It was December 23, 2023, 11:00 p.m., and my last night in Karachi. On my way to the airport, I had one final stop: to thank and say goodbye to Javid Bhai, a leader in Pakistan’s cochlear implant advocacy world.

Cochlear implants are surgically implanted electrode arrays combined with an external sound processor. They mitigate hearing loss by bypassing the inner ear structure and sending signals directly to the auditory nerve. Considered the gold standard in deafness intervention, they are expensive to purchase and maintain, and there is little state or nongovernmental support to reduce costs. Moreover, surgical skill and rehabilitation expertise are required before cochlear implants can result in listening and speaking children. Even then, there are no guaranteed results.

I had traveled to Pakistan to learn how families with implanted children were interacting with this relatively new medical technology. Javid Bhai, himself the father of cochlear-implanted twin girls, connected me with families and checked in with me daily during my visit. Indeed, everyone I met knew Javid Bhai, or Javid Brother. To families of children with the implants, he was like kin.

Javid Bhai and his daughters greeted me and my research associate Areeba Fatima, leading us down a series of lanes to his home. On the way, he chatted with us about the many WhatsApp groups of parents, cochlear implant distributors, audiologists, and speech and language therapists that he coordinates. He told us of a man in Karachi who needed a part, which Javid Bhai was able to provide thanks to his redistribution networks that spread from Canada to Saudi Arabia. He proudly explained that he was able to price the part for less than half of what the Karachi-based distributor would charge.

Javid Bhai then showed us a message on his phone. It was from a deaf-blind Pakistani man in North America who sends cochlear implant processors and parts from the US, Canada, Europe, and Australia. Considered obsolete in those countries, the devices take on new lives in Pakistan. The man was writing to say that he was sending over more parts. Javid Bhai then launched into a discussion of the intricacies of getting an older cable coil to work with a newer processor. I thought that it was too late at night, at least for me, to be talking about parts and prices. By contrast, Javid Bhai seemed like he could talk about these things forever. He took great pride in sharing the ins and outs of his redistribution networks, and the ways that he was able to provide families with parts that they would not otherwise be able to afford.

At his modest apartment, Javid Bhai brought out a large bag full of cochlear implant parts—battery chargers, batteries, magnet coils, cables. These were the parts that would keep his kin’s and friends’ implants working. Never mind that they were obsolete elsewhere. With the vital parts spread out across his coffee table, Javid Bhai explained that they were going to be given or sold to needy people cheaply. I asked his cousin and sister-in-law, who were sitting there watching us, if he often talked about cochlear implants. They smiled and confirmed that he was always on his phone, checking his WhatsApp groups to ensure he hadn’t missed a message from a family in need.

I had been introduced to Javid Bhai three years earlier through a Pakistani mother living in Dubai. She had explained that cochlear implant surgery and maintaining the devices is prohibitively expensive in Pakistan. Some of the key challenges that patients and their families face after surgery are finding parts, mapping their devices, and connecting with speech and language therapists. It was then that she began to describe a distribution network cutting across class and caste differences—where Pakistani families were working to support one another in the absence of state and corporate support. While very wealthy families can afford to go abroad for surgeries, device mapping, and rehabilitation, poor and middle-class people must cobble together funds and fend for themselves within Pakistan’s unregulated cochlear implant market. She subsequently introduced me to Javid Bhai, who promptly added me to the WhatsApp groups that he administers.

For the past ten years, deaf people and their families in Pakistan have no longer been able to travel easily to India for surgery and support. India has a more well-established cochlear implant infrastructure; three of the main device manufacturers have headquarters there. Previously, Indian surgeons and company representatives would also travel back and forth to provide training and support. These relationships with Indian institutions and individuals no longer exist. With the distribution of care and parts hung up in geopolitics, I was curious how Pakistani families were coping.

Globally, cochlear implant processors have become obsolete at different times, depending on geographic location. Bracketing concerns here about sensory hierarchies and questions about what kind of processor is “good enough,” a processor that is currently obsolete in the United States is still considered to be top-of-the-line in Pakistan. A processor that is no longer eligible for servicing or repair in the United States is still supported in Pakistan, and people are still able to get spare parts and repairs through local distributors.

However, these distributors are considered to be unreliable and corrupt, unmonitored by cochlear implant manufacturers, and their prices are prohibitive. To avoid usurious distributors, families and activists like Javid Bhai have formed informal redistribution networks fueled by supporters in other countries. These intercontinental networks enable the pooling of resources including funding, parts, and knowledge of the devices’ intricacies. Families, in turn, have taken to repairing devices themselves. Within this geography of obsolescence, families have learned to keep their implants working, thus ensuring that their children do not go “off ear.”

There is more at stake here than the threat and refusal of technological obsolescence. Families are also refusing to permit their children to become obsolete, or to be excluded from social, educational, and familial worlds. Their actions are especially notable at this current political and economic moment in Pakistan, in which disabled people are seen by mainstream society as having no future. A mother from a rural area who moved to Karachi to implant her child told me that she did this because the deaf people whom she knew in her village were nameless and excluded from social life. She refused this future for her child. In collectively refusing their children’s obsolescence, mothers offer to teach and provide speech therapy to one another’s children, and parents pool tips for home-based speech therapy practices, books to read and activities to do, and where to go for professional therapy. Families routinely donate funds to one another, and they provide encouragement and prayers.

I have argued elsewhere that obsolescence is not a neutral concept—that it produces abandonment, or a sense of being discarded and left behind.¹ When cochlear implant devices become obsolete, families frequently struggle to find funds for the “compulsory upgrade,” as it is called. They experience obsolescence then as a betrayal of a promised present and future in which their children can hear. Pakistanis feel abandoned by cochlear implant corporations, leaving them vulnerable to untransparent price inflation by local distributors. If they complain to corporate headquarters, families fear that local distributors will blacklist them. “Why don’t the corporations check up on us after surgery?” is a common lament. “Why don’t they come and see how we are doing? Why do they leave us at the mercy of these distributors?” The threat of technological obsolescence, as these statements attest, is closely tied to the realities of corporate abandonment. In fighting and circumventing this abandonment, families are refusing the abandonment of their children.

Javid Bhai introduced me to Umer Bhai, who owns a mobile phone repair shop in Lahore. Umer Bhai grew up with two siblings who wore hearing aids. Through trial and error, Umer Bhai slowly learned to repair these hearing aids for his family. After his own daughter was born deaf, he learned about cochlear implants, and he was able to have his daughter operated on through a charitable program. During his daughter’s surgery, he met other parents who were in the hospital for the same reason, and they formed a small support group. After a few years, when the children’s processors started showing wear and tear, Umer Bhai said that he would try to repair them, if the other families would support him. They said that they would. Similar skills, albeit a different device, and higher stakes.

Today, Umer Bhai is known throughout Pakistan (and according to him, throughout India and the Middle East) for his skill at fixing cochlear implants for a fraction of the distributors’ fees. Recognizing the value of his abilities, Javid Bhai and a host of grateful parents collectively purchased a special microscope in order to support Umer Bhai’s repair work. They call him Dr. Umer, in honor of his skills.

When I spoke with Umer Bhai, he contrasted the support that he provides to families against the support of corporations, distributors, and doctors, who he opined are only interested in profit, not in actual children. He does this work because he doesn’t want children “off ear and not hearing” simply because of a processor not working. He is now so busy with implant repair work that his apprentices are responsible for his earlier business of mobile phone repairs. Umer Bhai is under constant stress, though—he gets calls from distributors threatening legal action against him, and calls from families frantic about getting their children’s devices fixed. Still, he keeps on doing this work, even advising Indian mobile phone repair technicians on how to repair cochlear implants to expand the geographical reach of this network.

Javid Bhai and Umer Bhai are just two people who refuse to allow deaf children to become obsolete or abandoned, and in the process they take advantage of geographies of obsolescence.² To be sure, this is not an unusual story; other scholars and activists have chronicled how people in developing contexts have struggled to afford and maintain medical technology. Glucose strips and glucometers are well-explored examples.³ There is also something uneasy about putting all of our hope in technology. In the cycles of innovation, these technologies will likely (and soon) become obsolete. All of these risks are especially pronounced when intersecting with the life-transforming rhetoric around cochlear implantation, which often frames this innovative technology as a cure for deafness. I wished that some of the families I’d met would learn Pakistani Sign Language and consider sending their children to deaf schools, which I and other deaf scholars and activists worry are also becoming obsolete; we see Pakistani Sign Language as important for resisting obsolescence and abandonment, as well as safeguarding against language deprivation.

But, there is much to be said for the work of refusing to allow children to go “off ear” through obsolete cochlear implants. This is work that involves vigilant attention—to WhatsApp messages; to sending, receiving, and redistributing small but consequential processor wires, batteries, and magnets; and to reinventing identities as redistributors and repairers of cochlear implants. ■

1. Michele Friedner, “Who Pays the Price When Cochlear Implants Go Obsolete?,” Sapiens, March 29, 2023. ↩︎
2. I am thankful to Kelly Fritsch for helping me think of abandonment in this way; she has a current project in which she analyzes the ways that a disability justice perspective means that we leave no one behind and that we refuse abandonment of people. ↩︎
3. Amy Moran-Thomas, “Glucometer Foils,” Limn 9 (November 2017). ↩︎