About Madras ENT Research Foundation First CI in 1997 More than 2500 CI First ABI 2004 First Pediatric ABI 2009 More than 25 ABI Created Auditory Habilitation Professionals in Country.

The Indian Paradox Overall prevalence of deafness in India - 0.2% Significant auditory impairment - 6.3% ( 2011 census) 3 million profoundly deaf children 25,000 children are born deaf every year Population of Tamil Nadu – 72 million Deafness in Tamil Nadu – 0.6% (deafness state in the country) 2/3 rd were born to consanguineous parents

The Dilemma Balancing an advanced technology with the requirements of a developing country

Challenges in Large Scale CI Program Pre-Implantation Lack of awareness (Medical, Technology & TNCMCHIS). Acceptance of Technology – Social stigma Prohibitive Cost Peri –Implantation Surgeons., Infrastructure & Facilities Post-Implantation Experienced Team of Audiologist Availability of trained & experienced resource personel Accessibility to re/hab centers - Availability of Resources for re/habilitation across the state Sustained use of Implant – service facility, availability of spares. Motivation of the family – Mentors & Social Workers. Integration in school.

Solution to Lack of awareness (Medical, Technology & TNCMCHIS).

Solution to Prohibitive Cost TNCMCHIS Hon CM Photo with Cochlear Implantee

Peri –Implantation Surgeons., Infrastructure & Facilities

Experienced Team of Audiologist Availability of trained & experienced resource personel More than 15 audiologist More than 25 Auditory Habilitationist and Speech Language Therapist

Accessibility to re/hab centers - Availability of Resources for re/habilitation across the state

Factors influencing outcome 1. Early identification and intervention 2. Consistent Re/habilitation 3. Involvement of the family 4. Language 5. Accessibility to the Clinic 6. Supported Mainstreaming

Challenges… Availability of Rehab. Centre Accessibility - Distance Affordability- Cost Human Resources - Qualification - Training - Experience Sustainability of the Centre Mainstreaming PatientClinic

Reaching out…  Satellite Center ( National network of Rehabilitation Centers).  4 Satellite centers  Maximum time taken to reach the rehab center is 2hours 30 minutes.

Importance of Satellite centre Increases the regularity of attendance Reduces financial burden Environment Involvement of the family members Easy main streaming Increases the awareness to the locals Rapo between family and habilitationist Accessibility to the centre for trouble shooting

Mover & Shaker of the System? Annual income: Rs.25000/-. Lives 450 miles away from the rehabilitation unit. No family support Parents not alive, only grand mother support. Daily wager

Aim To establish a Viable Model To install Working System -

Total No. of children completed 1 year of rehabilitation n=222 Group A = 1 -2Yrs Group B = 2 – 4Yrs Group C = 4 – 6Yrs

Availability & Accessibility

Regular=88.6% Irregular= 10.9% Discontinue =0.5%

Clinic –Human resource B.Ed (HI) B.Ed PGDAH (Inhouse certificate

Total No. of children implanted under TNCMHIS No. of children completed one year of habilitation-415 a) Group A : between age (1-2) male: 85 & female:60 b) Group B : between age (2-4) male:75 & female:37 c) Group C : between age (4-6) male:90 & female:68

No. of children attending therapy :240 (yet to allot therapy:20)

Regular Visit – to install confidence

Modus operandi Identification of Children by Clinic Evaluation By Clinic Approval by the TNCMCHIS Surgery and Re/habiliation by Clinic Fund from TNCMCHIS – Insurance Staggered release of Payment after review of outcomes. Periodical review.

Total No. of children implanted under TNCMHIS No. of children completed one year of habilitation-415 a) Group A : between age (1-2) male: 85 & female:60 b) Group B : between age (2-4) male:75 & female:37 c) Group C : between age (4-6) male:90 & female:68

No. of children attending therapy :240 (Yet to allot Therapy:20)

Suggestion To provide only FDA products To subsidise spares and accessories To increase the duration of therapy from one year to two years. Early identification program – New born Hearing Screening National Network of re/habiliation centres. To choose good committed centres, never compromise of quality Methods to integrate implantees in society.

Future Working Model for a Deafness Free Society

Thank You…