Nepal ear camp

The British Nepal Otology Service (BRINOS) are a group of specialist Ear Surgeons, Nurses and Anaesthetists who travel regularly to Nepal to run Ear Camps. They set up a temporary Operating Theatre in order to do high volumes of Ear surgery, teach Nepali surgeons how to perform the operations and see many outpatients. Typically they will do about 120 major ear operations in 8 days between 4 surgeons.

Consultant Mr Angus Waddell, working at The BMI Ridgeway Hospital, is one of the Ear surgeons involved with the Nepal Ear Camp's. The most recent took place just last November (2015). We caught up with him before his visit to find out more:

How did you get involved with Ear Camp & BRINOS?

I was first asked to be involved about 10 years ago by another Ear Surgeon, Mr Robin Youngs from Cheltenham. We had done an Ear Camp together in Burma and trained surgeons there, Robin put me in touch with Neil Weir, the founder of BRINOS and this next trip in November 2015 will be our fifth one together. This will be Camp number 57 for the BRINOS charity since being founded in 1988.

There are usually two or 3 camps per year, in March and November when the risks of overheating, monsoons or catching Malaria are at their lowest. There have been Ear Camps in towns all over Nepal. We are currently building a hospital specifically for the treatment of deafness and other ear diseases in Nepalgunj in the West of Nepal. BRINOS is still in need of £30,000 to finish the project but are into the partly finished hospital now and we will be doing our operations in the patient waiting area for the time being. There will be 1 or 2 Nepali surgeons and 4 from the UK, one anaesthetist and 2 nurses. All of the other staff to run an Ear camp (about 20 people) will be local Nepali people. We hope to be able to hand over the running of the hospital to the team in Nepal and help to train other teams in other parts of Nepal.

Mr Angus Waddell

Mr Angus Waddell

Consultant ENT Surgeon

How long have you been working in otology?
I did my first ENT job in 1990 and have been a consultant Otologist since 2003

What made you specialise in otology?
It can be difficult both in the outpatient clinic and the operating theatre to do an expert job, but aged 49 there is still lots to learn and better outcomes to achieve. But, as they say, the more I practice the luckier I get.

Do you have any other particular interests?
I enjoy fly fishing in the Highlands of Scotland and kayaking down any white water river I can find.

Why is there a focus on ears?

Ear operation
A population survey in 1991 estimated that about 1 in 7 people in Nepal had significant deafness. It was the single largest disability in the country.

Most people in Nepal live in single room houses and cook on open fires. Many homes have no windows or chimneys so there is a lot of respiratory disease, this includes middle ear infections, perforated ear drums and preventable deafness.

In 1990 there was only one Ear and Eye surgeon to cover all the whole of Nepal so there was a massive unmet need.

What are the aims, what you do and who are the people you treat?

The aims of the ear camps are to treat ear disease and deafness, to train local surgeons and Community Ear Assistants and to raise money to support services in and around Nepal. A typical day at an Ear Camp starts at 08:00 sharp with 3 operating tables run at the same time (often all in the same room!).We do most of the surgery with the patient awake and under local anaesthetic, but children and those with more extensive disease have a General Anaesthetic.

We will try to do between 15 and 18 major ear operations per day. In the early evening we do an outpatient clinic seeing people suitable for surgery the following day. Most working days last 12 hours. At the beginning and end of each Ear Camp we have to set up or pack away all of our equipment including old NHS operating microscopes, basic operating tables and other kit.

What are some of the difficulties you face?

Nepal is a desperately poor country with very limited public services. There is no reliable electricity or water supply and transport can be almost impossible in the rainy season as some roads get washed away.

As we saw in April 2015 the country lies in a major earthquake zone so it often feels like 2 steps forward and 1 back. But there is always progress and the Nepali people are not only very strong, spiritual and patient but exceptionally grateful for the help that they receive.

Can you tell us more about the new Ear Hospital opening?

It has been many years in planning but it has been 2 years since the foundations were dug. Permanent staff at the hospital will be able to see many hundreds of patients every year with Ear Camps being done in a more permanent setting every few months or so. It is possible that regular operating will happen there when the UK team is not out in Nepal too and will be used by any member of the Nepali community. The hospital building project has been funded by charitable donation but a significant part has been paid personally by BRINOS founder, Mr Neil Weir. Many fundraising events have been held in the UK including sponsored marathons and cycle rides. From these UK donations we are able to pay for some Nepali staff and much needed medicines, but more money is always needed. The NHS has donated old equipment including many hearing aids. Each team member pays their own way for an Ear Camp and the time taken from NHS jobs is usually as annual leave. In 2013 BRINOS won the BMJ Medical Team of the Year award in recognition of their continued effort over many years.


How long are you out there for Ear Camp 57?

We will spend 2 weeks out of the UK of which the Ear Camp will run for 8 days. We will treat about 120 -130 surgical patients and see approximately 150 outpatients.

We will train 1 or 2 Nepali surgeons and help to train the Community Ear Assistants.

How does ear care compare in the UK?

The ear surgery we do in Nepal is almost identical to that in the UK – except for the setting. We achieve very similar clinical outcomes despite the more austere environment.

We ask those who can afford it to make a small financial donation for an operation but for those who cannot pay we do the surgery for free.

What can we do in the UK to look after our own ear health?

There are 4 top tips for good ear health:

  1. Have your vaccinations as a baby, DTP (Diphtheria, tetanus and Percussis) and HIB would be really important MMR is good too – as 1:1000 people who get mumps will go deaf.
  2. Don’t smoke. The middle ear – where we get most of our infections is connected to the back of the nose. These ear infections – aka Otitis Media are respiratory infections so anything that we know makes respiratory infections worse also gives us Otitis Media.
  1. Avoid excessively loud noise. The worst sorts of noises are the very loud (e.g. using a chain saw) or the high impact noise (eg gunfire). The damage is permanent because the inner ear hair calls cannot regenerate themselves…once you have lost a hair cell it is gone forever.
  2. Don’t put anything smaller than your own elbow down your ear, including cotton buds. Ear canals don’t need cleaning at all because they look after themselves. Shops sell cotton buds because people want to buy them – it’s a commercial arrangement and nothing to do with ear cleanliness. We usually find in clinics that people with the waxiest ears are the people who use cotton buds because all they do is push wax back down the hole it was trying to come out from!

Do you donate your time to any other similar 'camps' or events?

Ear operation
I have only been to Nepal and Burma but there are other camps run by UK Ear Surgeons in Uganda, Malawi, Thailand, Bangladesh; we are generous with our time and efforts.

Where can readers find out more about the Ear Camps in Nepal and the work of BRINOS?

The BRINOS Website, where there is a link for those wishing to make a donation.

If you would like to find out more about ear, nose & throat surgery visit our treatment page or enquire online.

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