HEARING NEPAL Program

A NAFA PROGRAM – KATHMANDU STREETS, THIMI SCHOOL, TAWAL AND REGIONAL VILLAGES

A FPMT PROGRAM – KOPAN MONASTERY, KAPAN VILLAGE, OTHER FPMT SITES AND MONASTERIES AND SURROUNDING VILLAGE COMMUNITIES

thimiHistory

Initially it was proposed to conduct a screening project at Thimi VSN School (on the outskirts of Kathmandu, Nepal) and a village in the Hilly Region, Tawal.

It was intended to determine if there was a need for hearing rehabilitation, and the sustainable form in which it could be delivered.

All equipment, with Audiologist Sue and Engineer Audiometrist Lew were to be supplied through Whitsunday Hearing.

It was paramount that a sustainable program (local need and desire for hearing assistance, practically applied and affordable) could be established before external funding was sought.

 Kopan Monastery:  Trial Program

sue testing hearingDuring a personal study program at the monastery, Lew was approached to see if he could help a senior monk who had been taken to Kathmandu for hearing assessment. It  was deemed that nothing could be done to improve his hearing ability, based on their test results. Communication would be via shouting, gestures or not at all!

After reviewing the results, it was clear that further diagnostic tests were required, before the current assessment could be endorsed.

Sue, at Whitsunday Hearing sent a diagnostic audiometer to the monastery.

Tests revealed that power hearing aids would be beneficial; these have been fitted, with a successful outcome.

This highlighted the real need for a complete diagnostic battery of test results to be available, for the best professional advice to be offered.

Sangye Tenzin, in charge of the medical clinic and his team, was enthusiastic in establishing a sustainable program of assessment, medical follow up if required, and provision of robust rehabilitation devices.

Tasks

For the success of the program at all sites, we needed to

  • Source a reliable power supply to support test and fitting equipment
  • Train local health personnel in understanding the testing and rehabilitation process so that they may accurately interpret proceedings, i.e. literal translation of testing requirements, and a sufficient understanding of procedures and expected outcomes that recipient questions could be satisfactorily answered. Locals were incorporated in the test process where possible, and certainly the practical fitting of moulds and the description of hearing aid operation and maintenance. Fault finding, night storage, battery change procedures were also taught by medical staff to the recipients.
  • Establish secure storage for equipment left in Nepal
  • Establish a routine where clients are presented in an orderly manner for assessment.
  • Establish client records, secure and confidential
  • Establish pathways for future funding to maintain the program – FPMT involvement
  • It was resolved that all aids would “belong” to the respective clinics, and if they were not being used effectively, they would be returned for alternate allocation.
  • Where possible, recipients would pay a modest amount to receive the aid and batteries consumed
  • Backup hearing aids or portable listening devices are to be allocated, so that continuity of rehab can be maintained within reason.
  • Establish fitting protocol:
    1. Client must have a binaural loss, with 3FAHL of 40dB or worse in the better ear. This equates to a moderate loss (first loss category is mild), where quality of life would be affected, rather than fitting “an inconvenient loss”, i.e. mild loss
    2. One aid / alternate listening device to each person, with one dry aid kit for aid storage. For severe losses greater than 70 dB, 2 hearing aids are to be considered.
    3. Temporary “Doc’s Pro Plug mould fitted with BTE power hearing aid – size 13 battery
    4. Impression for custom mould to be fitted next visit after manufacture in Australia

sue hearing testKopan Results:

  • Hearing assessments completed: 42
  • Medical follow up required :5
  • Hearing aids and dry aid kits fitted (Monaural):15
  • Hearing aids fitted (Binaural-exceptional circumstances): 1
  • Visits:, Nov 2009, Jan 2010, Feb2010, next visit March 2010

 

sue testing hearingEquipment left at Kopan in secure storage for future use in all Nepal programs

  1. Video otoscope and display unit and otoscope tips
  2. Otoscope (hand held
  3. Itera Diagnostic Audiometer, air, bone conduction, masking capability
  4. Surge protector, battery power back up, adaptors, multi meter, screwdriver set
  5. Impression taking : Earlights, Syringes, otoblocks, impression putty
  6. Mini Vac vacuum cleaning pump for aids and moulds
  7. Hearing aid batteries, Spare Hearing aids, mould tubing, ear hooks, temporary moulds, tubing blower, cleaning tools
  8. Medical wipes and sterilising materials
  9. Spare batteries, dry aid kits, Miracell ear oil, ear wax solvent

Total value $10,330

Equipment that we took back to Australia but will eventually be supplied and left in Nepal, for use at all clinics

  1. 2 laptop computers, 1 for hearing aid fitting, the other for diagnostic assessment and collation of results.
  2. MT10 screening tympanometer, with IPSI reflex assessment capability
  3. Otoflex Diagnostic Impedance meter
  4. Screening audiometer, battery powered, Air Conduction only

Total value $20,780

sue fitting aid

Sue fitting a hearing aid

 

 

 

 

 

 

Thimi VSN School NAFA Program

Sue doing an Impedance test

With the Kopan experience it was decided to ask the headmaster Surendra to supply 30 names of persons requesting assistance

Lew would screen with the portable screening audiometer and a hand held otoscope. Where wax blockage was an issue, apply wax sol and refer to local school medical clinic for treatment.

Sue would perform diagnostic audiology on those who failed initial screening (Lew) and the younger children. This included Video otoscopy, air and bone conduction testing (with masking if required), and middle ear impedance and reflex assessment.

 

sue testing hearing

Diagnostic evaluation would result in

  1. No further action, i.e. no medical follow up or loss meeting requirements for hearing aid / assistive listening device fitting.
  2. As above, but retest in 12 months
  3. Urgent medical referral – with recommendation to medical clinic that ENT advice would be prudent. Note that ENTs are not easily accessible, and so this advice was not given lightly!
  4. As above, with no urgency, e.g. Holes in ear drums, no infection present, clients under 15 yo, an age below which ENTs were unlikely to operate.
  5. Medical clinic referral for the removal of ear wax and organise for testing.
  6. Medical Clinic referral for primary treatment of infection
  7. Referral for hearing aid or assistive listening device fitting

Before fitting of the hearing aids, it was established that the headmaster would accept responsibility for the aids, maintenance and battery issue. Surendra was duly trained. He was also familiarised with the whole testing and result interpretation process, so that he could act as a reliable interpreter

It was decided that a fee of Rs 500 (about $8, 2 – 4 days wages) would be charged for each aid, although if the headmaster felt that less would be appropriate, then he would make that judgment.

Reliable power was an issue on the first visit, but remedied for the second visit.

Equipment was transported from Kopan for the exercise.

Only Spare batteries and hearing aid cleaning equipment were left at the school.

Thimi Results:

  • Hearing assessments completed: 33
  • Medical follow up required :11
  • Hearing aids and dry aid kits fitted (Monaural):3
  • Hearing aids fitted (Binaural-exceptional circumstances): nil
  • Visits:, Jan 2010, Feb 2010, next visit March 2010

Tawal and surrounding villages  NAFA Program

And so with the experience from Thimi School and Kopan Monastery, the accessible only by walking track program began.

Tawal has a medical clinic built and staffed by NAFA. (To be confirmed by Rod!) We camped nearby.

Strategy:

  1. To perform otoscopy, air conduction audiometry, and impedance and IPSI reflex measurement.
  2. Diagnostic evaluation would result in
  • No further action, i.e. no medical follow up or loss meeting requirements for hearing aid / assistive listening device fitting.
  • As above, but retest in 12 months
  • Urgent medical referral – with recommendation to medical clinic that ENT advice would be prudent. Note that ENTs are not easily accessible, and so this advice was not given lightly!
  • As above, with no urgency, e.g. Holes in ear drums, no infection present, clients under 15 yo, an age below which ENTs were unlikely to operate.
  • Medical clinic referral for the removal of ear wax and organise for testing.
  • Medical Clinic referral for primary treatment of infection
  • Referral for hearing aid or assistive listening device fitting
  1. To assess power availability, with the view to bringing more diagnostic evaluation equipment next visit
  2. To train staff (Beg) in the use of specialist equipment for cleaning of ears / ear obstruction removal
  3. To train staff in hearing aid management and maintenance, maintaining records etc
  4. To train staff to use screening equipment, so that when supplied, they will be able to conduct preliminary screening, freeing audiologist time for further assessment as required.
  5. To leave sufficient repair equipment and spares such that the program will retain its success until our next visit

Tawal Results:Assistive Listening Devices

  • Hearing assessments completed: 40
  • Medical follow up required :19
  • Hearing aids and dry aid kits fitted (Monaural):9
  • Hearing aids fitted (Binaural-exceptional circumstances): nil
  • Alternate listening devices; 4 allocated- to be delivered with 4 spares in March 2010. One device left at clinic
  • Visits Jan 2010,, next visit Jan 2011

Equipment left in Tawal

  1. Ear obstruction removal equipment, including head lamp / microscope, operating tools, instruction.
  2. Spare aids: 7 off programmed for each of seven recipients. We are not returning for 12 months and so felt it was prudent to do this first time around.
  3. Alternate listening device, on a neck loop with head phones. A further six will be sent to the village in March. These will also act as spare aids if necessary,
  4. Hearing aid cleaning equipment
  5. Spare temporary moulds for each of the aids fitted.
  6. Replacement hearing aid batteries size 13

Total Value $4870

Kathmandu        NAFA Program

We have a non discriminatory program, and believe that whoever makes their way to us for help, will be helped if possible.

And so…….

One person was fitted with a hearing aid that works at the Kathmandu hotel where we stayed

One person that we met at the hotel that is a guide was fitted with a hearing aid and after assessment by Sue was referred for an urgent MRI.

One very young person met us at his village one days trek from Tawal. The next day we were able to fit him with an aid, after his grand mother made the trek with him to Tawal!

Highlights:

Sue and Kopan nuns

Sue and the Kopan nuns

Kopan

4 Nuns who smiles and sincere thanks reflecting the value of now being able to clearly hear the precious teachings

Also …..The smile and grateful gestures of the 94 yo Geshe who had been told nothing could be done for his severe loss.

 

 

Thimi

lew fitting aid

Lew fitting a hearing aid

The turnaround witnessed in the little girl who said she did not think she really needed a hearing aid, but was asked to go out into the school yard and classes before giving us a final answer

Follow up reveals continued enthusiastic use. She can hear her teachers clearly.

 

 

Tawal

testing on teh roadThe successful fitting of the little boy from the neighbouring village who met us with his mother one day before arriving at Tawal was a time to rejoice!

 

 

 

Kathmandu

joy of hearingOur man from the hotel, with “deafness impaired speech” can hear the crows for the first time in his 56 years. If his smile was half an inch wider, the top of his head would fall off!

 

 

 

Funding

We have established that there is a need for hearing services, and that they can successfully be provided, in a sustainable manner, using locally trained health workers and visiting audiologists and audiometrists.

Kopan funding will be derived through the support of the FPMT (Foundation for the preservation of the Mahayana Tradition- a world wide network supporting the tradition of His Holiness the Dalai Lama)

NAFA Program

Support for these programs will come in measured considerations from the already extensive community aid programs undertaken by the NEPAL AUSTRALIA FRIENDSHIP ASSOCIATION. It is dependent on additional funds being raised, and executive approval for allocation to this program, having considered all NAFA program needs.

Want to help?


waiting for hearing tests

The waiting room

Contact Lew or Sue at Whitsunday Hearing or Burdekin Hearing, Tax deductible donations for equipment, hearing aids or assistive listening devices can be made payable to the NAFA Overseas Aid a/c, and we will do the rest.

Waiting their turn for a hearing assessment

 

 

 

Costings

45 Neo 112 power behind the ear hearing aids and temporary moulds were supplied by Whitsunday Hearing for both projects. Custom mould impressions were taken at the first fitting and have been / will be fitted at the follow up visit after manufacture in Australia. Cost approx. $18,300 the aim will be to raise funds to replace these aids so that more can be fitted in the future.

8 alternate listening devices have been purchased by NAFA, with a contribution to the NAFA projects totalling $2500:

And so sponsors are sought at various levels……..

One hearing aid, temporary mould, custom mould and batteries for one year $500

Up to 30 items per year for each of NAFA and Kopan projects

Maintenance of that aid and provision for replacement in 5 years $100 /year

One alternative listening device $150 Batteries per year $30 required:

30 for Kopan (remote areas where hearing aids would not be able to be serviced), 20 for NAFA

One video otoscope and display screen   $3800  2 required

One screening audiometer $1980 2 required

MT10 tympanometer   $3800 one required

Laptop Computer, Software for record keeping, report writing, programming aids and diagnostic equipment support   $ 2035

Otoflex Diagnostic Impedance meter   $11,000

Whitsunday Hearing will continue to supply equipment until funds can be raised for equipment to be purchased and left in Nepal.

Sue and Lew wish to sincerely thank NAFA and Kopan Monastery for allowing us to share in the joy of providing such a life changing service to persons who have no other source of assistance. With the beneficiaries of the Hearing Nepal program, we are extremely grateful for the richness added to our lives

At NAFA, Rod and Deb, Ross and Brenda have been unwavering in their support, and assistance in the coordination of the Thimi and Tawal programs. What amazing guys.

AND

Thankyou to

  • Brad and Gary at Bernafon (Hearing aid providers)
  • Doug and Bozzy at GN Otometrics (Equipment providers)
  • Leonard at Doc’s Pro Plugs (Temporary moulds)
  • Andrew at Word of Mouth (Alternate listening device providers)

For their generous assistance of time and product price revision, without which this project would not have been possible

Derai derai Dhanya bahd