Ranchen Nunnery, Tsum Valley
Project Proposal:
Monasteries are the hub of the villages in Nepal and in this region, Rachen Nunnery and Mou Monastery cared for by the FPMT organisation, administered from Kopan Monastery in Kathmandu.
HearingNEPAL Program was asked to evaluate the need for hearing services and run an ear camp in Tsum, with the support of Kopan Monastery and Rachen Nunnery, for the benefit of all residents of the region.
Location: Rachen Nunnery Medical Clinic, Tsum Valley, Nepal
Tsum is situated in the northern Gorkha region of Nepal, on the Tibet – Nepal border, at an altitude of above 4000 metres (14,000 ft). The valley is reached after trekking for five long days after the road ends.
Date Commenced: June 2010
Date Concluded: Ongoing
Partners: NAHOH; Kopan Monastery, Rachen Nunnery
Beneficiaries: Any person of any age living or working in the Tsum valley with an ear health or communication issue.
Trip 1 – June 2010
Partners: Kopan Monastery, Rachen Nunnery
Staff: Sangye Tenzin (Manager, Medicine Buddha Health Clinic, Kopan Monastery), Tashi (Health Worker, Medicine Buddha Health Clinic, Kopan Monastery)
Volunteers: Lew Tuck (HearingNEPAL Program), Tenzin Lhamo (English teacher, Rachen Nunnery), Paksho (Interpreter, from near by Chokhang village).
Objectives: To assess and provide immediate benefit in the region’s ear health and hearing ability.
Screen all persons who present with a hearing problem
- Using Video otoscope, inspect ears and note whether clear or % wax, condition of ear drum, any fungus or discharge
- Refer to Lew for full test if hearing loss in better ear greater than 50 dB, or ear discharge, or ear drum perforation
- Refer to Tashi for wax / obstruction removal, prior to going home or seeing Lew
- Refer to Tashi for ear drops or medication for infection
Lew would conduct full hearing test, including confirmation of otoscopy, Air conduction and bone conduction tests, and tympanometry.
Fitting of hearing devices if better ear had 3FAHL > 50 dB, or special cases as assessed.
Outcomes:
- Number persons screened: (aged 2 – 85 yrs) 102 persons
- Referred for wax removal: 23 ears
- Referred for medical advice, but unable to go to Kathmandu
- Ear drum perforations: 25 ears
- Ear asymmetry, sudden onset of hearing loss with tinnitus: 15 persons
- Referred to NAHOH for further medical assessment (Nepal Association of the Hard of Hearing, Kirtipur) : 3 persons
- Referred to Audiologist Sue (in Australia) for audiological review : 51 persons
- Medium power behind the ear hearing aid fitting: 28 persons
- (Bernafon Neo 112, temporary Doc’s Promould, Dry aid kit with regenerating silica gel drying agent- for hearing aid storage, and an ear impression taken for a custom mould – provided by Bernafon Australia, to be fitted, no later than one year hence).
- High power behind the ear hearing aid fitting: 4 persons
- (Bernafon Extreme 121, temporary Doc’s Promould, Dry aid kit with regenerating silica gel drying agent- for hearing aid storage, and an ear impression taken for a custom mould – provided by Bernafon Australia, to be fitted, no later than one year hence).
- “Maxi” alternate listening device fitting: 4 persons (with one awaiting a sponsor) (For those elderly persons not wishing to cope with the management of a behind the ear hearing aid )Conclusion:
- Camp was highly successful in achieving its objectives.
- Professional ear care was provided within the competency of the team members
- Tsum valley residents were extremely grateful for the visit, and in general, very happy with relief from their problems, within team and material limits.
- Hearing aids were fitted outside best ideal practice of seeking medical advice prior to fitment, where medical referral was necessary.
- Local support for the project was overwhelming
Recommendations:
- Revisit next year. Some team members WILL NEED TO FLY IN AND OUT.
- Add to team: Sue, Audiologist, and ear technician from NAHOH. This will greatly raise the level of immediate service / advice, and provide valuable training for other team members.
Trip 2 – June 2011
Partners: NAHOH, Kopan Monaastery, Rachen Nunnery
Staff: Keshab Dangol CMA (NAHOH), Dhargye & Tashi (Health Workers, Medicine Buddha Health Clinic, Kopan Monastery)
Volunteers: Sue & Lew Tuck (HearingNEPAL Program), Jade Fredericksen (Audiologist from Australia)
Objectives:
- Review outcomes and hearing aid fittings for all people seen last visit, and provide primary ear care and rehabilitation for new referrals.
- Train Kopan Health Workers in audiometry techniques and use of audiological equipment.
Outcomes:
- Primary Ear Care examinations: 224
- Diagnostic Hearing Tests: 28
- Hearing Aids fitted: 17
- “Maxi”ALDs fitted: 3
- Hearing Aid Fitting Reviews: 17 (3 recipients deceased or left area, 8 recipients unable to attend during visit – for review next visit)
- The most beneficial advancement this year was the training of the local Tibetan Doctor, Ani Dolka, by Keshab, in primary ear care. We also left the western medicines for use by the Doctor when dispensing health care to the locals, visiting the Rachen Nunnery clinic.
Trip 3 – July 2012
Partners: NAHOH, Kopan Monastery, Rachen Nunner
Staff: Keshab Dangol CMA (NAHOH), Sangye Tenzin, Kehrab (monks from Kopan Monastery)
Volunteers: Sue and Lew Tuck, Australia
Objectives: To follow up those from previous 2 years and offer further access to primary ear care and training for the local health workers.
Outcomes:
Rachen Nunnery Clinic
- Primary Ear Exams: 130 (6 perforations)
- Diagnostic Hearing Assessments: 15
- Hearing Aids fitted: 4 (new), 5 (replacement)
- “Maxi”ALDs fitted: 1
- Hearing Aid Fitting Reviews: 11
Sirdibas Clinic (1 day)
- Primary Ear Exams: 125 (11 perforations)
- Diagnostic Hearing Assessments: 8
- Hearing Aids fitted: 10
- “Maxi”ALDs fitted: Nil