Nepal: Kanti Childrens Hospital
Medical Ward Treats 639 Patients: Q2 2019
October 24, 2019
Ganesh Shrestha, Dr. Sanish Manandhar, and Dr. Sujan Pun
Summary of Activities
Shortly after the April 2015 earthquake, Real Medicine Foundation (RMF) started its support of Kanti Children’s Hospital by donating more than $400,000 worth of medicines, medical supplies, and laboratory supplies. RMF continues to support a blood bank, lodging, food, transportation, medicines, laboratory services, and other necessities for needy patients and their families. In March 2017, RMF also began supporting human resources at Kanti Children’s Hospital and is now providing the hospital with medical officers who serve in the Surgical ICU and Neonatal ICU, as well as registered nurses who serve in the triage area and Medical ward.
- 102 patients were treated in the Surgical ICU.
- A total of 639 patients were admitted and treated in the Medical ward. Among them, 239 (37.4%) were female and 400 (62.6%) were male.
- RMF nurses classified a total of 633 patients at the triage area, among whom 67 (10.6%) were classified in the red zone and 566 (89.4%) were classified in the yellow zone.
- The ICU beds provided by RMF are fully functioning and being utilized in the ICU.
From April to June 2019, RMF nurses triaged a total of 633 patients. RMF nurses use a triage system while serving in the Emergency Unit of Kanti Children’s Hospital. Through this system, they classify and provide tags to the patients: code red requires immediate medical action for survival, code yellow indicates a serious but not life-threatening condition, code green indicates a less severe condition that can wait, and code black means dead on arrival.
From April to June 2019, a total of 639 patients were admitted to and treated in the Medical ward. Among them, 239 (37.4%) were female and 400 (62.6%) were male. Children under 1 year of age had the highest admission rates, followed by children 1–3 years of age. The most common conditions treated in the Medical ward were respiratory, followed by cardiovascular diseases.
RMF medical officers have served a total of 102 patients in the Surgical ICU of Kanti Children’s Hospital from April to June 2019. The most common disease treated in the SICU was anorectal malformation (ARM), followed by Hirschsprung’s disease, both of which are congenital disorders that affect the digestive system.
Kanti Children’s Hospital is the only government referral level Children’s Hospital of Nepal. The hospital was established in 1963 as a general hospital with 50 beds, which today have a capacity of 320 beds. The hospital treats children up to the age of 14 from all over the country, a total target population of 13-14 million children. Following the earthquake, where parts of hospital building were damaged, there is in general a need for equipment and capacity building for better health service delivery.
- Provide necessary medical supplies, blood, and nutritional support for patients. Also providing access and transportation to testing and procedures
- Give instruction of patients needs, education, amenities during hospital stay, and financial support to family of the patient
- Management to various hospital programs such as a blood drive program, a free-of-cost kitchen for patients and families, playroom and library for patients and siblings, and clothes bank for needy patients and family
2-year-old girl Nirjala KC was referred to the Surgical department from the Medical department on May 31, 2019, after the incidental finding of a right diaphragmatic hernia on a USG. She was admitted to the Medical department with diagnosis of pneumonia, and once the pneumonia was resolved, she was referred to the Surgical department for the management of the right diaphragmatic hernia. The CT scan of chest was done, and the report confirmed a right posterolateral diaphragmatic hernia.
Nirjala was scheduled for surgery. All the baseline preoperative investigations, including an echocardiogram, were sent. After all the investigations results came back, normal and the patient was deemed fit for operation, the surgery was performed on June 2, 2019. The surgery was successful, and Nirjala was transferred to the Surgical ICU, where she remained for 3 days. As the postoperative days were uneventful, and the patient was improving and was stable, she was transferred to the Surgical ward. There, she was kept for 2 more days under observation. On the 6th postoperative day, June 8, 2019, Nirjala was discharged with oral medications.
The patient’s parents were very happy about the successful surgery their daughter underwent in our hospital and were thankful to entire surgical team.
Srijana Lama’s 2-day-old baby daughter was brought to Kanti Children’s Hospital’s Emergency department on April 10, 2019, with a reddish mass protruding from her abdomen below the umbilical region. After an examination, the baby was diagnosed with bladder exstrophy. She was in stable condition, and all baseline investigations, including a pelvic x-ray and an ultrasonography, were done, after which she was admitted to the Surgical ICU.
All of the investigation results were within the normal ranges. The USG confirmed that the baby was a female, as the genitalia of the baby was not differentiated initially. The surgery was planned, but surgeries for bladder exstrophy require an orthopedic surgeon, as the pelvic bones must be separated. Since the orthopedic department was not available in our hospital, an orthopedic surgeon from another center was called, and the surgery was scheduled for April 24, 2019.
All the preoperative preparations were done, and blood was arranged in case it was required intraoperatively. The surgery started around 10:00 AM and ended at around 4:00 PM. The surgical repair of bladder exstrophy with osteotomy was a success, and the baby was transferred back to the Surgical ICU. Her postoperative days were uneventful; the baby was stable with a hip spica cast on. On the 6th postoperative day, April 30, 2019, the baby was transferred from the ICU to the Surgical ward, as her condition was stable, and she had started breastfeeding. After 2 weeks, the hip spica was removed, and after 3 weeks, the catheters were removed.
As the baby was healthy, she was discharged on May 16, 2019, after 38 days at the hospital. The parents were happy about the successful surgery their baby underwent, and thankful to all the teams.
Rinika Baral is an 8-year-old girl who was brought in to the Emergency department with abdominal pain for 5-6 days, 2 episodes of vomiting, and an on-and-off fever. Her bladder and bowel movements were normal. On examination, the clinicians found tenderness over the right iliac fossa and umbilical region. Rinika’s stomach was soft and not distended, and on deep palpation, a mass was felt measuring approximately 2×2 cm.
All blood investigations were within normal limits, except white blood cell count, which was raised above normal levels. An abdominal USG was done, showing an appendicular lump. Conservative management was done, with antibiotic therapy for 5 days, and later she was discharged and advised for an elective appendectomy after 6-8 weeks.