On the surface too, such a program and intervention maximizes the independence and agency of deaf children, as government administrators, surgeons, audiologists, and speech and language therapists stressed to me. On the surface, this program appears to be an ambitious and cutting-edge program, providing listening and spoken language to deaf children through the latest technology. In addition to cochlear implant surgery, the central government program provides cochlear implant mapping, two years of re/habilitation therapy, and two years of warranty for the external processor. Cochlear implants are considered among the most successful neuroprosthetics and are increasingly a gold standard in the treatment of deafness. In its revision, for the first time, cochlear implants were included, specifically for children under the age of six and living below the poverty line.
Previously, the program provided a range of devices, including wheelchairs, crutches, hearing aids, and modified scooters. In 2014, India’s central government revised a key program providing goods and services to eligible disabled people, the Assistance to Disabled Persons for Purchase/Fitting of Aids and Appliances (ADIP) scheme. Ultimately what is at stake is expanding health practitioners’ ideas of what it means to maximize potential, particularly in the face of new technological interventions around disability. Disability justice is part of structural competency. Since cochlear implants are the “gold standard” in intervening on hearing loss and increasing numbers of countries in the Global South have started state-funded cochlear implant programs, an exploration of India’s program provides an opportunity to analyze both the importance of infrastructure and the need to combat ableism within structural competency frameworks.
Based on interviews and participant observation with key stakeholders, this paper argues that in focusing only on “a right to hearing” and on cochlear implants as a solution for deafness, health care practitioners ignore the complex work required to maintain cochlear implant infrastructures, as well as the advocacy work done by disability activists in India and internationally to transform existing political, economic, educational, and social structures.
The program is remarkable in its targeting of the poorest of the poor to provide them with expensive technology made by multinational corporations and its development of new surgery and rehabilitation infrastructures throughout India. In 2014, the Indian state revised a key program providing aids and appliances to disabled people to also include cochlear implants for children living below the poverty line.
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