Introduction
Deafness is an invisible and often neglected disability that can have profound effects on the individual, family and community. In a survey of disability conducted in the Year of the Disabled (1981), deafness was the highest single disability in Nepal. Children with deafness often fail to develop speech and language and, as a result, never reach their full potential. Adults with hearing loss find it difficult to secure employment or are less well paid. The older deaf person is often socially isolated and withdrawn. In Nepal, the effects of deafness are made worse by the lack of awareness of the problem, poor nutrition and the lack of facilities for diagnosis and treatment. Some untreated ear infections can be life-threatening or result in permanent disability, including facial disfigurement.
Ear disease is frequently neglected by health personnel who are already busy with other seemingly more important health problems. Communities do not consider ear and hearing health a priority and, besides, families often regard hearing impairment as a social stigma. Improved awareness, both on the part of the community and the health worker, plays a key role in preventing problems and reducing their impact.
Fifty per cent of deafness is preventable, often by simple measures. Hearing aids are not available to the vast majority of those who need them and specialized surgical procedures to treat ear infections or their consequences are available only to a few.
The only way to reach out to those poor, needy and un-serviced people is through a community ear care strategy which encourages awareness of deafness and ear disease and supports community members to take action themselves. This strategy is delivered initially through Female Community Health Volunteers (FCHVs) who are trained in recognition and prevention of ear disease and then by Community Ear Assistants (CEAs) who can diagnose and treat. Only those people who require surgical treatment will need to be cared for by an ear surgeon.
So, to provide community ear care with a group of health worker has started community ear care service from 2000, while formally established with the name of XXXXXXXX) Ear Health Community Service in Nepalgunj. To provide the service of OPD and operation, XXXXXXXX Ear Care Centre was established in Nepalgunj-7 in November 2016.
9 Community Ear Assistants (CEAs) who has passed the government Auxiliary Health Worker examinations has received six months training in the diagnosis and treatment of ear disease and in the science of hearing testing and rehabilitation and the provision of hearing aids (audiology). The CEAs have been equipped with diagnostic tools (otoscopes, audiometers and suction machines), all of which are portable and can be used in the field.
9 CEAs are either frequently mobilized in different 4 districts and are deployed in XXXXXXXX Ear Care Centre, Nepalgunj for providing ear care services.
XXXXXXXX, UK Charity Commission Registration No. 800453 was founded in 1988 by ENT surgeon Neil Weir. Since 1989, XXXXXXXX has held 52 Surgical Ear Camps in Nepal, examined and treated 40,000+ people. Volunteer surgeons from the UK have helped train Nepalese doctors and nurses and have carried out over 4000 major ear operations of which 1,640 were life-saving.
In 1990/91 XXXXXXXX conducted a survey of deafness and ear disease in Nepal[1]. The major findings were:
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- 2% of the population of Nepal (19 million in 1991) were significantly deaf (2.7 million individuals including 1.9 million school-age children)
- 860,000 individuals had middle ear infections, which can be life-threatening and result in permanent disability, including facial disfigurement
- of the 39% of individuals aware of ear problems who had attended a local health post, two-thirds were dissatisfied with their treatment
- 50% of all ear disease is preventable.
From 1994-1997 XXXXXXXX together with IMPACT Nepal conducted a pilot programme in the Kavre District of training and equipping government general health assistants (HAs) in the care of ear disease. This project was not universally successful. Some HAs kept good records; others did not even use the instruments provided. Most did not devolve their knowledge to village level, thus few patients attended the health post. Mainly the HAs were pre-occupied with more demanding problems such as communicable diseases, trauma and medical crises. XXXXXXXX and IMPACT Nepal concluded that the HA, even with special training and the provision of ear instruments, is not the most appropriate person to deliver community ear care.
Thus in 2000 XXXXXXXX commenced community ear care delivered by Community Ear Assistants (CEAs)[2] in Banke district. With increasing popularity among community people, the service was extended in Bardia, Surkhet and Dailekh between 2001-2004 in partnership with Nepal Red Cross Society (NRCS),
Till December 2016, XXXXXXXX has provided services in 4 districts and has covered 183 VDCs.
XXXXXXXX Ear Health Community Service has collaborated with the following government organization, local level bodies for effective service delivery and ownership at the local level.
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- Nepalgunj Medical College
- Bheri Zonal Hospital
- District Public Health Office
- Primary health care centre, health posts and sub-health posts
- District education office
- District development committees (DDCs)
- Village development committees (VDCs)
XXXXXXXX Ear Health Community Service has carried out the following services in Banke, Bardia, Surkhet, Dailekh and Kailali districts.
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- Primary ear care training has been provided to 1100 Volunteers (FCHVs and others), 120 Health post staff and 252 Primary level teachers.
- Organized 1010 Primary ear care camps (mobile camps) between 2000 – 2015 and has examined 101720 patients, among the examination 10503 cases are referred for surgery and further treatment.
PRIMARY EAR CARE CAMPS (2000 To 2015)
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- XXXXXXXX Ear Health Community Service has reached 461 schools under School Ear Health Programme between2000 – 2015. 106699 students were examined and among them, 8855 were referred for surgery and further treatment.
The OPD Record shows that the number of patients is increasing day by day. With the increase in the number of patients, XXXXXXXX Ear Health Community Service is facing difficulties to provide services with limited types of equipment, qualified human resource and other resources. With effective from 2016, XXXXXXXX Ear Care Centre has got permission from the Ministry of Health Government of Nepal to operate 5 beds hospital. But due to the unavailability of equipment, proper residential facilities for the doctor, it is not in operation. So, there is an immense need for construction of building for doctors and purchase equipment for effective service delivery.
Therefore, XXXXXXXX Ear Care Centre, Nepalgunj seeks support for;
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- Building construction for Doctor’s Quarter.
- Purchasing equipment including an X-ray machine, lab equipment, ECG, full range of medical equipment etc.
Objectives of the Programme
The main aim of the programme is to strengthen the capacity of XXXXXXXX Ear Care Centre and provide quality and timely ear care service to community people. The specific objective of the programme is ;
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- To strengthen the physical capacity of XXXXXXXX Ear Care Centre for providing quality, accessible, affordable and effective outpatient and inpatient ear care services to community people.
- To purchase the required equipment and increase the outreach activities especially run mobile camps in different districts and provide quality ear care services in the doorsteps of poor and socially excluded communities.
Programme Activities
Construction of 6 Unit Doctor’s Quarter
The programme will construct 6 units doctor quarter with a total area of 3216.54 Sqm in the premises of XXXXXXXX Ear Care Centre. The detailed design as per the norms of Ministry of Health, Government of Nepal has been attached in Annex I and photos of different activities of the program
Purchase of Equipments
The programme will purchase the following listed equipment, especially for laboratory, OPD and outreach activities. The programme will purchase the following listed equipment as per the procurement policy of the Government of Nepal
Program Impact
With the establishment of 6 units’ doctor quarter and purchase of required equipment, XXXXXXXX Ear Health Community Service will be able to reach more and more community people and provide effective and timely ear care services. The additional impact from the program will be;
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- Construction and operation of 6 units doctor quarter will help XXXXXXXX Ear Care Centre to run 24 hours ear care services.
- With the increase in equipment, XXXXXXXX Ear Care Centre will increase the capacity to provide additional ear care services to 100 patients daily.
- With the availability of equipment, XXXXXXXX Ear Health Community Service will reach to additional 50,000 patients in remote areas of Banke, Bardiya, Kailali, Dang Surkhet and Dailekh districts.
