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.

photo 4, photo of section of road on way to jumla


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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.

photo 2 on road to camp

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!

photo 7, operating theatre in Jumla

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.

photo 6, section of road to Rare

The road to Rara

photo 9, carpet of flowers in meadow near Rara

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!! ...

Visa-2

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!


bishesh


form






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.

web---Minister-of-health,-Mr-Gagan-Thapa-addresses-the-Conference


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.

Dr-MIke-Smith-delivers-presentation-about-rural-ear-camps,-meeting-chaired-by-Prof.-Bimal-Sinha---web


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.