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A large multinational group flew into Jumla two days after arriving in Kathmandu. It was rewarding to make such quick progress across Nepal as such remote areas are not always as accessible. Jumla sits in a wide open valley with fabulous views of the snow-capped Himalayas. The landing strip was thankfully flat! At 2500 metres Jumla is a moderate sized district centre with a population of 110, 000. It has a well-appointed hospital with a range of general medical specialties as well as a lab, an X Ray room and a base for training of medical technicians. We were given the use of a number of rooms and the INF team who had driven for several days with the equipment had already set up a spacious ear clinic ready for our use. The operating theatre was in a newly built operating room with plenty of space for our three operating tables and was clean and airy – and it was to transpire – very cold!

Our accommodation was a short walk through the town and when we arrived the following morning there were patients already waiting for us. It was not long before we had patients already being lined up for surgery. By the afternoon we were operating and it became clear that we were going to need to find a source of heating, not only for our benefit as it is difficult to operate when shivering, but also for that of the patients who would be lying on a table for a number of hours. A gas fire meant that the operating theatre became the place to congregate at the end of the day, and patients would be found not only on the operating tables, but on the floor in-front of the fire as they recovered from their sedation. The audiology rooms, being at the north facing side of the hospital suffered with the same temperature issues, and the audiologists had to undertake their hearing aid fittings outside in the sun as it was the only way they could make the material used for impressions set.

We saw 1405 outpatients in the 9 days of camp, undertook 130 procedures and fitted over 100 hearing aids. As always, middle ear disease was very prevalent and the majority of the patients came with discharging ears and deafness. A greater number of patients than usual failed to turn up for their surgery, and we wondered if waiting in the cold was putting people off. However we were always able to fill the places on the day and operated until late on the evening on most days. The hospital had made a room of 6 beds available to the patients and this was helpful for those that we had their surgery late in the day who would be able to sleep off their sedation rather than having to be carried through the cold night to their lodgings.

The INF team at Surkhet had made us aware of a baby that had been born with deformed ears and no ear canals. This meant she would have a significant hearing loss and little chance of developing speech without help. They had travelled for 4 days to Jumla and we were delighted when a specially donated hearing aid from Oticon clearly gave her some hearing. This is vital whilst her speech is developing and when she is older we hope to be able to fit her with a more permanent bone implanted aid.

We treated a patient with long-standing mastoid disease who had lost the majority of his hearing at the age of 7 and so had had to stop school. Whilst we do not hold much hope for improving his hearing, we were at least able to stop one of his ears discharging.

To ensure that there is ongoing support for people with hearing aids, the audiology team trained the medical technicians at the INF clinic in Jumla in the basic maintenance of aids. This is an important step forward and in the longer term we hope to be able to support the training of an audiological technician to provide a more extensive service to the population.
We were sad that some patients refused surgery, some are too young and some arrive too late when all the operating time has been occupied. These patients are treated with antibiotics and advice and we hope that for some, this will lead to at least a temporary resolution of their infection. What however is clear is that there is a need for another camp in Jumla in the very near future.

Baby, 5/12, born with no ear canals

Bone aid on softband for the babyay