Tawal trip- January 2011

From Australia: Sue, Lew and hello Jade!
From Nepal: Macha Bhai and Keshab, and of course Tashi the monk from Kopan Monastery
With thanks to NAFA (Aus), NAHOH and JOY FOUNDATION (Nepal)

We have much progress to rejoice, including new sponsors, additions to our team, and most significantly our aim of “assisting Nepalis to provide primary ear care and hearing loss rehabilitation to all creeds and castes in Nepal”.
• Nepal Association for the Hard of Hearing (NAHOH) President, Macha Bhai Maharajan, and Ear Assistant, Keshab Dangol, were introduced to the Board of another Nepali organization, the Joy Foundation.
(The Joy Foundation is a group of Nepali business men and supporters who offer assistance to a range of social and health projects, such as disaster recovery, vocational training, remote cataract surgery eye clinics, and helping the disadvantaged and discriminated people in Nepali society.)

Ramita, an employee of the Joy Foundation, was made available for the Tawal Ear Camp where her skills as an interpreter and liaison officer with locals were invaluable. We look forward to encouraging this relationship of “support” and “practical application”.

Picture left: Raju, President of Joy Foundation watches Keshab check Sue’s ear with the new “Vorotek” donated by NAFA. Macha Bhai, President of NAHOH looks on.

Sue and I were excited to receive an email in November with photos and report from NAHOH’ s Keshab, showing him fitting and programming hearing aids as a result of training and equipment provided during our previous 2 visits to Nepal.

Kopan Monastery are training 3 younger monks, this year completing high school education, and sitting externally accredited exams, then 2 years study to complete their CMA Certificate in Primary Health care. They will then spend time with the ENT’s at the Teaching Hospital gaining practical clinic experience, followed by audiological training from Sue and our new addition, Jade Fredericksen, audiologist from Australian Hearing who has extensive experience in remote audiology work in aboriginal communities in the NT, Australia.

As a great side note, 2 nuns from the Kopan associated nunnery have asked to join the monks and complete SLC, then CMA, with a view to providing health care at the nunnery, so there are now 5 new “career paths” in the pipeline. Lew only asked for 1, and that he also has now. Tashi, a community health worker works jointly at the monastery’s Medicine Buddha Clinic and at the medical clinic of Kapan village below. He has been allocated to our Program while the others train. Tashi has been assisting us since Program inception in November 2009.

Return to Tawal village

Tawal is a remote village in the hilly region of the Ganesh Himal, in Dhading district, 5 hours uphill walking from the road head.

In the first visit to the village last year (January 2010), Sue and Lew took battery powered screening equipment, video otoscope and hearing aid programming equipment, fitting hearing aids and ALD’s to 12 adults and 1 child.

In November 2010, we installed (with the help of our friends from NAFA) a 1Kw Solar Power system with 240V AC pure sine wave inverter at the Tawal Health Clinic. A smaller 350Watt system was transferred to the multipurpose room at the school (also built with NAFA funds).

Ear Syringing

Tawal this year…….What a team…..What a difference!!!

This year’s visit extended over 6 days, which allowed for the entire school to have Ear Checks as well as word to spread to Tawal residents and those from surrounding villages, about the service. This longer stay contributed in several ways to the success of the visit.

A Primary Ear Care clinic set up in the multipurpose room at the school, staffed by Nepalis, Keshab from NAHOH, and Tashi from Kopan Monastery checked the ears of 509 school children and adults from Tawal and surrounding villages.

Results….”Similar outcomes to other ear camps in Nepal, with only the foreign bodies different!” according to Keshab. These included a cockroach in a teachers’ ear, stones, some wire through the eardrum and pieces of feather.

Keshab proudly demonstrated the use of his new Vorotek (head mounted light and magnifier), sponsored by NAFA and kindly discounted by the Melbourne suppliers….thanks guys!

Checking Ears

Locally mixed GSB solution, a mixture of glycerin, and sodium bicarbonate was given to those with impacted wax, and ears were then syringed 1-3 days later. Locally printed (NAHOH) posters were the key to education of adults and students about caring for their ears.

Medication was also dispensed by Keshab (NAFA sponsored) to those with ear infections.

Jade, performing hearing test

Audiological referrals were made to Jade (photo left) or Sue (at right) who were working from the Health Clinic with quality 240V ac power, supplying diagnostic audiometer, video otoscope and full impedance testing with reports produced on a colour printer!!

Sue, setting up the equipment

This allowed for audiological reports to be provided to those where ENT referral was recommended. These referrals will be facilitated through NAHOH connections in Kathmandu.

Lew fitted hearing aids or ALD’s where recommended, and reviewed all previous fittings from last year.

Spira Tube meets power dome!

This year, thanks to Bernafon and Phonak, (Spira 1.3mm tubing and Phonak Power domes) were able to successfully” first fit” many losses with a permanent acoustic arrangement, without the need for a custom mould (up to ~60dB 3FAHL).

Individual consideration was given to persons with losses less than 50dB in the better ear, as these were below our fitting criteria.

Doc’s Promoulds with standard tubing were used for larger hearing losses, and impressions taken for custom moulds to be made up in Australia.

Aids fitted 12 months earlier were re-programmed, accounting for acclimatization, vent changes, ability to hear family member talking softly from behind, MPO check, echo, wind and “monkey sound” (reduced 250 to 750Hz).

Follow-up results were very positive with some local issues with the wearing of the aids, e.g. women had trouble with the aid being dislodged from behind the ear when carrying “dokos” the traditional baskets carried on the back with a band across the forehead. Solutions to this are now being trialed, by the use of an under-scarf stretch headband…See next years’ report!!! (Any member suggestions from “practical experience” are most welcome!!)

In general, aids were not used in the fields, in the forest, or when carrying water.

Maxi ALD’s allow communication

The “Maxi” ALD’s were well-received, but purchase of quality alkaline batteries was an issue. NAFA will look into this, with the possibility of rechargeable batteries being issued (at cost) from the health clinic, bragging its new 240V AC power.

Another great “side” benefit of the power at the clinic is that NAFA has purchased a camping fridge, allowing the clinic to become a remote “hub” for vaccination programs (typhoid etc) to be extended into remote areas. And on NAFA’s radar, a microscope for checking blood samples to speed up treatment response or to reduce wasted journeys ( 5 hours walk, 4 hours bus) to hospital in Dhading.

In summary, causes to rejoice include:

All local children in Tawal area examined by Nepali health workers….what a great inspiration for them also!
Provision of resultant primary ear care.
Full battery of audiological tests, with onward referral path established for ENT advice via NAHOH.
Provision of current digital hearing aids and Assistive Listening Devices.
Provision of drugs and medications for ear infections and conditions.
Commencement of education for teachers and adults in the importance of proper ear care.
It was such a great honour to work with such a competent team (Lew speaking here) reducing the effects of an ear disorder or hearing loss.

Other stuff!

Jade, Macha Bhai, Ramita and Sue at Sanku stopped to pose!

We (Keshab and Macha Bhai with Tashi, Sue and Jade, Ramita and her Youth Group and lew the roadie) ran at Ramita’s request a one day hearing camp in her village, Sanku, outer Kathmandu.

Great outcomes included clean ears, treated ears and referred ears. What a joy to see them working so happily for the benefit of others.

And next?