NEWS from Pokhara, December 2017

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!

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.

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.

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.

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.

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.

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.

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

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