BRIEF PROPOSAL FOR THE CONSTRUCTION OF AN EAR HOSPITAL IN POKHARA NEPAL
March 2012

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PURPOSE
The purpose of this proposal is to seek funding of Euro 500,000, in order to construct an ear Hospital/Centre in Pokhara, to provide corrective surgery to the poor in the mid-western region of Nepal.

SITUATIONAL ANALYSIS
Deafness is an invisible disability. Without good hearing we cannot develop normal speech and language. In the developing world sufferers are frequently unable to benefit from education and therefore have very poor employment and social prospects. The hearing disabled are the largest group of handicapped people in Nepal. In 1991 Briton Nepal Otology Service (BRINOS) conducted a nationwide survey of deafness and ear disease in Nepal. The main findings extrapolated from 16,000 people surveyed were:
• 16.8% were significantly deaf. Based on the current population of 26 million (2011 Census figures) this equates to 4,368,000 people;
• 8% had abnormal ear drums indicative of preventable ear disease;
• 32% of hearing impairment is associated with middle ear infection or its sequelae;
• 70% of those suffering from middle ear infection or its sequelae are of school age;
• of the 39% who had received treatment, 66% were unsatisfied; and
• 50% of all ear disease is
preventable.

In Nepal there is one Ear Nose and Throat (ENT) surgeon for every 600,000 persons and one audiologist for every 6,000,000 persons. Ear surgery is being done in the capital Kathmandu and in Pokhara, a city about 200 kilometres west of Kathmandu. The table below highlights the magnitude of the surgical task that lies ahead in order to treat some common cases of hearing impairment in Nepal.

Types of Otitis Media Total cases in Nepal Operations done every year Time to finish operations
Perforated tympanic membrane 1,296,000 300 4,320 years
Otitis Media with Effusion 287,000 300 990 years
Cholesteatoma 162,000 100 1,620 years

There are about four to five overseas organisations that run mobile ear camps in the whole of Nepal on an ad hoc basis, whenever, overseas surgeons are able to visit Nepal and volunteer their services. The INF on the other hand has been running ear camps for nearly 20 years. Surprisingly moderate / severe deafness is the commonest disability in Nepal. Congenital deafness and chronic infection are the principal problems. Children commonly have many years of ear discharge and progressive hearing loss. Some die of complications such as mastoiditis, meningitis or brain abscess. Many of the camps are not equipped to conduct surgery and people have got to be turned away. Referral to Kathmandu or Eastern Nepal is not an option as people are too poor to be able to meet the costs of travel and surgery. The facilities available in Pokhara for ear surgery are attached to a medical school and they have indicated that they are not interested in community work.

SPECIFIC NEEDS
There is a desperate need for an ear Hospital/Centre in Pokhara that provides specialist services to the wider community of the western region of Nepal; to date there is no such Centre. INF can provide treatment and surgery to a few, through its mobile Camps, but the needs in western Nepal far exceed what INF can offer with the current facilities. Therefore INF is seeking funds to pay for the construction of a specialist ear Centre in Pokhara. The Centre will provide quality care for acute and chronic ear conditions including infection and deafness. The different working area of expertise is medical, surgical and hearing aids. It will also: serve as a base and referral Centre for rural ear camps in western Nepal; provide training in and use of appropriate techniques and research low cost and appropriate intervention for the treatment of patients with hearing disability; and provide training for health personnel not just from Nepal but also from South Asian Association for Regional Co-operation countries. The Centre should also have the flexibility to develop access to new developments such as cochlear implantation, bone anchored hearing aids and their long term care, seeking appropriate cost sensitive appliances.

IMPACT
The ear Hospital/Centre will be first of its kind in the Western region of Nepal providing specialist services to the community particularly the poor in this region who are not able to travel to Kathmandu or Eastern Nepal for treatment. INF has received a commitment from a British Surgeon to serve at the hospital as the resident ear surgeon and will also have 3-4 visiting surgeons per year. One full time Nepali surgeon (who will initially undertake the 6 month fellowship programme offered by the Hospital/Centre) and one full time Nepali medical officer will assist the Swiss surgeon in his work. The Hospital will be providing middle ear constructive surgery and hearing aid tests. In the short term the hospital will be conducting approximately 1,200 major operations per year and approximately 20 - 30 consultations per day or approximately 5,000 per year. The hospital will be able to also provide accommodation for 16 patients and this is to particularly serve patients with complicated ear procedures who require an extended stay at the hospital. In the long term, the Hospital/Centre will be able to train 4 audiologist per year and 2 hearing aid technicians per year. The hospital will also be providing a 6 month fellowship/year to enhance the skill of a Nepali surgeon. The Hospital/Centre will also be training ear care workers who will work closely with community groups in identifying people in the community with ear problems and providing whatever care they can give to help such patients. Overall, the Hospital/Centre will not only be providing the only kind of service for the community in Western Nepal, it will also be restoring hearing to many of the poor in Nepal who would never have the opportunity to hear once again. The training being conducted at the Hospital/Centre will substantially increase the pool of ear specialists in Nepal required to provide better and timely services to the people. The Centre will be registered by the Government of Nepal.

BUDGET
The total planned budget for the construction of the Centre is Euro 900,000. This will be finalised after architectural plans and building tenders, costs of equipment and fittings, are complete in early 2013. INF has received a commitment from an external donor to provide 25% of the funds and as such INF is seeking to raise 75% or Euro 675,000 from other external donors. INF will provide the land necessary for the construction of the hospital at no cost to the project. INF has a donor who has funded the purchase of all the equipment necessary for the hospital at phase one start up; the equipment is already in Nepal or in containers in the United Kingdom waiting to be shipped to Nepal. INF has an agreement in place with a construction company to plan and build the Centre. It is now needed is to raise the funds required for the construction of the Centre. INF is confident that in the event it is able to raise the Euro 500,000 then INF will be able to raise any shortfall from its existing pool of donors. A detailed business case and future plan has been prepared.