The Pakistan (Lahore) cochlear implant programme: issues relating to implantation in a developing country

Abstract

The Pakistan cochlear implant programme was started in Lahore in August 2000. It was initially established with the technical support of the Manchester cochlear implant team. There are no government resources available for cochlear implantation in Pakistan and the cost of cochlear implantation is met by the candidates and their families. Up till December 2005, 52 individuals have been implanted. Forty-four (84.6 per cent) of these patients were children and eight (15.4 per cent) patients were adults. Congenital deafness (94 per cent) is the main aetiological factor in children. Seventy-six per cent of these children were born to blood related parents. All patients received a Med-El Combi 40þ device. The listening progress profile, the meaningful auditory integration scale and the meaningful use of speech scale were used to assess the auditory performance in children. Thirty-nine children achieved an average listening progress profile score of 37.7 after 12 months of implantation. The overall rate of major and minor complications was 11.5 per cent. Failure rate for the device itself has been 3.8 per cent. In addition to considering these preliminary outcomes and funding issues, the problems of setting up a cochlear implant programme in a developing country are discussed.

Barriers to Accessing Surgical Care in Pakistan: Healthcare Barrier Model and Quantitative Systematic Review

“…These studies represented all four provinces of Pakistan [23]; Sindh , Balochistan [45][46][47][48][49][50], Punjab [51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68], and Khyber Pukhtunkhwa [62,[69][70][71][72][73][74][75][76][77][78][79][80][81]. Two studies came from Gilgit-Baltistan, a northernmost self-governing territory [3,82], while a single study came from Kashmir [83] and from the Federally Administered Tribal Areas (FATA), an autonomous region comprising seven tribal agencies in the northwest of Pakistan [84].…”

“…Although most of the studies were from an urban setting, likely due to patterns of referral, studies involving the more rural [23,37,50,56] and mountainous [3,69,70,73,82,84] populations were also identified. Articles spanned the range of surgical disciplines [82,83], including General Surgery [30,31,33,51,57,61,63,65,69,70,73,77,79], Otolaryngology, [24,29,53], Urology [45,48,49,52,60,75], Neurosurgery [29,34,39,64,67,78], Plastic Surgery [74], Ophthalmology [23,25,28,56,71,84], Obstetrics and Gynecology [27, 35-38, 44, 46, 50, 59, 62, 66, 68, 72, 76, 80, 81], Cardiac Surgery …”

“…Women residing in the tribal areas must be accompanied by male relatives when outside the home, making it less likely that they will be able to access health services when traveling significant distances is required [28,73,84]. A negative social stigma may be attached to certain diseases or conditions [53,74], for example breast cancer (or procedures such as hysterectomy), reducing the likelihood that patients will seek treatment. [27,30,31,46,51,57,72].…”

Costs involved in using a cochlear implant in South Africa

“…In contrast, cochlear implants are mostly self-funded in many developing countries, necessitating consideration of a patient's financial resources to fund both the implant system and the subsequent rehabilitation at the outset of pre-assessment (Khan et al, 2007).…”

“…Despite this, they are used in low volumes (Khan, Mukhtar, Safeed & Ramsden, 2007). As of December 2010, approximately 219 000 individuals had received cochlear implants worldwide (NIDCD, 2011).…”