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Deafness means loss of hearing and it may be partial or total. Hearing impairment cannot be seen and hence its effects are not visible to others, so deaf suffer in silence. Unlike blindness, deafness often provokes ridicules rather than sympathy. A deaf person is so isolated from family and friends and greeted by unsympathetic attitude he/she is often depressed and needs psychological counseling. The consequences for a child born with hearing loss are quite severe. It is well established that a child with hearing loss cannot develop speech and language abilities. This puts the child at a disadvantage in school, keeps him away for higher education and limits future professional opportunities. The problem of the child deaf from the birth is quite different from that of the adult who become completely deaf after school age or in adult life.
The statistics are staggering - 360 million people in the world suffer from disabling hearing loss. This constitutes a substantial 5.3% of the world's population. The prevalence and incidence of hearing impairment in India are substantially high. The prevalence of deafness in South-East Asia ranges from 4.6% to 8.8%.In India, 63 million people (6.3%) suffer from significant auditory loss. Four in every 1000 children suffer from severe to profound hearing loss. With over 100,000 babies are born with hearing deficiency every year, hearing impairment is a serious and grossly neglected condition in India. The country also suffers a huge economic impact due to lost productivity, higher unemployment, and lower wages for the hearing impaired.
It is important to note that without hearing a child cannot develop speech and language. Hence, the aim should be to recognize deaf child before the age of 1 year because from 1 to 3 years onward babies start hearing the speech. Unfortunately, hearing loss is often not detected until a child is 2, 3, or even 4 years old, especially in rural areas due to the poor awareness about deafness and its relation with speech and language development as well as lack of infrastructure such as the non-availability of ENT surgeon, audiologist, audiological equipment, and speech therapist.
A probable strategy to ensure that children with hearing loss are identified and treated early is to ensure that every baby is screened for possible hearing loss at the birth in hospital. Early detection and consequent treatment lead to better speech development in children, enhanced scholastic achievements in school, and limitless professional opportunities. This strategy has been implemented in countries such as USA, Singapore, Australia, UK, and many more. Since India does not have such a program in place, it was with this thought that Rotary Club of Bombay Seacoast made its first effort and installed/set up a state of the art "Audiology Centre" in Dr. R. N. Cooper Municipal General Hospital in Juhu, Mumbai with a District Grant in the year 2015- 2016. This Audiology Centre consists of equipment for detection of hearing loss in new born babies as well as hearing testing for others. Annually, more than 3,000 individuals have been benefitted, since the establishment of this Centre.
There is clearly a need for a "universal newborn hearing screening" program throughout India. Neonatal and infant hearing screening programs can eventually improve the linguistic and educational outcomes for the child. The importance of a screening program is to provide effective treatment at the earliest opportunity, thereby reducing suffering due to hearing impairment. A cochlear implant is probably one of the best inventions in the recent history of medical science for bilateral severe-profound deaf. It is the first device that can restore one of the five senses. Cochlear implants are expensive and as cost is still a limiting factor in India very few children can avail of this invention. A universal newborn hearing screening program will only bolster such government initiatives by enabling the hearing impaired children access to cochlear implants sooner. The sooner a child gets access to hearing, the better are his/her chances of getting fully integrated into mainstream society.
Rotary Club of Bombay Seacoast plans to undertake the Cochlear Implant project in India to provide "Gift of Speech & Hearing" to under-privileged deaf & dumb children (from 1 year old to 5 years of age). We intend to cater to children who can't afford such costly corrective surgery (cochlear implant surgery) which can make them normal. We plan to undertake this project at the renowned Public Hospital named Dr. R. N. Cooper Municipal General Hospital in Juhu, Mumbai, which is fully equipped to undertake these surgeries.
The cost of undertaking a Cochlear Implant surgery per child is as follows:
1 Hospital Pre Operative Diagnostics Tests - INR 10,000 (USD 143)
2 Hospital cost for Operation Theatre, Doctor's fees and Admin cost - Nil
3 Implant cost - INR 609,000 (USD 8956)
4 Hospital cost for Medicines & Consumables - INR 12,000 (USD 171)
5 Speech Therapy Rehabilitation Program for 1 year - INR 46,800 (USD 669)
6 Contingency - INR 11,700 (USD 167)
TOTAL - INR 6,89,500 (USD 9,850)
District 3141 collectively has signed an agreement with Maharashtra Government to support up to 50% of the cost of Cochlear Implant Surgery. We expect a support of up to Rs. 2,00,000/- (USD 2,857) per case/child in the case of such families having income less than Rs. 1,50,000/- (USD 2,143) per annum. We may also receive financial support from other NGOs including the NGO "Being Human" (Film Artist Mr. Salman Khan's Foundation) up to Rs. 50,000/- (USD 714) per case/child. In such an event, it may be possible to undertake more than 10 surgeries depending upon the amount of financial support received from Maharashtra Government and other NGOs.
This is a Humanitarian project and will be conducted at Dr. R. N. Cooper Municipal General Hospital in Juhu, Mumbai, India from 01-12-2018 to 30-11-2020.
SUSTAINABILITY
What community needs will your project address and how were these needs identified? Provide any relevant data or survey results
Over 32 million children live with disabling hearing loss and over 60% of childhood hearing loss is preventable. Poor children suffering from this hearing loss cannot afford costly Cochlear Transplant surgery and hence they are considered to live with this disability for the rest of their lives. This community need was identified during the pre-screening camps organized by NGOs and medical outreach camps of hospitals. Some children between the age of 1 to 5 years, have already been identified by NGOs and the process is ongoing as similar surgeries are been conducted in Mumbai at Municipal & Private Hospitals.
Detail how your project will address these community needs.
Children from underprivileged background (between the age of 1 to 5 years) whose parents cannot afford the expensive Cochlear Implant surgeries will be assisted by our Rotary Club through this global grant project. We will fund their pre & post operation/treatment cost at Dr. R. N. Cooper Municipal General Hospital in Juhu, Mumbai and thereafter fund their Speech Therapy & Rehabilitation Program for 1 year. Through this project we will be treating underprivileged children suffering from hearing loss defects to enable them lead normal healthy lives. Their treatment will be done under the specialized care of trained doctors at Dr. R. N. Cooper Municipal General Hospital (and specialist doctors attached to other Municipal & Private Hospitals who will operate at Dr. R. N. Cooper Municipal General Hospital) which is equipped to undertake these surgeries. Post-surgery, the child will be referred to Speech Therapy Rehab Centers which are located across Maharashtra, depending upon their proximity. Attached is Annexure I, which has the details of these locations. It is intended to support the financial cost for Speech Therapy Rehab Program during the first year through Global Grant funds. It is expected that the parents and child will be motivated enough to undertake the cost of Speech Therapy Rehab Program for the second year.
How were members of the local community involved in planning the project? Does your project align with any current or ongoing local initiatives?
The local community are the direct beneficiaries of this project and are not directly involved in the planning process. However, the community shall be involved in the post operation care of the child and in the Speech Therapy & Rehabilitation Program. It is intended that the parents of the child will be made aware about the process, pre and post-surgery care of the child, Speech Therapy & Rehabilitation Program and care and maintenance of the implant.
Currently, Dr. R. N. Cooper Municipal General Hospital runs and operates the "Audiology Centre" established by Rotary Club of Bombay Seacoast with District Grant from RID 3141 for early detection of hearing loss in new born babies as well as others.
Describe any training, community outreach, or educational programs, if applicable, and who will conduct them. How will recipients be selected?
TRAINING:
The beneficiaries will undergo the following training programs:
1. Post Operation Training shall be imparted to the parents and child (where possible):
a. Care and maintenance of the implant
b. Dos & Don'ts by the child regarding physical care
2. Speech Therapy & Rehabilitation Program - There will be a structured training by Doctor at Speech Therapy & Rehabilitation Centers of the children for 1 year (2 to 3 times a week). Training will be of Audio verbal therapy of children under supervision of AVT qualified trainers. Parents will also be trained to handle children after operation. They will be trained one on one. This training will be evaluated by:
Integrated Scales of Development (ISD)
Listening Skill Development (LSD)
Category of Auditory Perception (CAP)
Speech & Intelligibility Rating Scale (SIRS)
COMMUNITY OUTREACH & EDUCATIONAL PROGRAM: We will hold community talks on benefit of this project at the hospital and Rehab Centers in Mumbai.
SELECTION OF BENEFICIARIES:
As mentioned earlier, referrals of such cases are made by many other hospitals and through medical outreach camps of Dr. R. N. Cooper Municipal General Hospital itself. Cases which require monetary assistance shall be referred to us where the applicants shall be interviewed, and the case papers/background will be verified, before being selected for assistance. We shall then recommend the child's case for admission. Thereafter, the entire process of admission, operation & treatment shall be carried out as per the administration process laid down by Dr. R. N. Cooper Municipal General Hospital.
Trained doctors shall evaluate the medical reports of the children and select after conducting pre-operative tests at the hospital. The recipients will only be from lower income group, who cannot afford surgeries. Each case assisted through this grant by our rotary club will be interviewed to ascertain that the child's family is not able to afford the surgery cost and are from the underprivileged sections of society.
Areas of Focus
Which area of focus will this project support?
Disease prevention and treatment
Measuring Success
Disease prevention and treatment
Which goals will your activity support?
Preventing physical disability resulting from disease or injury. Also promoting disease prevention programs, with the goal of limiting the spread of communicable diseases and reducing the incidences of and complications from non-communicable diseases
How will you meet these goals?
By performing Cochlear implant surgeries with proper Speech Therapy Rehabilitation Program to the needy underprivileged children. We shall plan the schedule and completion upon receipt of funds.
How will you measure your project's impact?
Measure Collection Method Frequency Beneficiaries
Number of recipients of disease prevention intervention Direct observation Every month 1-19
Who will be responsible for collecting information for monitoring and evaluation?
A committee of our club members and Anns will be responsible for collecting data of surgeries performed with names and addresses of the children. We will also take the help of respective avenue chair and related officials in the host club district in keeping a track of all recipients of this global grant.
Details of the Co-operating Organization:
The Dr. R. N. Cooper Municipal General Hospital is a public hospital located in Juhu, Mumbai, India. It is owned by the Brihanmumbai Municipal Corporation and is operated under a public-private partnership.
It was started in 1969 as a maternity home before it was converted into a full-fledged general hospital in 1970. The hospital underwent massive reconstruction after the original building was declared unfit for use in 1999. The new upgrade, at a cost of ₹321 crore, includes more beds, as well as systems for rainwater harvesting and sewerage treatment. The new hospital design includes an infection control design to prevent doctors from contracting infections while on duty. This 636 bedded secondary care hospital is with all general specialties. Hospital is accredited by national board of examinations for DNB in 2007. Hospital also imparts practical training in medical laboratory technology, nursing and observer ships in different specialties.
The hospital has highly qualified team of doctors and nurses to undertake surgeries in various fields. The hospital has already undertaken Cochlear Implant surgeries since April 2014. Attached are press releases part of Annexure II highlighting the work done by the hospital in Cochlear Implants. The surgeries will be undertaken/overseen by two of the most well-known ENT surgeons viz. Dr. Samir Bhargava and Dr. Hetal Patel, both attached to Municipal Hospitals of Mumbai. Both doctors have undertaken in excess of 200 Cochlear Implant Surgeries.
Describe the role that host Rotarians will have in this project.
Host Club shall arrange preliminary screening of children to ensure that children selected for implant surgery are from the underprivileged section of the society. Host Rotarians will arrange admission, surgery and discharge from hospital. Host club Rotarians and Anns will visit children at hospitals during surgery and offer care and required assistance to the child. Rotarians and Anns will also be involved during the period of Speech Therapy & Rehabilitation Program of the children receiving the Cochlear Implants.
Describe the role that international Rotarians will have in this project.
International partners will be in touch through e-mail and phone to ensure smooth and successful completion of the project such as coordinating the progress of the project, offer expertise, release bulletins in home club & home district, give press release etc. for adequate coverage of the project in International print and visual media, monitoring project implementation progress, assisting in the closure report and also highlight the humanitarian work done by Rotary International.
SUSTAINABILITY
Describe the role that members of the local community will play in implementing your project. What incentives (e.g. Compensation, awards, certification, and promotion) will you provide to encourage local participation?
Post-surgery deaf & dumb children become normal which itself is big enough incentive for participation. Our endeavor will be to publicize this project so that more and more people come forward to support both financially and in the Rehabilitation process.
Identify any individuals in the local community who will be responsible for monitoring outcomes and ensuring continuity of services. How will you support these individuals to help them take on this leadership role?
In each case, the parents of the beneficiary will be responsible for monitoring the outcome and the success of the operation and the Speech Therapy & Rehabilitation Program.
We shall help the parents of the beneficiaries in identifying the nearest Speech Therapy & Rehabilitation Centre and encourage the parents to enroll the child in a 2- year Speech Therapy Rehabilitation Program. In each case, the parents alone shall ensure the continuity of the rehab program.
A group of 3 to 5 beneficiaries shall be allotted to a group of Rotarians and Anns from Rotary Club of Bombay Seacoast who shall be in touch with the parents of the beneficiaries to monitor the progress and to support the Rehab program. Our club members will do a regular follow up with the parent to ensure that the child goes through the program. In the case of Mumbai based beneficiaries, our Rotarians & Anns will visit the Rehab center along with the child and parent wherever possible.
Describe the process for selecting these budget items. Do you plan to purchase any items from local vendors? Have you performed a competitive bidding process to select vendors? Do these budget items align with the local culture and technology standards?
The Cochlear Implant shall be purchased from the Indian wing of the Australian Company - Cochlear Medical Device Company India Pvt Ltd . Cochlear Limited is one of the oldest dealers of Cochlear Implants in the world with the highest reliability factor. The product is upgradable and adjustable. It comes with a warranty of 10 years. Attached are the technical specifications and Warranty Details of the product. The implant requires little or no maintenance except for some adjustments for the sound quality. Only the battery must be replaced post 3 years. It is expected that the battery replacement cost will be met by the parent of the child receiving the implant. In special/deserving cases, Rotary Club of Bombay Seacoast will support the replacement cost of the battery.
How will the beneficiaries maintain these items? If applicable, confirm that spare or replacement parts are readily available and that the beneficiaries possess the skills to operate equipment.
The beneficiaries will be trained in the usage of the device. The spares are readily available though no regular maintenance of the implant is required. It is expected that the repair/spare replacement cost will be met by the parent of the child receiving the implant. In special/deserving cases, Rotary Club of Bombay Seacoast will support the repair/spare replacement cost.
Who will own the items purchased with grant funds at the end of the project, including equipment, assets, and materials? Note that items cannot be owned by a Rotary club or Rotarian.
The Cochlear Implant will be owned by the beneficiary.
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