Please listen, for you can hear

DECCAN CHRONICLE.
Published Feb 8, 2019, 1:29 am IST
Updated Feb 8, 2019, 1:29 am IST
There are others who, for many reasons, had to go for self-funded implants.
Visually challenged playback singer Vaikom Vijayalakshmi along with cochlear implanted children at a union organised in Kochi.  (DC  file photo)
 Visually challenged playback singer Vaikom Vijayalakshmi along with cochlear implanted children at a union organised in Kochi. (DC file photo)

Cochlear implants have helped hundreds of hearing-impaired people, especially children, get back to the world of sound. But many are yet to get them while those who got them find it difficult to maintain due to high costs. Some may even fall back into their old world.  The government must  step in to help them, says  Kerala Cochlear Implantees' Charitable Trust.

Cochlear implants can get hearing-impaired people back to near-normal with up to 80 per cent success in terms of alphabet recognition, compared with 10 per cent other hearing aids can manage. Realising the value of this scientific device, people all over the world make use of it. In Kerala, the government had in the past launched schemes to help people get cochlear implants done as the costs are prohibitive for most people. There are others who, for many reasons, had to go for self-funded implants.

 

Now, it's time that the government and society come to the aid of them for a second time as they find it difficult to maintain them, replace the faulty parts and get others repaired. There must be favourable policies as well as financial packages if they were to continue to live normal life as all other human beings. Lest, they will slip back into the world of silence.

High taxes: For a cochlear implantee, the CI device is not just an electronic device; it's an organ which allows them to be one among others in society.

Something which let them hear others; lets them think and respond to others. Sadly, these life saving devices are categorised under the 5-28 per cent tax bracket.

For example, a 45-cm optical fibre cable connecting the processor and the headpiece is worth Rs 6750 (Rs 5720.35+18% tax) while a battery charger costs Rs 17200 (Rs 13438 + 28% tax). Similar are the cases with others.The waving off tax on these devices will reduce the burden on these kids and their parents.

The government must declassify these equipment/ spares from the 5-28% category. In fact, it's unfair to charge heavily the disabled people who suffer on a daily basis in a country where commodities ranging from beauty-enhancing products like 'Bindi' to satellite launching rockets are exempted from GST.

High maintenance cost: The post-implantation period and maintenance for a life time turns the future of patients, parents and caretakers into a nightmare.

Maintenance of the implant and accessories require a substantial amount as the replacements are heavily priced. These are highly expensive to maintain especially since these are imported from their parent countries like Australia, Austria and US.

There are children who had done cochlear implantation surgery a few years ago and had recently developed issued causing the processor shutdown/ functioning. Due to highly expensive repairs/ replacement requirements, their parents are unable to afford it and the helpless children are being pushed back into the world of silence. Imagine the mental/ emotional state of the child, their parents when they have to get them enrolled in special school for deaf children from regular schools.

There must also be clarity about the coverage and applicability of the funds allotted in support of cochlear implantees.

Low income ceiling: Under the government's Shruthitharangam scheme, children aged up to 5 with hearing disability and from the family whose annual income is less than Rs 2 lakh are selected for free cochlear implant scheme, on meeting other criteria. Even though the scheme has managed to bring numerous children to the world of sounds, the same remains a one-time assistance. Unless the government follows up with more support, it will end up a failure.

The implant maintenance in the form of cable and battery replacements cost around Rs 20,000. If one were to go in for an upgradation, then the cost will runs into lakhs of rupees.

There are many families whose earning members are based outside India and are generally considered as financially sound. They are forced to manage/arrange funds for the treatment on their own. However, there are many instances in which they end up selling their land or houses in lieu of implant procedures.

The income limit needs to be raised from 2 lakh to 5-6 lakh or above. The extremely high cost of maintenance makes it practically impossible for a family with an annual income of less than 2 lakh to support in maintaining the hard-earned artificial hearing.

Lack of rehabilitation support: Establishment of an integrated rehabilitation centre where all therapies (speech, occupational, behavioural and vocational therapies and job-oriented training) can be done at district levels and services of excellent experienced therapists can be made available for the people in need.
The centre can be established even in public-private partnership model (PPP model). As a pilot project, the same can be tried and worked out in one the isolated districts.

KCICT can provide all assistance in supporting this venture. It is worthwhile to note that majority of implantees depend on the three major cities (Thiruvananthapuram, Kochi and Kozhikode) in Kerala for rehabilitation which again impose a huge financial burden on them. A single day's Auditory-Verbal Therapy (AVT) session of 40-45 minutes is being charged between Rs.200- 300 and most the cases these kids needs to be given training thrice a week and 4 weeks a month and 12 months a year. This itself leaves a burden of nearly Rs50,000 for the implantee's family. In addition, the lengthy travelling hours for reaching these 3 major cities for therapies turns out to be hectic.

Setting up of district wise training centres, the above mentioned problems could be reduced to a large extent.

Lack of insurance coverage: The expensive processors whose price ranges from Rs 6 to 17 lakh are vulnerable to theft. They can be misplaced as they mostly being implanted in young kids from 10 months to adults who had lost hearing under various reason ranging from injury to illness.

Insurance companies should be instructed to consider these devices too to be placed under the insurance coverage policies or government should take initiative in launching schemes like life insurance on pan India basis as we represent only a percentage of people living in the helpless world of silence.

Currently the government-supported insurance of Niramaya (health insurance scheme) is covering only persons with autism, cerebral palsy, mental retardation and multiple disabilities. However, all other disabilities too need insurance support and hence all disabilities, including hearing loss, need to be included under the Niramaya Insurance coverage or an alternate insurance scheme should be introduced.

Recording and monitoring: With the technological advancement, there are numerous hospitals under government and private sector that perform cochlear implant surgery. However, we understand that proper records of the implantation done in Kerala are yet to be managed. A system needs to be put in place by whereby a detailed report on the implantations done is uploaded to the central depository on a monthly/ quarterly basis.

(The writer is Jestin K Jose chairman, Kerala Cochlear Implantees' Charitable Trust)

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