PHOTOGRAPHS: BRINOS/NEIL WEIR Health education
given by volunteer ear care assistant.
Senior CEA Puran Tharu conducting ear examination
product of ear disease and that we should be concentrating on prevention. In 1991 BRINOS conducted a nationwide survey of deafness and ear disease in which 16,000 people were surveyed by a joint British and Nepalese team. Te survey found that 14.2 per cent of the population of Nepal were significantly deaf (2.7m individuals including 1.9m school age children out of a population of 19m) and 860,000 individuals had middle ear infection. Of the 395 individuals aware of ear problems who had attended a local health clinic, two-thirds were dissatisfied with their treatment. We also found that 50 per cent of all ear disease is preventable. Initially we thought that by training
general health workers in ear disease and providing them with the necessary equipment we could reach out to the people at village level. Tis was not successful as ear disease came low on their priorities. Tere was a vital link missing. So in 2000 we established community ear assistants (CEAs), who are health workers trained exclusively in ear disease. CEAs are equipped with examination
SUMMER 2013
instruments, portable re-chargeable suckers and field audiometers and, in turn, train female volunteer ear care assistants (now numbering over 1,000) who live in the villages covered by them. Te care is ‘bottom up’. Te volunteers, who teach ear care and disease prevention (to 16,000 villagers in the last five years), find the patients and call in the CEAs who then diagnose and treat common ear conditions. Before this time villagers were totally unaware of the significance of deafness or ear discharge; they assumed it was either normal or their burden in life. Tose cases considered for surgery join our ‘waiting list’ which is never longer than six months. Te aſtercare of the operated patient is entrusted to the CEAs.
Success and new challenges Since 2000 over 98,000 school children have been screened for deafness and ear disease, 86,000 patients have been examined in the villages and a further 27,000 in the daily Nepalgunj clinic where in the last five years 1,200 hearing aids have been fitted. Tis form of primary ear care
“ The recovery ward is on the first floor adjacent to the theatre but the main ward is temporarily located in a large bicycle shed”
delivery has been accepted as the model for the country by the Society of Nepalese ENT surgeons and the project has contributed to two important developments: the people of Nepal are now much more aware that ear disease can be treated and there has been a marked increase in young doctors wishing to study ENT. But there are additional challenges.
Recognising the limited space in which our CEAs perform their vital work, BRINOS and our sister NGO the BRINOS Ear Health Community Service have acquired a site on which to build the BRINOS Ear Care Centre. Preliminary site works have started and BRINOS is actively seeking funds to continue the work. For further details please visit
www.brinos.org.uk
n Mr Neil Weir MD MA FRCS is an ENT surgeon and founder director of BRINOS
n MDDUS was the principal sponsor of the 2013 BMJ Group Awards at which BRINOS was named both Karen Woo Surgical Team of the Year and Medical Team of the Year
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