Watching the engaging proceedings, one gets no inkling that the little girl is hearing-impaired. All of four years and nine months, the child has been coming to Naad, an early hearing intervention centre, for three years already. Her problem was identified early, at three months, as her mother is a paediatrician, says her father Sanjay Keskar.

Sara was initially put through different hearing tests and finally, a year later, her parents decided in favour of a cochlear implant (CI), a medical device that facilitates hearing. The whole procedure cost them about Rs 5.5 lakh and it was just the first step in a long journey for Sara and her parents, who are residents of Pune.

Sara's mother Ujjwala travels with the child to Mumbai every Friday for the therapy. "It is worth the expense. You can sell your house and do it. Money is immaterial," says the father with a smile. Sara's progress has been worth the effort that her young parents have put in.

Naad is part of I Hear Foundation and children between four and 18 months are referred here by doctors or brought by parents when they suspect something is not right, says Malu Patel, an educator at Naad.

Asked if four months is too early, she says screening infants for hearing problems is mandatory abroad. In India this practice is virtually non-existent, besides being expensive, she adds.

Parents are encouraged to talk constantly to the baby while massaging or changing its clothes. The child then learns to listen and communication becomes fun, says Malu. Hearing impairment is one of the most common disabilities and often gets overlooked, with parents waking up to the problem only when there is delayed speech.

Early intervention brings better results. Globally, about one in 1,000 people are said to have hearing disability, she says.

At Naad, the audiologist, counsellor and therapist work with the parent/caretaker and the child. Senior audiologist Geeti Char insists that parents listen in on the improvements and errors made by the child. They are encouraged to take the training home and weave it into daily conversations.

"We are told to gappa maro with her, rather than always have a teaching-tone," says Sara's father. He is away on business most times and it is the mother who guides the child's every step in her new world filled with different sounds.

In fact, this world was so new to her that little Isha started crying when her cochlear implant was switched on, exposing her to a deluge of sounds, recounts her mother Rashmi Vartak. "It is how a person feels when he comes from dark to light," she marvels. Seven-year-old Isha has "graduated" from Naad, after being with them since age one.

At 15 months, with the use of a hearing aid, she started addressing her father `baba'. But there was still no clarity of speech. "She said `I want waa' for water and `I am hungie' when she was hungry. Only a mother can understand," says Rashmi, recalling her anguish then. The child resorted to temper tantrums simply because she was unable to understand other people or make them understand her. Even schools were a little wary of admitting her, adds Rashmi.

The implant, followed by therapy and counselling, has helped Isha communicate better. In the beginning Rashmi had to explain to her daughter every new sound... the doorbell, the telephone ring or even a vessel falling to the ground. Now Isha attends a regular school, learns to play on the synthesiser, has a host of friends and stands among the top five in her class, says the proud mother.

The early years are the most critical when it comes to hearing impairment, says Naad's Director, Shefali Shah. Her organisation set out to offer all services — testing, counselling and therapy — under one roof. "About 16 per cent of dropouts happen because people have to run from one place to another," she points out.

The centre charges a fee in order to instil a sense of commitment among the parents. It is waived in the case of needy families, she says.

Tucked away in a multi-storied building in South Mumbai, the silence is one of the first things that strikes visitors at Naad. And, naturally, the rooms are soundproof. There are audiology rooms where the children are tested and others where joint-sessions are conducted with parents. The children are allowed to borrow books and games to take home, on condition that they are returned in the same state.

Shefali regrets that in the absence of early intervention parents are put through a lot of hardship. Many travel to Naad weekly from places like Delhi, Pune and Assam. The centre staggered the training schedule for one child from Assam, to save the child a punishing travel schedule.

Stressing the importance of early hearing intervention, Shefali says: "Parents should listen to their instincts. They are misled into waiting for the child to grow up a little."

Hopefully, parents are listening.

Why early intervention?

"Human beings are pre-programmed for speech. The human ear responds to sounds in utero at 20 weeks. Every newborn has this hearing and speech potential. This does not necessarily mean that they grow into high-functioning children. For the auditory area of the brain to develop, children must receive auditory stimulation through direct and meaningful experiences. `Auditory living' is even more crucial for children born with a hearing loss. Delayed auditory stimulation results in inefficient language facilities. A baby deprived of appropriate language simulation during the first three years of life may never fully attain optimal language function."

By P.T. Jyothi Datta
http://www.thehindubusinessline.com/life/2005/11/11/stories/2005111100040300.htm