Tawal

tawal clinic

Tawal Health clinic

Project proposal: NAFA (Nepal Australia Friendship Association) has supported health clinics, schools and other projects in the TAWAL region since 1998. Together with Kopan Monastery, HearingNEPAL Program was invited to run an ear camp and evaluate the need for hearing services in the region.

Location: Tawal is a remote village in the hilly region of the Ganesh Himal, in Dhading district, 5 hours uphill walking from the road head.

Date Commenced: January 2010

Date Concluded: Ongoing

Partners: NAFA, NAHOH, JOY Foundation

Beneficiaries: Any person of any age living or working in Tawal village or the surrounding region,  with an ear health or communication issue.

Trip 1 – January 2010

Staff: Ramita Shrestha, JOY Nepal

Volunteers: Sue & Lew Tuck (HearingNEPAL Program)

Objectives: To assess the need for ear health services, and provide immediate benefit in the region’s ear health and hearing ability.

Strategies:

  1. To perform otoscopy, air conduction audiometry, and impedance and IPSI reflex measurement.
  2. Diagnostic evaluation would result in
    1. No further action, i.e. no medical follow up or loss meeting requirements for hearing aid / assistive listening device fitting.
    2. As above, but retest in 12 months
    3. Urgent medical referral – with recommendation to medical clinic that ENT advice would be prudent. Note that ENTs are not easily accessible, and so this advice was not given lightly!
    4. As above, with no urgency, e.g. Holes in ear drums, no infection present, clients under 15 yo, an age below which ENTs were unlikely to operate.
    5. Medical clinic referral for the removal of ear wax and organise for testing.
    6. Medical Clinic referral for primary treatment of infection
    7. Referral for hearing aid or assistive listening device fitting
  3. To assess power availability, with the view to bringing more diagnostic evaluation equipment next visit
  4. To train staff (Beg) in the use of specialist equipment for cleaning of ears / ear obstruction removal
  5. To train staff in hearing aid management and maintenance, maintaining records etc
  6. To train staff to use screening equipment, so that when supplied, they will be able to conduct preliminary screening, freeing audiologist time for further assessment as required.
  7. To leave sufficient repair equipment and spares such that the program will retain its success until our next visit

Outcomes:

  • Hearing assessments completed:                           40
  • Medical follow up required :                                  19
  • Hearing aids and dry aid kits fitted (Monaural):     9
  • Hearing aids fitted (Binaural-exceptional circumstances): nil
  • Alternate listening devices:-                                  4 allocated- to be delivered with 4 spares in March 2010. One device left at clinic

Equipment left in Tawal

  1. Ear obstruction removal equipment, including head lamp / microscope, operating tools, instruction.
  2. Spare aids: 7 off programmed for each of seven recipients. We are not returning for 12 months and so felt it was prudent to do this first time around.
  3. Alternate listening device, on a neck loop with head phones. A further six will be sent to the village in March. These will also act as spare aids if necessary,
  4. Hearing aid cleaning equipment
  5. Spare temporary moulds for each of the aids fitted.
  6. Replacement hearing aid batteries size 13

Total Value $4870

Trip 2 – November 2010

Partners:  NAFA

Staff: Beg (Health worker, Tawal), Installation Team workers

Volunteers: Rod Setterlund, Ross Hazelwood, NAFA Australia

Objectives:

  1. Design and supply a reliable power supply for Tawal village Health Clinic to provide sufficient power for week-long Ear Camps and continuously power a vaccine storage refrigerator.
  2. Design the power system in conjunction with the suppliers in Nepal.
  3. Purchase the approved system.
  4. Provide funding for the system to be transported to the site and installed.

Outcomes:

  • Solar panels and power/lighting/fridge installed at health clinic. This will enable a vaccination program to maintained to surrounding areas (fridge) and we shall be able to take a full battery of diagnostic equipment for our ear camp – examining all local children in January 2011
  • NAFA supplied the Vaccine Fridge (WAECO Camping fridge)
  • Rod Setterlund (President, NAFA) went to Tawal to oversee the installation project
  • Project successfully completed.

Trip 3 – November – January 2011

Partners: NAHOH, NAFA, JOY Foundation

Staff:  Keshab Dango,CMAl (NAHOH), Ramita Shrestha (JOY Foundation, Nepal)

Volunteers: Sue and Lew Tuck (HearingNEPAL Program) , Jade Frederickson (Audiologist, Australia), Rod & Deb Setterlund, Ross & Brenda Hazelwood (NAFA), Tashi Sherpa ( Kopan Monastery).

Objectives:

1.   Review the persons from previous visit who were fitted with hearing aids.

2.   Recall any person requiring Primary Ear Care identified on previous visit.

3.   Extend the Primary Ear Care clinic to any person living in Tawal and the surrounding villages.

Outcomes:

  • Primary Ear Care Examinations :                       509
  • Diagnostic Hearing Assessments :                      44
  • Hearing Aids Fitted:                                           12
  • NAFA volunteers witnessed the value of NAHOH’s contribution to Hearing Nepal Program, particularly in remote villages. This strengthened their support of this critically important part of future Ear Campos, and engendered interest in future financial support proposals to the HNP. In particular, it embodied their charter of empowering Nepali people to provide the services themselves, as well as serving as a role model to the young people looking to future career possibilities.   

Trip 4 – November – December 2011

Partners: Dr Detlev Gueck, Eye Surgeon, Germany, NAHOH, NAFA, Kopan Monastery

Staff: Keshab Dangol (NAHOH), Sangye Tenzin ( Manager of the Medicine Buddha Health Clinic at Kopan monastery) and Dhargye, Khenrab & Tsundu (monks from Kopan Monastery)

Volunteers: Eb Mol (NAFA), Sue & Lew Tuck (HearingNEPAL Program)

Objectives: Combined Ear / Eye Camp

  • Assessment each person’s vision
  • Treat eye infections
  • Prescribe and fit pre-assembled glasses (brought from Germany by Dr Gueck)
  • Assess each person for ear health (primary ear care)
  • Treat ear obstructions (wax, debris, foreign bodies) and infections
  • Assess hearing where indicated
  • Fit hearing aid or assistive listening device as appropriate
  • Refer people for further ENT assessment or surgery as required.

Outcomes:

  • Primary Ear Care Examinations :                       1078
  • Diagnostic Hearing Assessments :                      25
  • Hearing Aids Fitted:                                           18       

One thousand and seventy eight registrations for the primary ear clinic, they then went next door to the eye clinic. Many left with eye glasses and a hearing device, all left with clean ears and eye drops!

Follow up Planning:

Sue and Lew visited the Tilganga Eye Hospital in Kathmandu, seeking a surgical path for suitable cataract candidates. They have said they will plan a screening camp in the area in future.