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Barnsley company helps clinch a surgical first in Malawi

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A Barnsley company has teamed up with Yorkshire doctors to help one of the most deprived parts of Africa break new ground by equipping two deaf children with the gift of sound, music and speech.

With the help of MED-EL, the team from the Yorkshire Cochlear Implant Service at Bradford Royal Infirmary (BRI) took its world-class expertise in the field of audiology 5,000 miles to perform the first ever cochlear implant surgery in Malawi.

And the first two words spoken by one of the patients after the tiny devices were switched-on six weeks later summed up perfectly the life-changing success of the operations: “Ndikumva!” (“I hear”)

The end of the children’s world of silence marks a dream come true for the driving force behind the link-up, Dr Wakisa Mulwafu, who is the only ear, nose and throat (ENT) surgeon in the whole of Malawi, and based at Queen Elizabeth Central Hospital (QECH) in Blantyre.

Now it is hoped the breakthrough will act as a springboard for the development of healthcare services for the high number of people in the country with hearing problems and other ear conditions.

The intricate surgery was carried out in Blantyre on 16-year-old Richard Mohammed and 9-year-old Joyce Chapotera by one of Bradford’s ENT and cochlear implant surgeons, Mr David Strachan.

It involved drilling into the bony wall of the inner ear and inserting a hi-tech device designed to provide a sensation of sound by sending an electric current to the auditory nerve in the brain.

The Yorkshire Cochlear Implant Service at the BRI has carried out approximately 1,000 such operations over 25 years.

Mr Strachan said: “Initially, these sounds can appear strange and quite robotic but with perseverance and rehabilitation practice by Joyce and Richard; support from their families and friends; and specialist services from skilled audiologists based both in Bradford and Malawi, this will gradually become the normal way of hearing for the children.

“Thanks to the vision and perseverance of Wakisa, his hospital colleagues and charity supporters, this is a ‘first’ for Malawi.

“Everyone in the Bradford team is honoured to have been part of this team effort that has created medical history – and paved the way for propelling its audiology service into a new era.

The focus has now switched to ensuring both children reach their full potential on their hearing journey.

“Cochlear implantation is not just about the surgery – in fact I always say we are simply the ‘plumbers’ – but the key is the rehabilitation after the operation,” said Mr Strachan.

“This requires both the commitment of the patient and family and the rehabilitation team including, of course, the audiologists who programme the implant.

“This process requires a number of regular visits initially and the rehabilitation can take many months of hard work. That way the benefits of the cochlear implant can be maximised.”

With a population of around 15 million people, Malawi has a high rate of preventable hearing loss and disorders – partly as a result of mumps, measles and malaria.

Dr Mulwafu, who observed both operations first hand, said: “Although cochlear implantation is very hi-tech and a remarkable innovation, this project will deliver other far-reaching benefits as it has created a platform for developing a broader provision of otological (ear) treatment in Blantyre.

“The surgical drills used in the cochlear implant surgery we carried out are now potentially usable for treating all aspects of ear disease – equipment which was previously unavailable in the whole of Malawi. This is a legacy that will benefit many more patients in the future.”

The ENT unit in Bradford has forged strong links with Blantyre in recent years. Mr Chris Bem, a consultant head and neck surgeon, has travelled to Malawi several times to support Dr Mulwafu and his ambitions to develop services there.

The idea of exploring if the country’s first cochlear implant was possible was triggered when Mr Strachan visited QECH in November 2013 as part of a four-month sabbatical.

By chance, the first patient who attended his first clinic on the Monday morning was a child who had been deafened by meningitis four weeks earlier.

Mr Strachan said: “At her age, she had already developed speech and would find it very difficult – if not impossible – to communicate fully by sign language. Nor would she be able to continue her education.

“After discussions with Wakisa and Chris, we decided that despite the scale of the difficulties involved, we would strive to look at how to bring cochlear implant surgery to Malawi.”

The idea gathered pace and an international partnership was formed which pooled Bradford’s expertise with support from MED-EL, the technology leader in hearing implant solutions, with whom the Bradford team has worked for more than 20 years.

The finishing touches to the plan were added in July, when Dr Mulwafu and audiologists from Malawi met with Mr Strachan at the Coalition for Global Hearing Health in Oxford.

MED-EL donated both implants as well as arranging extra training for the Malawi-based audiologists who are overseeing the children’s progress. In addition they arranged for an audiologist from Munich (Johannes Schmelzl) to be present in Blantyre at the time of surgery to test the implants after they had been surgically inserted.

EARS Inc audiologists Bec and Peter Bartlett from Australia, work for the African Bible College (ABC) Hearing Clinic and Training Centre in Lilongwe; and Dr Courtney Caron, hails from America, and is sponsored by the Sound Seekers charity to lead audiology services at the hospital. All were present with MED-EL’s engineer Peter Clementi in December at ABC for the switch on of devices for both children.

Joyce and Richard are now having fortnightly follow up and rehabilitation appointments at ABC.

Dr Mulwafu, who visited Bradford Royal Infirmary four years ago for an insight into the cochlear implant team’s work, added: “The past year has been an amazing journey for everyone involved in trying to turn this dream into reality

“We are grateful to David and the whole Yorkshire Cochlear Implant team for sharing their expertise with us and creating the impetus for ear surgery in Malawi to develop and expand in a way in which we never thought possible.

“Both patients are making excellent progress. We previously have had to write things down for Richard in Chichewa (the indigenous language) but at his latest follow-up he could understand our speech pretty well so no paper and pen was needed.

“Richard reports that his understanding is improving day-by-day, and can respond and answer people in conversation now. He loves his implant. We are hoping he can return to school soon, to tell his teachers ‘Ndikumva’.”

CI Richard and Joyce post op
A Barnsley company has teamed up with Yorkshire doctors

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