare, education, employment, housing, sports, technology — to the full architecture of a life lived with dignity?
What if we leveraged the tourism economy of Puerto Plata to directly benefit the Deaf community?
Comunidad Connect is beginning to do this. We do not have all the answers. But we know how to build relationships across different cultures and languages. We know how to show up — until something changes.
Language is how I found my community. It is how Comunidad Connect found its purpose. It is the vehicle through which we understand ourselves and each other.
The Deaf individuals we serve were born with every capacity for a full and meaningful life. What they needed — what they still need — is for the rest of us to show up differently.