Cochlear implant in a 2nd & 3 tier city
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Transcript of Cochlear implant in a 2nd & 3 tier city
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Cochlear implant in a 2nd & 3tier city
Dr. N. Murali Chand MS (ENT) DLOFellowship in HIV medicine [ FHM ]
www.skullbase360.inBikaner 19-2-17
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My teachers – Dr. Satish Jain sir & Dr. Vidya Sagar sir
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Let us discuss this topic in 5 headings
1. Neonatal screening & case detection2. Surgery & CI centres 3. Programming / Mapping of CI implant 4. AVT therapy 5. Insurance to CI implant & accessories
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Neonatal screening & Case detection
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1. can current number of CI Surgeons/Centres are enough to screen peripheal villages & tribal areas
2. If we don’t involve peripheral ENT surgeons in CI surgery programme how can few CI surgeons enough
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Surgery & CI centres
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- Is CI surgery a difficult surgery?
- How much Otological experience is sufficient for CI surgery?
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CIGI [ www.cigi.in ] guidelines - Instead of this introduce/ recommend “ Fellowships of CI surgery ” in all Universities of INDIA
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Why a DLO post-graduate can’t do CI with structured training [ most of the DLOs are in periphery ] - DGO’s doing excellent laproscopic surgeries &
running excellent IVF centres
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CIGI [ www.cigi.in ] guidelines - Instead of this introduce/ recommend “ Fellowships of CI surgery ” in all Universities of INDIA
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Dr. Manu ( 31 yrs ) & Dr. Satya kiran ( 37 yrs ) ... both vellore implantology fellows . ... too good ... telugu people … Students of
Prof. John Mathew sir who made gems of implantology
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• Recently Prof. Mohan kameswaran sir said at hyderabad APOLLO hospital CI conference - there is NO DIFFERENCE between complications rate between 3 to 4 yrs experienced assistant professors & senior professsors .
• Junior assitatnt professors also very serious & dedicated in implantology science .
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Programme started by Prof. O.C. Abraham HOD , General
medicine , Vellore – Not recognised by MCI ,
Recognised by NACO
• 13 modules of books. like HIV & women , HIV& CHILD , HIV & TB , HIV & lung etc etc
• 1 year programme• 6 contact courses each 10
days & ward rounds to LRS TB hospital
• Theory & Practical exam• Eligeable to ART centres
medical officers along with MD(Gen ) , MD ( Chest ) MD ( Skin ) ; recognised by NACO
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Only 2 CI centres in whole Seemandhra of 13 districts - VIZAG recently started - CIGICON 2017 is in VIZAG !!!!!!
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• CI Science will develop if more number ENT surgeons think about it
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Prof. M.V.Appa Rao , Retired HOD of Vizag medical college wishing
1. Every ENT centre be a CI centre2. Every ENT Surgeon be a CI surgeon
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- If a poor patient cannot go to corporate hospital and afford their heavy bill, what is the other alternative for them?
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- what is the ideal place for rehabilitation- with mother and siblings or a clinical set up?
- why not rehabilitation done at home?
- why not public rehabilitation centers?
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- what is the incidence of SN loss &
can current number of CI Surgeons are enough to surgery for all of them.
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How much money for surgeon in aarogyasri CI programme
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• ONLY ONE YOUNG CI surgeon in seemandhra
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Suppose if the parents wants to take 2nd opinion – how it is possible with few surgeons
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CI hospital infrastructure under Aarogyasri scheme in Andhra Pradesh
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What about bulk purchase order by the state & central government & reduced price can be used
for insurance of the implant
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• Of the 65 who underwent CIs, only seven successfully underwent the rehabilitation programme, enabling them to join normal schools.
• Four patients could not be traced, 23 are still undergoing rehabilitation and 31 patients who underwent rehabilitation for a year need more ‘lessons' since they were unable to acquire sufficient language/communication skills. However, since they cannot afford to pay for the services after the one-year period, they are not attending.
• These patients hailing from below the poverty line families are also not in a position to buy external speech processor if necessary or even buy a set of rechargeable batteries costing Rs. 35,000, thus making the princely sum of Rs. 6.5 lakh spent on CI go abegging.
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• Regional HOD deafness certificate to undergo CI surgery under ADIP scheme --- The minute parents get deafness certificate most of the rural parents not attending Government authorized CI private hospital .
• Reason – parents are satisfied that they will get bus & train tickets free
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Southern institute / staff - They are not giving digital hearing aids -- most of these institute activities are restricted /limited to only submission of deafness certificates
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No sufficient qualified staff to run peripheral AVT centres
• Regular BEd teachers AVT training by modules can be used for peripheral / rural AVT therapy staff – by Prof. Mohan Kameswaran
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Dr. Duvva Shyam Kiran MS ( ENT ) UK experience ; Rajamundry
• Particularly in Andhra Pradesh.Skill/professionalism/Humanity/Trust/Quality/Empathy.
• All been removed from dictionary.• Two things remain and prevails
Cash and Community• Sorry to say this because I was at a recieving end having Established one of the best
ENT unit to do or give something back to society with all good faith• I couldn't get Arogyasri or CI implant programme• Everywhere money from application to inspection.
• I am against it they disqualified my application for 8 times.• I left it when I can survive in better way with my patient client tail I don't need any
govt initiative programme• Pity I tried to contact CI device teams in India they are purely a syndicate with deep
down arrogance• Pity having trained in UK lived up to ethical practice
No one values any thing.
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• People before to do something they think what is the benifit I have. Untill this is gone We as a doctor's or IndiansCan be at par with global teams.
• Last but least comming to research before no practioner or no college or institute have provision time to develop this.
• Every one want to be recognised as super or good surgeon.Every wants to run conferences and workshops good.There are more conferences and workshops than doctors now a days.
• Please people like you and there are good hand full of teachers hope you all can come together and make not our profession big.
• Let us give the uniform care across the board.• If pt in UK/USA/DUbai/
Gets a protocol based care not treatment• Same an Indian should get.• Thank you
This is just opinion from my experience.
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System should be beyond TRUST
Answer : National registry with website monitored by all the professionals in CI
science
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Laminar flow OT in Narasaraopet town by Dr. Jagan Mohan Reddy MS(ENT) DLO
Narasaraopet – Chilakaluripet are like twin towns
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What about indigenous CI
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What about indigenous CI
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MAPPING
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Distant mapping
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AVT
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Senior CI surgeon said
40% dropout for AVT therapy in post-CI children when the CI centre in cities . Now once peripheral AVTs established only 5 % dropouts
How will you address dropouts ??
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Daily this mother has to come from Vijaywada to Guntur for AVT
All the 13 districts parents has to come to guntur for AVT therapy for 1 to 2 years
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e-Rehabilitation – Is it possible in INDIA with rural population / parents
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e-Rehabilitation
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e-Rehabilitation
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INSURANCE
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