Since 2001, Cubex has worked with the Britain Nepal Otology Service (BRINOS) to help thousands of Nepali’s achieve better ear and hearing health and life quality. Adam Shulberg initiated the audiology programme and has made it his responsibility to facilitate, train and supervise a team of Community Ear Assistants (CEA’s) and to date, over 1000 volunteers.

Under the co-ordination of a team of CEA’s and Cubex (UK) an Audiology programme is now running in Western Nepal and offers a sustainable hearing care service. In developing countries this presents many difficulties. Hearing aids are sophisticated devices which require batteries and maintenance. Each hearing aid has to be fitted individually with a well fitting ear mould, verified and the patient and their family then require counselling and training. By training the Primary Ear Care workers in hearing aid fitting maintenance and counselling, Adam has established a fully sustainable hearing care service.Since humble beginnings we now have a team of 6 Community Ear Assistants (CEA’s) delivering Primary ear care and Audiological support to a catchment of nearly 1 million people in some of the harshest terrain and conditions the world has to offer. In addition to this we have a network of over 1,000 volunteers delivering primary ear and hearing care in villages in the Terai and in the Himalayan foothills.The Nepal team is led by Mr Puran Tharu who has been working with Adam and the founder of BRINOS and ENT Surgeon, Mr Neil Weir for 11 years.

I remember the first time I was introduced to Puran,” recalls Adam. “A young man, who did not speak a word of English, nor did he know anything about Audiology. 12 years on, and he heads up the only Audiology service outside of Kathmandu. More important is his role in the transfer of skills to the rest of the Audiology team and the CEA’s.

The focus of the last few Audiology camps was: patient centered care – understanding the communication needs and motivations of the patient and their family to ensure that the most relevant and appropriate care is always delivered; training – placing a more formal and closely monitored process for assessing competency of trainees undergoing the CEA course; early identification and intervention – the team kicked off screening programmes for young children in 2010, and in 2012 we worked on finalizing plans for the first phase of an infant screening programme.Many of the children seen at the camp have acquired hearing loss through ongoing infections during infancy. Unfortunately, many are Deaf by the time we reach them.

It is heartbreaking to meet these bright, beautiful and resilient children, born with normal hearing, who slowly progress into a world of silence because poverty prevents them from receiving the care and management that could have given them a chance at school and socially.

Hearing loss can be avoided through primary prevention and many can be treated through early identification and appropriate management.

We are constantly working on ways to reach communities who are not aware of the ear camp to raise awareness on hearing loss, but more important, ways to prevent it. The primary prevention camp is ongoing and includes primary ear care workshops for parents and teachers, pre and primary school screening, identifying and referring high risk infants and more. We hope to make this process easier by acquiring the screening and equipment and tools necessary to complete infant screening.

BRINOS recently purchased a substantial property to create a dedicated Ear hospital to be staffed and managed 365 days per year. This is a really exciting phase, ensuring the future hearing healthcare needs of the people of the Terai for many years to come.

It was always the aim to provide a fully sustainable program; that is the key. Nepali’s are proud people and their only wish is to be independent. All they need are the “tools” to continue this work. It is never easy taking the time out from a busy and demanding work life to make these trips, however, educating and supporting the Nepal based team has been a great source of pleasure, reward and joy for me and I look forward to meeting our aims and objectives.

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