EXCITING NEWS from the Ear Hospital, April 2018 ...

Lots of exciting things have been happening in recent weeks!

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Reception area, patients waiting to be seen in out-patients.


The 3rd March each year is WHO World Hearing Day. The INF Ear Services Team organised a rally, walking through the streets of Pokhara and finishing with presentations at the Ear Centre. Nearly 200 people marched with placards and banners, to publicise the needs of hard of hearing and deaf people and give educational messages. There were talks about the dangers of loud noise and other preventable causes of hearing loss. Many nursing students attended and it was great to have participation by a large contingent from a local school for deaf children, with their sign language interpreter.


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WHO local representative making a speech at World hearing day.


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On the march!


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Mugs made locally for presentation, health education and as gifts for donors and visitors.


On 16th March there was a half-day training for over 40 nurses from around Pokhara; topics included common ear conditions, their prevention and treatment, and nursing care for those having surgery.

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Nurses in the training hall of the INF GPH Ear Centre.


From 18th-29th March a surgeon visited us from Los Angeles. Adam Masters is a senior resident at the well-known House ear clinic. The link was made through our EAN network and a senior colleague in the U.S. The clinic promotes ‘humanitarian’ visits by their residents at the end of their specialist ear training. Adam participated in a number of events. On the 24th March we held a seminar for ENT doctors and audiologists, with 16 participants, including two from Kathmandu. Adam led four talks and we had good audience participation when we discussed a number of ear problem case studies. Then, on the 25th March we visited the home village of one of our Medical Officers and with the excellent assistance of village leaders including the health post in-charge, where, at the youth club, we were able to examine the ears and hearing of 145 people of all ages. Several had significant problems that could benefit from surgery, many more require hearing aids, and plenty had very hard wax blocking their ears and we were able to clear this for them. Medicines were also provided. We made arrangements for those needing help to attend the Ear Centre.

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Visiting senior resident from House Ear clinic.


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Mike at the community ear care outreach day in the village of Nirmalpokhari,
first of many we hope, once ear care workers are trained.


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Receiving a certificate of appreciation from local youth club, and health post in-charge.


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Ladies line waiting for ear checks outside the school in the village


EAN makes significant contributions to the INF Green Pastures Hospital Charity fund, part of which is specifically allocated for Ear Centre patients. This has been well used in recent months, many patients have had heavily subsidised or free treatment. We will top up the fund as required every few months. All patients are already treated at significantly reduced cost because the buildings, equipment and some supplies have been provided from charitable sources, including EAN. Some patients need extra subsidy and there are staff assigned to assess their individual needs. We are very grateful to donors for this opportunity to assist needy patients. We are seeing more people, travelling from further afield, knowing they will get good care.

In coming weeks we will have a Swiss medical student join us for about four weeks, and a team of four from Warwick University visit for one week.

The Warwick team are developing a research programme, intending to assess the needs and requirements for low cost hearing aids for lower income countries. As part of this there is need to develop a supply and maintenance infrastructure and train local people to test peoples ears and fit the aids. This is a fact-finding initiative and fits well with our own desire to train ear care workers for community work. INF have recently advertised five posts for ear care workers, practitioners and health educators, all of which we will need to train! We have also recently appointed two new nurses and had requests to train other paramedicals such as those working with the Gurkha Welfare Trust for retired army personnel and their families and home villages.

Sandra, our Austrian audiologist recently married Dorje Lama and there was a lovely wedding celebration in Kathmandu. The 10-year-old son of a family in Dorje’s community from far northeast Nepal recently became profoundly deaf due to mumps. He was assessed as very suitable for a cochlear implant in Kathmandu and EAN has made a substantial donation towards this. We will be following his progress with excitement.


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Dukchung, the young deaf boy we are supporting for a cochlear implant. He joined in Sandra’s
wedding dances but clearly could not hear the tune. He still followed the dance steps though!


Over recent months INF have developed a 3-year plan for developing ear services at the Ear Treatment and Training Centre as well as providing outreach community work. Wonderfully, funding was approved by SON our Swiss sister organisation. On 27th March a formal agreement was signed between SON and INF in the presence of the Swiss consul from Kathmandu. Mike Smith gave a talk about the past camps, the present Ear Centre and the future development of services to be offered, based on the Ear Centre at GP Hospital. GPH overall is also undergoing major service developments for prevention and rehabilitation of other disabilities, including the start of a plastic surgery department, and the Ear Centre may play a part in helping to develop facial plastic surgery services.

Neonatal screening EAN trustee Phil Holt and his practice manager Aimee Cooke have been a great help in helping to source and coordinate the purchase of a generously discounted diagnostic audiological system (Otometrics, ABR/OAE/VEMP, for those in the know!). This is needed in order to start a testing programme for babies and young children. We hope to work with the regional hospital to screen new-borns. Statistically we estimate that a baby will be born with profound hearing loss once every 1-2 weeks in that one hospital. Setting up and staffing this project is a major challenge, let alone providing care and treatment for families identified.

Continuing Medical Education We have run one journal club for our ear doctors and audiologists to review medical articles of interest, and led two of the regular GPH morning CME sessions, one about anaesthetic care pre- and post-op and one about facial nerve palsy.

Our chief Nepali ear surgeon recently attended a short conference on endoscopic ear surgery at a hospital near Chitwan and our two audiologists are currently attending the annual conference for audiologists and speech therapists in Kathmandu.

Surgical Laser With help from SON the Ear Centre recently acquired a portable laser (KTP) for use with certain types of surgery, (particularly stapedotomy for otosclerotic deafness). It has taken some months of planning and a member of the company (Marcel Ernstberger of A.R.C.) came from Germany to help us set up and use the system safely. The first patient, who had particular technical issues for which a laser was ideal, has had a good outcome.

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Marcel demonstrates the compact laser system.


Endoscopic ear surgery With the purchase of a medical HD video system by SON and the use of a number of Endoscopes and instruments donated or purchased through EAN contacts in the UK we have started endoscopic ear surgery. This technique is gaining importance world wide because it gives a particularly good view and access into the middle ear, and avoids large skin incisions.

Donated microscopes We are using several outpatient and surgical microscopes donated from the UK, particularly from EAN trustee’s ENT department in Worcester. These are in daily use and invaluable. We have video connections (funded by EAN) so that staff can be trained, and patients and families can observe (if they want to!).

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Out-patient, ear microscopy room.


EAN Otology Bursary In 2017 EAN organised a very successful bursary for two Nepali ENT surgeons to visit the UK for a course in Dundee and a period of observation in a major London hospital (aided by Trustees Tom and Rosie Martin, and Dr Jeremy Lavy, consultant Otologist). We have offered this bursary again, this time for up to two ENT surgeons and one audiologist, this has been advertised through the Society of Otolaryngologists in Nepal and their contacts. We will shortlist in June.

There is much more to come, but we can save that for the next news item!







NEWS from Pokhara, December 2017 ...


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Three Rolpa childen

Greetings to all,

After the monsoon the mountains have been wonderfully clear in Pokhara and the views spectacular.

The INF Ear Centre in Pokhara has been hectic in recent months. In November there were 62 ear operations. Amongst these were 22 children that came down from Rolpa, sponsored by INF North America. We hope to see another 20-25 Rolpa patients, aged over 18 years soon, which we hope to sponsor through EAN. (It costs about 40-50,000 Nepalese rupees (£290-360) each, for the surgery, travel and two-weeks in Pokhara). The children and their guardians who came down had a marvellous time. As well as the operation, they also had good food and went on boats on the lake. In the evenings they sat in the hospital waiting area laughing wildly at cartoons on our big TV!

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Mike is helping write the 5-year development plan for the ear services. This includes new staff, some equipment and also ear camps of various sizes. Because of the difficulties with visas for volunteers we are working on a variety of options including short out patient assessment community screening work, medium length outreach camps with intermediate surgery which will be almost entirely Nepali staffed, up to full surgical camps similar to those we had before, with expat volunteers. We are sorry for the many potential volunteers that EAN is in touch with. It has been a difficult time as we have been unable to arrange regular camps or trainings that they can help with, however we are hopeful of breakthroughs in 2018. We may be able to use individuals at least one or two at a time more frequently, and will be in touch as we work this out. Many people continue to help with advice and contributions and we are thankful for that.

INF is looking to donors such as our
Swiss colleagues and also EAN to help us kick-start these developments. In particular we hope to recruit staff in early 2018. Our hope is that with more staff and more community work we will increase patient throughput and that paying patients will help sustain the process. We have included posts such as health educators and community ear care workers that may not recover costs, so we will need to continue fund raising for these.

EAN made a large contribution to the ear poor fund this year, and this greatly helps those who cannot afford to pay for their care. All care is sponsored to some degree because expatriate staff are free of cost and most of the equipment has been donated. Through EAN we were able to purchase a lot of small items such as otoscopes and medical textbooks for the nurses and theatre staff.

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In November we sent a small team to a hospital near Chitwan in the Terrai. We saw about 250 ENT patients. About 50 of these would benefit from ear surgery or a hearing aid. We are planning how to meet those needs, probably by sending a team to fit the aids, and arranging for the surgical patients to come to Pokhara. We are also thinking of adding that place to our list for winter camps, when we cannot go to the hills due to the cold. Part of the development plan will include training paramedicals in basic ear care, so members of EAN are working on training materials ready for the spring.

Queuing for ENT examination in Chitwan

We have been getting some
quite complex referrals lately, some with malignant tumours affecting the ear and surrounding skin. We have difficulty getting pathology results here, so this makes treating such patients all the more challenging. These and some cases with malformed ears are causing the surgeons to look into doing more plastic surgical type procedures. If any of our contacts have experience with reconstructions including congenital defects like microtia we would love to hear from them.

We have recently had some good conversations with a team at Warwick University about a research project that will trial low cost hearing aids and their maintenance in the field, and they want to work with EAN on the training materials. The possibility of working with different teams to provide cochlear implants remains on the wish list for the future.

In November, two Nepali ENT surgeons were in the UK on an EAN bursary, they both attended an ear surgery training course at Ninewells hospital in Dundee (we are very grateful for the assistance of the course organisers including Mr Musheer Hussain), and an observer-ship at the Royal National Throat, Nose and Ear Hospital in London (many thanks to Mr Jeremy Lavy and colleagues). Rosie and Tom from our trustees organised this and also hosted them in Oxford.

Dr Jeremy Lavy and the two Bursary doctor receipients in UK

Rosie and Tom Martin in Oxford with the two bursary recipients

We hope to repeat this in 2018 and are in communication with the Society of Otolaryngologists of Nepal (SOL) who we hope will again help to select suitable candidates.

We recently had a lovely staff party at Pokhara lakeside for all the ear centre staff. Mike showed photos past and present to help new staff know the history of the ear camp work and there was laughter when Min our driver’s photo came up with white hair, miraculously it is black nowadays! Then Ashish the audiologist took the microphone and went on stage to display professional Bollywood singing talents.

Ear Centre staff party

Our much loved Austrian audiologist Sandra Eisner, who spent many months in Nepal on a research visa when other people’s work visas expired, left us recently to get married. She went through all the data from ear camps, which included diagnoses for some 70,000 ears! We hope all the best for them, she married Dorje from eastern Nepal and we may see them back at some point.

Meanwhile Mike and Fiona’s visas will need renewal in February and we hope all will go smoothly!

Sister Ellen Findlay visited us recently; many of you have worked with her on ear camps. It was great to see her go round the wards talking individually to the staff and the patients from remote places.

Over the last month we have had Karuna Kotur, a visiting consultant anaesthetist from Newcastle, England here with us, she has been really helpful as a colleague for the local team and she also managed to bring some very heavy equipment with her that enables us to use our anaesthetic machine, and also some spares for operating microscopes.

Dr Karuna Kotur, visiting anaestheteist, with our Dr Bibek

In December the local and national elections went off with very little trouble. The votes are still coming in and it looks as if the recently aligned communist parties will take most seats.

Crowds listening to election results in Pokhara


Things are getting very exciting now with the Ear project and we look forward to developing news in 2018.

We are still very much in need of a treasurer to join the EAN trustees, if you are interested please let us know, it would be a great Christmas present!

We do hope that all our friends and supporters will have a lovely Christmas and New Year.

Our love to all,

Mike Smith and the EAN trustees

Child from Rolpa



For donations, please click here:

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RETURN TO NEPAL - NEWS FROM THE FRONT ...

May/June 2017

Mike and Fiona returned to Pokhara at the beginning of May. At that time there was still no certainty of a work visa, however Mike was pleased to be able to take leave from his locum at the Queen Elizabeth University Hospital in Birmingham in order to see the on-going work at the Ear Centre and attend an ear outreach camp.

Mike had passed one hurdle, with a letter from one Nepali ministry confirming that he should have a work permit, however there were further delays because of a change in passport during the waiting period.

Soon after arrival he was able to help with some difficult surgical patients, including young children with extensive mastoid infection and a lady with a paralysis of one side of her face due to a damaged facial nerve, that required grafting.

a street in Jumla, pre monsoon rains

A street in Jumla, pre monsoon rains

In the run-up to the monsoon season there were some heavy rain-storms and also some very clear days. All around he hospital flowers are in bloom and the grass growing tall and bright green. The snow level on the mountains lowered so they look spectacular.

photo 1, packing ready to leave the ear centre for the camp

Packing ready to leave the Ear Centre for the camp


About 10 days after arrival Mike and the rest of the INF team from the Green Pastures Hospital Ear Centre headed off on a marathon road journey to Jumla. We were joined by Dr Fredi Bacchetto as a representative of SON the Swiss donors. Sadly Dr Lukas Eberle of SON remains seriously unwell. Fredi’s wife Christine stayed in Pokhara and spent time with Mike’s wife Fiona. This was our 5th ear camp in Jumla, spaced over many years; the last was two years ago. On that visit the presiding memory was of being very cold, especially the poor audiologists, working in a windy dark corridor! This time the temperature as we crossed the Terrai on the Nepali border was very hot and humid, approaching 50
C, but then as we ascended into the hills it became very pleasant.

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A section of road on way to Jumla


The hill roads have to be seen to be believed, apparently they featured on a
TV programme as one of worst roads in the world! It took three long days of about 12 hours each in the 4WD vehicles to reach Jumla. One land-rover developed a broken gear box and had to stop and wait for an alternative vehicle. They then missed the police road curfew and spent a night in a rather primitive hotel before joining us.

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The 4WD breaks down!


After a day setting up the theatre and out patients and meeting the local doctors we were ready to start the next day, but that evening we had a call about an emergency. A lady who also happened to be deaf and dumb had fallen from a tree. She was probably cutting fodder for her animals. She had a very nasty cut across the whole face, just below each eye, cutting her eye lids and going deep into the nasal cavity, with further cuts to lips and tongue, and a broken wrist. The local doctors were happy to have an ENT team arrive, so we cleaned the wound of grass and mud and repaired the lacerations and nose. We were worried she may get an infection or have eye damage, but the swelling subsided and she did well, going home a few days later. Because both she and her husband could not hear or speak it was hard to know how she felt, and it must have been very frightening for her. The pictures are rather gory, so we have not included them!

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Operating theatre in Jumla

trimming a graft to reconstruct an ear drum

Trimming a graft to reconstruct an ear drum


As it is a short farming season in Jumla, and people were very busy with planting out rice seedlings and harvesting wheat, we were unsure how many would attend the clinic. Also we were a smaller team than usual, so we did not advertise. Nonetheless, we saw nearly 500 out patients, did nearly 40 operations, 200 audiograms and fitted 50 hearing aids. There is a local man who has worked with us for many years; he will help with follow-up and hearing aid supplies. Two men walked two long days from Mugu for hearing aids. Most surgical patients had infected perforations of the ear drums, some had more extensive cholesteatoma disease of the mastoids, though these were fewer than usual. Mike and the team did a teaching session to about 25 final year nurses from the local nursing school.

photo 8, INF team with many of the surgery patients

INF team with many of the surgery patients

photo 3,mike teaching final year nursing students at Karnali college of health sciences in Jumla

Mike teaching final year nursing students at Karnali College of Health Sciences in Jumla

When it came to leaving, the team were very keen to take a side trip to visit Lake Rara. This is famous in Nepal as a beautiful remote place. The road was even more extraordinary, crossing vast cliff faces, entirely unmade-up and with numerous small landslides. At the end of the road journey we walked three hours through pine woods and lovely meadows full of sweet smelling flowers, then round the lake to the far side to stay in a rather basic lodge. It was an amazing experience. On the return journey the truck developed fuel and electrical problems and broke down twice. So they took four days to reach Pokhara.

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The road to Rara

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Carpet of flowers in meadow near Rara

preparing fish for lunch

Preparing fish for lunch


On our return, we were delighted to discover that there were four audiology trainees on a one month attachment to the ear centre, from the Teaching Hospital in Kathmandu. We were invited to a dinner by local ENT doctors and were able to discuss the EAN bursary candidates. We will make a final decision at our EAN trustee meeting in the UK in June. One of these will receive sponsorship to attend an ear related course abroad and an attachment to an ENT unit for two weeks. We also talked about other trainings we hope to arrange in Nepal. On this visit Mike was able to take a lot of medical textbooks paid for by EAN and also return several audiometers that had been recalibrated and repaired in the UK, again paid for by EAN. He also took a large batch of hearing aid batteries donated by RayoVac.

Mike and Fiona return to England in early June, thankfully with the work permit finalised. Then they will finish Mike’s locum in Birmingham and hopefully return to Nepal in late September or early October, just before the festival season.

We remain committed to further ear camps and to volunteers coming as teachers to the hospital. We are still awaiting the final health agreement that we depend on, between the government and INF. The minister has just signed it, so it should not take long now. Once that is in place we believe it will be possible to facilitate short permits for interns, students and other volunteers, and also their medical registration, to respect all local regulations. We are told that a large number of clinics and hospitals have been closed down by the authorities for failing to follow appropriate rules. Thank you to the many professionals and others who have supported us and who have offered EAN to come as volunteers and for your continued patience.

photo 5, Rara lake in the evening

Rara lake in the evening





HURRAH - MIKE GETS HIS VISA!! ...

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After a very, very, very long wait, Mike Smith's visa finally
comes through enabling him to continue his work in earnest!




96 DOCTORS ATTEND EAR HOSPITAL SOL CONFERENCE ...

On three days from 16-18th February 2017 we were delighted to help run the Society of Otolaryngologist’s of Nepal (SOL) biennial ENT conference in Pokhara.

The conference alternates between Kathmandu and other cities. About one year ago we requested that the next should be in Pokhara. We are very happy that the SOL secretariat made contact with us. Our friend Dr Devesh Singh, the ENT chief at the Government Western Regional Hospital in Pokhara became the chief local organiser. We all worked closely together to enable a special meeting with a strong emphasis on ear problems. We ran an extra conference day, of live ear surgery at the Ear Centre.

With a lot of help from the INF electrical and IT teams we were able to set up some new equipment paid for by our Swiss partner charity (SON) and bought in the UK and transported by Mike. This enabled us to have High Definition video images relayed from the operating room and the surgical microscopes directly to the main ear centre training hall, and to the theatre lounge. We also had audio feeds so that the audience could talk to the surgeons as they operated, and ask questions and debate techniques.

We were really pleased when numbers exceeded our expectations, with 96 doctors attending. We were even more pleased that the equipment all worked! We had a very reputable visiting surgeon (Prof. Vijay Hanurappa) from Bangalore in India, organised by SOL. Mr Jeremy Lavy from the Royal National Throat, Nose and Ear hospital in London was organised by EAN. Jeremy has visited us before and we hope will do so again. He has a particular reputation for stapes and otosclerosis surgery. These surgeons and Mike were able to demonstrate several major middle ear operations. During the rest of the conference, all these three and our own Sandra Eisner, based in Pokhara on a research visa and analysing our ear camps data, plus short term visitor, Anne Markey, who is a senior ENT trainee in the UK, were able to give guest lectures, chair sessions, judge the research poster competition and present research papers. Anne won a prize for her short paper.

We all received plaques, certificates, rosettes and thanks! We are grateful that the course organisers also honoured the INF team from the ear centre for their excellent hard work.

All the surgeries went well and we are confident that the patients will do well. The wards were the busiest we have seen them so far, with all ward beds and private cabin beds occupied.

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A small number of the conference delegates and organisers gather on the last day.



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Prof. Vijay demonstrates to Dr Nirmal, one of our two staff ear surgeons




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Mr Jeremy Lavy receives his plaque of thanks from Prof. Mishra






SEVEN THOUSAND AND SIX!! ...

In February 2017 the staff at the Ear Centre were excited to realise that they had just seen their 7,006th new patient since opening in November 2015! Many have retuned for follow up, so the total number of consultations and out-patient procedures is even larger. They have also now done 517 ear operations. Despite obstacles and delays with visas and with importation of medical items, the work has gone on and the team are very happy to be able to report that so many people have been helped. The hospital is highly regarded and has recently been used as movie set twice! Several thousand people have also had hearing tests and nearly 500 hearing aids have been fitted.

I attach a photo of Bishesh, one of the new INF staff who works in Registration and Statistics, standing with just some of the patient files. We have designed record books for out-patients and for in-patient episodes and these are working very well. Note the doll behind him that the children in the waiting area play with - it was knitted by one of our supporters!


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SOL LAUNCHES EAN BURSARY ...

The Society of Otolaryngologists of Nepal has announced the EAN Otology Bursary.

On the occasion of 8th National Conference of Society of Otolaryngologists of Nepal held on 17-18th February 2017 in Pokhara, Dr. Michael C F Smith on behalf of INF’s Ear Centre, Green Pastures Hospital has announced a £2,000 Ear Aid Nepal Educational Otology Bursary to facilitate the selected candidate to attend an OTOLOGY course or conference preferably in the UK or internationally recognised centre.

Full details here:

http://solnepal.org.np/ear-aid-nepal-educational-otology-bursary





1st COMMUNITY EAR CARE CONFERENCE ...

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(L to R) Mr Ashish (audiologist), Miss Sandra Eisner (audiologist and speech therapist)
Dr Mike Smith, Dr Nirmal Thapa (ENT surgeon)

The 1st Community Ear Care in Nepal Conference was held over two days at a hotel in Kathmandu in November 2016.

The conference was sponsored by the Government of Nepal and Impact Nepal.

It was well attended and a great encouragement. In recent years there has been a great deal of activity to push the plight of the deaf and those with ear disease into the awareness of the public and the health services in Nepal. Although they are still not a high priority, despite the vast numbers involved, it was excellent that top politicians and civil servants took the time to attend and participate. It was marvellous to hear of the many projects springing up around Nepal. Particularly the recognition of the need for a network of dedicated Ear Care Workers and additional training in understanding, diagnosis and treatment of ear disorders for paramedical workers. EAN hope to be involved in helping to develop this based around the INF Ear Centre in Pokhara.

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The chief guest speaker was Mr Gagan Thapa, the Minister of Health for Nepal. Professor Rakesh Prasad Srivastava, was the hugely experienced principle medical speaker.

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Dr Mike Smith was an invited speaker. He delivered a talk on the subject of INF ear camps over the past 25 years. Sandra Eisner has been undertaking a research study under Kathmandu University, to analyse the data for these camps and Mike was able to present some of this. Including the numbers of patients with different types of ear disease and varying degrees of hearing loss that have attended the camps. The data include over 40,000 patients. Mike was delighted to be able to visit the Minister of health and the secretary for health in their offices shortly after the conference.

We are now planning for the Society of Otolaryngologists (SOL) of Nepal biannual conference. This will be in Pokhara in February 2017. There will be an additional satellite day of conference, held at the Ear hospital, with demonstrations of live surgery.








HAPPY BIRTHDAY EHTC ...

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Namaste and Greetings from Nepal!

Today is the 3rd of November,
it is very important day for us because our dream project the EHTC was opened on
3rd November 2015.

So it is a first BIRTH DAY OF EHTC.

Still the situation not very helpful to develop but day to day is excellent,
it is very good for us. The total OPD number is 5,730 in a year which is very good number.

I would like to give you all, very, very thank you so much
for all your hard work and support for EHTC and congratulations!!!

Best Regards

Eka Dev and Family






GLOBAL HEALTH PRIZE WINNER ...

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Mr Mahmood Bhutta DPhil FRCS (ORL-HNS), (currently Otology Fellow at Royal Perth Hospital, Australia and Honorary Research Fellow at the University of Western Australia), has won the 2016 MJA, MDA National, Nossal Global Health Prize. This was for an essay he wrote discussing the effects of hearing loss, and of a changing world, on elderly populations. The essay was inspired by events from his trip to our Ear Hospital in Nepal last year, and will be published in the Medical Journal of Australia in November 2016.

Congratulations to Dr Mahmood!

Download the essay here