CEHP's Community Ear Care service delivery model                     Back to first Page

During this quarter, CEHP carried out series of primary ear care camps in 9 locations in Banke district collaborating with VDC, Health Posts, schools and local Red Cross units. Total of 560 (222 with COM) patients were screened and 45 patients were referred to Bheri Zonal Hospitals and Nepalgunj Medical College Teaching Hospital for medical and surgical interventions.

The school ear health activities is a part of this programme has been starting since 2001 from Banke and latter started in Bardia, Surkhet and Dailekh. The strategy of the programme is to provide primary ear care training to primary level school teacher for 3 days. After the training, the CEAs visit to each of the school to support the teaches to carry out educational activities and the CEA also carry out ear examination of all students from primary level. This is all done in coordination with District Education Office, Resource centers and schools.

After completing training of teachers on primary ear care, The CEAS were visited total 12 schools and they examined ear health of 2,556 students. Out of them 861 had Wax, 166 COM, and 39 had OME. 238 students were referred to hospitals in Nepalgunj. During school visit, the teachers were very happy with the programme and provide active support.

The ear care volunteers carried out community ear health education sessions in 23 locations for total of 457 community people with the support of CEAs. They were provided education on cause of ear discharge (CSOM) and its prevention and method of ear mopping in local level. 

Community Ear Care activities in Bardia district

The community ear care activities in Bardia district is implemented by Bardia Red Cross with the support of Nepalgunj Medical College (NGMC) for all 32 VDCs in the district, and the equipments, IEC materials and logistics are supported by the BRINOS and CEHP.

During this quarter, Bardia Red Cross carried out 1 primary ear care camps and screened 55 cases (30 COM). 10 cases were referred to the hospitals for further management.

NRCS Bardia operates a weekly ear clinic at Gularia town at primary eye care centre every Sunday. During this period total of 431 (167 COM) ear patients were treated and 75 patients were referred to the hospitals in Nepalgunj for further management.

Mr. Deepak BC, CEA from NRCS Bardia also provided basic ear care orientation to 25 students of Nepal Red Cross Society Junior Red Cross Circle of Sri Kusma Devi Lower Secondary School, Ranipur-Padnaha, Bardia.

Mr. Dipak also provided support to a general health camp at Dhodari VDC in Bardia organized by Nepalgunj Medical College, Kohalpur. The ear care programme in Bardia is supported by Nepalgunj Medical College.

Community Ear Care activities in Surkhet district

The community ear care activities in Surkhet district is implemented by Surkhet Red Cross with the support of BRINOS in 5 VDCs (out of 50) of the district. It was started from July 2003.

During this quarter, NRCS District Chapter Surkhet with the help of CEA, conducted series of primary ear care camps in 13 location of the 5 VDCs Latikoili, uttarganga, Gadhi, Jaburta and Chhinchu. Total of 646 patients (306 COM) were examined. 32 patients required further management were referred to the hospitals in Nepalgunj.

The CEAs also carried out refresher training on primary ear care for 20 volunteers of Jarburta VDC to update their skills and knowledge on primary ear care. This time high number of volunteers had participated in the refresher training and they were very happy to take training and gather again to get updated on ear health. The refresher training was conducted in collaboration with District Health Office, Sub-health post, VDC and NRCS sub-chapter.

 With the help of CEA, the ear care volunteers carried out community ear health education session in 6 locations for 248 community people. The ear care volunteers provided education on causes of CSOM in their society or family. They had also given education on how to mop the ear discharge to make the ear dry.

The CEA from NRCS Surkhet also visited in 5 schools and examined total 824 students of primary level with the help of their   teacher.  Out of them 225 had Wax, 75 COM, 8 had OME and 9 had hearing loss. 5 students were referred to hospitals in Nepalgunj. A teacher each from these schools was already trained on primary ear care by the programme.

NRCS Surkhet also operates a weekly ear clinic at Birendranagar town on every Sunday. During this period total of 100 (45 COM) ear patients were treated and 17 were referred to the hospitals for further management.

Community Ear Care activities in Dailekh district

Dailekh Red Cross with the support of BRINOS implements the community ear care activities 5 VDCs (out of 50) in Dailekh district. It was started from July 2004.

 A series of primary ear care camps were conducted in 2 locations in Dailekh and total of 168 (78COM) ear patients were examined. 20 patients who required further management were referred to Dailekh district hospital and hospitals in Nepalgunj.

The CEAs provided primary ear care refresher training to 22 FCHVs (Female community health volunteers) from 2 VDCs which Belpata and Kalbhairab VDC to update their skills and knowledge on primary ear care. This time high number of volunteers had participated in the refresher training. The refresher training was conducted in collaboration with District Health Office, Sub-health post, VDC and NRCS sub-chapter.

The ear care volunteers carried out community ear health education sessions in 2 locations for total of 100 community people with the support of CEAs. They were provided education on cause of ear discharge (CSOM) and its prevention and method of ear mopping in local level. 

NRCS Dailekh also operates a weekly ear clinic at Nayabazar town on every Sunday at primary eye care centre. During this period total of 119 (74 COM) ear patients were treated and 10 were referred to Dailekh district hospital and hospitals in Nepalgunj for further management.

Ear Surgery Camp

BRINOS provides technical support to Nepalgunj Medical College to conduct ear surgery camps 2 times (March and November) in a year. These camps are held at teaching hospital of Nepalgunj Medical Collage at Kohalpur, which is 20 KM north from Nepalgunj city. The surgical camps mainly aimed serving the patients identified and referred by the ear care volunteers from the programme area in 4 districts started above.

Hearing Rehabilitation

This has become one of the important activities of the community ear care programme. CEHP has got most of the provisions to support rehabilitation of hearing impairment. BRINOS and Cubex provided equipment for assessment. Regular supplies of hearing aids have been received since 2002 from Mr. Adam Shulberg, who is the head of Cubex-UK, a private firm for hearing rehabilitation. Mr. Adam is the expert audiologist and has trained the CEHP team members for hearing assessment, rehabilitation, hearing aid fitting, repairing, etc. Now the BRINOS has also started providing hearing aids to the CEHP.

Around 30 patients were attending the hearing rehabilitation clinic at CEHP in a day considering this situation; CEHP has now increased service days for 1 more day. So the activity will take place for 3 days in a month hearing rehabilitation activities will be carried out at CEHP, which is 10^th, 15^th and 25^th day of each month as per Nepali Calendar. CEHP has also made some revision on the service charges considering need for self-reliance in future. The hearing aids are provided on subsidized rate. A hearing aid provided Rs. 600, if patients referred from field, health post, volunteers and CEA from the programme VDCs. If the patients are from out of programme area, they are charged Rs. 1,500.

During hearing assessment days, the revisiting patients also get services on repairing of the hearing aids and supply of additional batteries with nominal cost, i.e. Rs. 120 for 12 numbers of batteries. Irreparable hearing aids replaced for the patients from programme area with small charges, i.e. Rs. 250.

During this period 156 patients were served; 59 with new hearing aids with batteries, 41 got replacement of hearing aids; 5 got their hearing aids repaired and 51 patients received new batteries.

With the support of Mr. Adam Shulberg from CUBEX and BRINOS; CEHP continues production of ear mould since month of April 2006. During this quarter, 3 more ear moulds were produced.

IEC (information, education and communication) activities

The IEC material produced by the CEHP has become very popular. The items available are listed in the table below.

Development of a Flip Chart for community health workers like – FCHVs, Red Cross is completed. It was produced with the support of Cubex, UK.

During this period, 115 number of primary ear care (yellow) books, 45 number of posters about COM, 45 number of posters about early sign/symptom of hearing impartment in children and 1,170 number of brochures about prevention of COM were supplied mainly to the ear care volunteers, teachers and health personnel. 3 ENT books for paramedics were also provided to the health post staffs.

Coordination and Sustainability

Coordination is vital part for sustainability of the programme. In principle, CEHP supports/implements community ear care activities in a particular VDC for 2 years, and transfers the responsibility to the Health posts in order to sustain the programme.

Considering sustainability aspects of the programme, the chapter in Bardia, Surkhet and Dailekh are supported only with nominal external support. A significant part of the programme is organized at the local level by the chapter. This has been successfully demonstrated by the Bardia chapter mobilizing various institutions at the local level and also expanding its coverage in the district. Similar success is expected in the other programme districts as well. Operation of the weekly clinic has also promoted possibility for sustenance of the services.

NRCS CEHP is coordinating to related organizer like Nepalgunj Medical College, GOs/ NGOs for sustainability of the community ear care programme.   

Challenges and Constraints

The Maoist and the main political parties carried out revolutionary movement to bring change in the political situation. This has led to a completely new context in the country with the changed political security situation. The new government and the Maoist have announced ceasefire with no time bound. The security situation in the country was improved to a significant level from mid of this quarter.

Now it has also become much easier to reach the remote and interior part of the districts. However, still most of the NGOs and government agencies are hesitant to go to the interior because of security reasons.

In the present context, the local development bodies are also inactive or not in presence because of security reason. This has led to a threat to the sustenance of the programme. Even in the presence of obvious benefit from the programme, at present, the health related NGOs and government institutions have given low priority to the deafness control programme. In such context, it greater challenge for NRCS for its expansion and sustainability.

Despite of conflict situation, CEAs continuously maintained operation of field activities through proper coordination with conflicting parties. Both the parties provided positive support to the programme.

Administration

CEHP is receiving continuous request from Jumla, Rukum, Salyan and Pyuthan district for the support to start up community ear care activities. CEHP is in discussion with BRINOS on these requests. Some of the districts requested for the support are not linked with the road access which makes it difficult to monitor the programme.

A Maoist leader looking after health care for the Maoist activities visited CEHP and requested for special subsidy for their patients on eye and ear health. CEHP informed that Red Cross CEHP can not violate one of its principles providing such provision.

CLINICAL STATETICS

Period:  July to September

Primary ear care camp                                                                                                      Year: 2006

School ear health programme (schools visited and screening)                      

Weekly clinic OPD (examination and education)

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