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PROJECT DEAF INDIA EXPANDS FOCUS
By: Raj Desai, M.D. Newport-Balboa
India is one of the largest nations on this Globe with a population of more than a Billion people. The exact number of people with Hearing impairment is unknown. However it is estimated that approximately 25,000per million people in the rural area and 7000 per million people in the urban areas are deaf, this totals to about two million deaf people are deaf in India this is a very modest estimate.
Separately it is estimated that about 5 million people in the world are deaf and 200 million are suffering from various degrees of hearing loss (Indian council of Medical research, 1983)
The most common causes of deafness in India are newborn infections, malnutrition, low birth weight, poor medical care during pregnancy and lack of vaccination for Rubella and measles. Other factors such as consanguinity, acute and chronic Ear Infections, Noise, polluted water supply, irrational use of Medical drugs for Malaria, Tuberculosis and antibiotics also are contributory factors.
Vaccination is one of the most effective measures for prevention of the morbidity and mortality of diseases, such as Measles, Mumps and Rubella. These viral infections cause significant number of deaths in India, for which effective vaccine is available ( MMR vaccine) It is estimated that deaths due to measles alone are about 80,000 a year in India and its incidence is increasing (Pedicon = Pediatric congress of India, 2004) The exact number of cases of Rubella in India is unknown.
Rubella infection in the first trimester of pregnancy can cause multiple newborn defects such as Deafness, cataracts, heart abnormalities and mental retardation.
For example before the discovery of MMR vaccine in the USA, there was an epidemic of Rubella in 1964, when approx 60,000 newborns were born with hearing impairment After 1969 following the availability of MMR vaccine, there is a major decrease in the Rubella syndrome.
Most of the developed nations use two doses of MMR schedule to vaccinate their children as advised by the WHO (World health organization) to eliminate the global mortality from Measles.
The “Universal Vaccination scheme of India” to best of my knowledge does not provide MMR vaccination in the remote villages and even in the urban area.
It is well known that the Rotary International and Rotarians of India have done an excellent job in eliminating POLIO. Like wise MMR vaccination for the whole of India is most advisable to reduce the morbidity and mortality due to measles and Rubella
MMR is an injection like many preventable vaccinations; it is manufactured in India at The Serum Institute of India in Pune. They are one of the largest suppliers of most of the vaccines in the world
The economical conditions in India probably prevent the government of India to include the MMR vaccination in their plan; however, it is obvious that the various deformities of the newborn, due to lack of preventive MMR vaccination are a great burden NOT ONLY FOR THE FAMILY BUT ALSO A BURDEN TO THE SOCIETY AND THE NATION AS AWI-IOLE.
The Communicable Disease center (C D C) of USA advises that even the vaccination with Measles and Rubella MR to the preadolescent women (all women who are not pregnant) will drastically reduce the number of defects caused by Rubella syndrome.
For example the city of Pune has about 100.000 city girls and 100,000 “slum” girls If all of the 200.000 are given MR vaccine it will cost approx $200,000
This due to the generosity of Dr Cyrus Poonawala, the owner of the Serum Institute of PUNE, who has agreed to give MR. vaccine at a reduced cost for the city of Pune.
If all of the rotary clubs of district 3130 combine their efforts and my district 5320 from USA, we can achieve this dream of vaccinating young women of Pune and reducing the future abnormalities of the newborn due to Rubella syndrome in Pune.
Second project:
EARLY DETECTION OF DEAFNESS AT BIRTH
AND IT’S INTERVENTION (EHDI)
The second goal is to establish EHDI= Early detection of hearing of every child born in all health facilities in Pune, similar to the MANDATORY practice of EHDI in the developed nations
Early diagnosis of hearing loss permits the deaf to be treated immediately for their underlined cause such as surgery, etc if the defect persists, after a follow up for several months to a year, by confirmation with more accurate AABR machines, (Depending upon whether it is mild or severe), it is treated with Hearing aids or Cochlear implants. Early detection also helps to plan the family and public support and develop more communication skills.
It is only in the past ten + years that accurate computerized instruments are available to detect hearing loss on the day a child is born when a child has hardly has opened the eyes. In all USA, UK and developed nations EHDI is mandatory
If the EHDI is introduced in the city of Pune, what are the requirements and estimated expenses?
All public hospital and Private nursing homes will have to buy one or more machines called OAE (oto- acoustic emission) machine, depending on the number of new birth a day.
The trained pediatric audiologists to use the machines, are also needed. Once the newborn is suspected to have a hearing defect a data base and follow up is encouraged to CONFIRM THAT THE CHILD IS HEARING IMPAIRED. More accurate machines called AABR which transmits signals to the brain are almost 98% accurate for final detection of deafness They cost double or more($ 14,000) as compared to OAE machines which cost $ 6000 approximately. A single machine as AABR can be kept at a central hospital to confirm the results of OAE instrument
Due to the lifestyle in India where newborns are kept for 5-7 days in the hospital after delivery, it may be economical to buy a few Scooters and allow the Audiologist to go to various hospital or nursing home to check all newborns. The machines are small like a portable computer and easy to transport.
Knowing well, our lifestyle that some deliveries in villages may be at home with the help of midwives a mobile unit to test deafness with a van equipped with a “soundproof cell” and an audiologist may go to remote areas and all the newborns tested before the age of one month at a central place like a temple or a church Further on the treatment can be provided at the nearest city facility.
The above two goals for the city of PUNE will change the future of High incidence of deafness and also allow immediate intervention to permit effective treatment of the disabled deaf child and his/her communication skills and education
The modern Cochlear implant although expensive at present may permit a profoundly deaf child not suitable for Hearing aids, a new tool for listening as early as possible and even mainstream that child to normal educational facility
It must be noted that the amount of expense invested is small as compared to the benefit of the lifetime of a deaf child
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