I can’t overstate how fantastic it has been having the new microscope here this week.

We have now done 15 Cochlear Implant patients in Malawi over the past 4 years. As I am sure you are aware, it’s a genuinely life-changing intervention for those kids who have basically lost all their hearing. In the UK kids born deaf get bilateral CIs by age 1-2 and go to mainstream school, communicate with normal speech, listen to music etc etc. It does mean diagnosis needs to be early as  you really need to implant by 2 years to optimise results (we now aim for 12 months in our unit).  In Malawi we have only implanted ‘post-lingually’ deafened kids ie those who have had hearing (& speech) but lost it due to causes such as mumps, measles, meningitis etc – mostly ‘avoidable’ causes. These kids really would not have been able to continue their education and would therefore be ‘lost’ as deaf schools don’t take children over the age of 6 and are oversubscribed anyway.

I can’t overstate how fantastic it has been having the new microscope here this week.

We have now done 15 Cochlear Implant patients in Malawi over the past 4 years. As I am sure you are aware, it’s a genuinely life-changing intervention for those kids who have basically lost all their hearing. In the UK kids born deaf get bilateral CIs by age 1-2 and go to mainstream school, communicate with normal speech, listen to music etc etc. It does mean diagnosis needs to be early as  you really need to implant by 2 years to optimise results (we now aim for 12 months in our unit).  In Malawi we have only implanted ‘post-lingually’ deafened kids ie those who have had hearing (& speech) but lost it due to causes such as mumps, measles, meningitis etc – mostly ‘avoidable’ causes. These kids really would not have been able to continue their education and would therefore be ‘lost’ as deaf schools don’t take children over the age of 6 and are oversubscribed anyway.

Cochlear implants are expensive however (approx. $12 – 25 000 depending on which country being bought in) and we have, up to now, relied on implants generously donated by a CI company called Med-El who are based in Austria and one of around 4-5 manufacturers worldwide. Doing CIs would also not be possible without the excellent audiology facilities in Blantyre – primarily funded by a UK charity (Sound Seekers).

Having shown that we can successfully do the surgery, switch on and follow up, Wakisa and the team in Blantyre are keen to look at becoming more sustainable by attracting privately funded Cis and also looking to attract other charitable support for the project. Although CIs are now the standard care in wealthy countries the need is ‘of course’ enormous in Sub- Saharan Africa as well as developing countries worldwide.

Alongside doing the CI’s, the aim of all our visits to Malawi (which now involves other ENT surgeons and nursing staff) has always been ‘training’ as we look to develop the whole of ENT, audiology including all aspects of hearing loss, and ear care. This training is aimed at nursing staff and clinical officers as well as the few ENT medical trainees.

So back to the microscope! Although we had done 11 cases before this week it was with an old and ‘far from ideal’ microscope so whilst Wakisa has done more and more of the surgery it was restricted by my ability to monitor the surgery and visualisation.  The technique used to insert a CI does involve delicate microsurgery going close to dura, labyrinthine organs and the facial nerve which means that surgeons, developing their skills, need close supervision. During my visit this week we had, for the first time, the opportunity to do 4 cases so with the surgery planned for Tuesday and Wednesday it was perfect timing that the Leica rep flew in on Monday to assemble the new microscope. With an integrated HDMI output we went out later that day to buy a local HDMI TV to act as a monitor.

As such Wakisa did the 4 CI cases this week with much improved visibility for him, and perhaps just as importantly, I was able to oversee the surgery using the HDMI monitor. It was a huge benefit and actually enabled two of the surgeries to be done by Wakisa without me actually getting ‘scrubbed up’. That was fantastic as these were, without doubt, one of the few CI cases done in a Sub-Saharan country carried out by a native of that country.

So a huge thank you to you and the OR Charity for your support – please pass that thanks onto all involved. The imminent arrival of a stacking system will also greatly improve the ability to carry endoscopic tympanoplasties as we have been teaching the Clinical Officers (as well as the Registrars) to do this technique. It has already been revolutionary in their ability to treat tympanic membrane perforations in children (& adults).

If Kids OR are able to continue to support the ongoing work and training in Malawi that would of course be wonderful.

Kind regards

David

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