Nepal: Orphanage Support
Improvement of Monitoring and Reporting: Q1 2017
May 31, 2017
Ganesh Shrestha, Program Manager, and Pragya Gautam, Program and M&E Coordinator
Summary of Activities
During the month of January, 78 children became ill at NCO Naxal and Sifal. 72 had minor ailments and were treated by RMF’s nurses. 6 children required treatment at different hospitals, and RMF funded the treatment of 2 of these children. Similarly, in the month of February, 78 children were sick, and 12 of them were treated at the hospital. RMF sponsored the treatment of 4 of these children. In March, 63 children were treated by RMF nurses, and only 2 children were sent to the hospital. The illnesses of these 2 children were not serious, and NCO itself bore the cost of treatment.
The children whose treatment costs were borne by RMF had serious illnesses and required costly diagnostic interventions. NCO was unable to afford the treatment of these children, so RMF’s nurses took over these cases and requested that RMF Nepal’s office provide the needed financial support. Although the number of children supported by RMF for treatment in the hospital (6) is lower than those whose treatment was sponsored by NCO (14), the financial weight was higher for those sponsored by RMF.
201 Patients Treated
RMF Providing Financial and Medical Support
201 children were treated in the months of January to March with RMF helping to fund treatments for 6 of these children. The children whose treatment costs were borne by RMF had serious illnesses and required costly diagnostic interventions. NCO was unable to afford the treatment of these children, so RMF’s nurses took over these cases and requested that RMF Nepal’s office provide the needed financial support.
Improvement of Monitoring and Reporting
Acknowledging Nurses Accomplishments
In order to improve the monitoring and reporting of our nurses’ accomplishments at NCO, RMF Nepal’s team has designed and implemented a recordkeeping format. The nurses are recording their activities and treatment of the children, medicines administered (including doses and times), and other nursing care provided. RMF’s nurses not only provide basic treatment to the children, but they also treat the NCO staff for minor ailments, such as headaches and simple cuts.
Established in 1964, Nepal Children’s Organization (NCO), also known as Balmandir (The Children’s Temple) is one of the oldest non-profit organizations in Nepal working for the protection and promotion of childrens’ rights and providing residential care to the children at risk. This includes orphans, differently-abled, abandoned and conflict affected children.
After the devastating earthquake on April 25th, followed by another strong earthquake on May 12th, an estimated 2,023 children have been confirmed dead. Likewise, the number of the injured children has been established at 876 and approximately, 200 children have lost their mothers and 112 have lost their fathers. Nearly 2 million children are said to have been affected by this mega quake and the powerful aftershocks thereafter. (Ministry of Women, Children and Social Welfare, June 2015)
Among those children who lost their parents, many have come under the tutelage of NCO, whose own shelter home was heavily destroyed by the disaster. Currently, through their 10 children’s homes within and outside Kathmandu valley, NCO has been caring for 280 children, including the earthquake-affected.
RMF will be supporting NCO in improving orphanage-based children’s health by providing better quality primary health care, including nutrition, sanitation and hygiene.
- Provide psychosocial counseling to deeply affected children
- Construct a room for infants
- Health and sanitation trainings for house mothers and children
- Construct a room for differently-abled children
- Provide better quality primary healthcare
- Provide qualified staff nurses at NCO’s centers
- Enhance knowledge and awareness of health and nutrition
Happy Feet for Sapana Gole
Meticulous Care and Emotional Support
Sapana Gole is a seven-year-old girl who lives at Bal Mandir (the NCO children’s home in Naxal, Kathmandu). Her problem was an oversized second toe, which she had since birth. Sapana was uncomfortable, as the toe was visually odd and she could not wear a shoe on that foot. Moreover, people would stare and laugh at her foot. She felt ashamed.
At NCO, RMF nurses and NCO staff planned treatment for Sapana. They took her to Sushma Koirala Memorial Hospital in Sankhu, which is a specialized hospital for plastic surgery. At the hospital, doctors told us that she would have to undergo multiple stages of surgery until the size of the toe is decreased to near normal. Her first surgery was performed in July 2016, and the second stage surgery was performed in January 2017. RMF provided all the financial support for Sapana’s surgery. This case was a huge success; Sapana had thought she could never feel happy because of her disfigurement, and she was very grateful to RMF. RMF Nurse Sanskriti provided meticulous care and emotional support to Sapana. Nurse Sanskriti is happy, but Sapana is happier. Now Sapana looks forward to wearing any footwear without embarrassment.
Chronic Condition Diagnosed
NCO received young Prapti Balika on October 17th, 2016. Upon her arrival, routine blood tests including HIV, HBsAg, and VDRL were done, and the results were negative. However, day after day, Prapti struggled with health-related issues. Within five days of her admission to NCO, she started suffering from diarrhea and a cough. After a check-up and treatment of those symptoms, other difficulties immediately arose.
A toddler should be active and playful, but Prapti slept frequently and was weak and frail. She would not play and or take part in other activities. She had subacute intestinal obstruction and underwent surgery for that. She then had a severe infection in her urinary tract, for which she was again hospitalized. She suffered from mumps, chickenpox, dysentery, and a respiratory tract infection. Gradually, her appetite worsened as well.
Despite all the care and treatment she received, Prapti was not recovering at all. She was grasped by disease after disease and lost more than 6 kg of body weight. Upon her 3rd hospitalization for a severe UTI, it was found that Prapti had enlarged lymph nodes all over her body. Doctors suggested a repeated test for HIV. The test was performed, and Prapti’s results were positive. It was sad to witness the diagnosis of a 2-year-old with HIV. All the staff of NCO was heartbroken. Doctors did suggest, however, that Prapti’s condition will improve once she is started on antiretroviral therapy (ARV).
As NCO cannot provide proper rehabilitation to HIV-positive children, Prapti’s condition was communicated to another NGO, Maiti Nepal, where they provide care for children with HIV. Prapti is now under the care of Maiti Nepal and receiving ARV treatment. RMF nurses cared for Prapti both in the hospital and at NCO. It was sad when the RMF-supported case had to be transferred to another center. Nevertheless, there was a satisfaction that RMF had financially and psychologically supported a child who would have died without proper treatment and rehabilitation.
Aasika Balika is an 8-year-old girl who was received by NCO in January 2016. Her mother had died in the megaquake of April 2015. Aasika always had discharge of pus from her right ear, which was foul-smelling and embarrassed her. The persistent discharge needed medical attention, hence she was taken to the otorhinolaryngology department of Tribhuvan University Teaching Hospital, Maharajgunj. Upon examination, it was discovered that Aasika had moderate conductive hearing loss due to chronic infection of the middle ear. A CT scan was requested in order to obtain a detailed image of her ear canal. It revealed that she had cholesteatoma (a destructive, expanding skin growth in the middle ear). The condition required surgery.
Aasika received surgery: Right MRM with TORP replacement with conchal cartilage augmentation with mastoid fistula repair. After receiving meticulous care from RMF’s nurses before and after the procedure, Aasika is now recovering. Her condition has improved significantly, and she has developed self-confidence, as she is no longer embarrassed by her foul-smelling ear discharge.
The investigations and the surgery, as well as the medical supplies for the surgery, were sponsored by RMF. RMF staff is satisfied to see the treated child with an ever-smiling face. NCO is grateful for the support of RMF.
Effective Treatment of Cerebral Palsy
Dipisha Oli, a 3-year-old girl, was received at the NCO children’s home in Sifal, Kathmandu in October 2016. She had been previously diagnosed with cerebral palsy. Shortly after Dipisha’s arrival, abnormal jerky movements were noticed in her body. Because of suspected convulsions, she was immediately taken to Kathmandu Medical College Teaching Hospital for further treatment. Her poor health status was addressed through neurological, eye, ENT, and skin-related consultations and treatment. Cerebral palsy had a serious effect on Dipisha’s overall systems, resulting in poor vision, moderate hearing loss, and of course convulsions. She was prescribed sodium valproate (Valparin syrup 100 mg) twice a day as lifelong treatment. She was also recommended for regular follow-ups and, as necessary, visits to the hospital.
NCO did not have enough funds for Dipisha’s treatment, hence RMF took over the financial responsibility for her treatment. Once the medication was started, no reports of convulsions have been received to date. RMF Nurse Pushpa Khadka takes care of Dipisha around the clock, along with other staff at the center. Dipisha’s treatment and medicine are fully funded through RMF.
Rare Case of Open Lip Schizencephaly
Prem Balak, a 12-year-old boy, was received in March 2016 at the NCO children’s home in Sifal, Kathmandu. On February 3rd, he suffered multiple episodes of convulsions. The convulsions were alarming, and Prem was rushed to Kanti Children’s Hospital for treatment. He was admitted immediately and stayed there for five days. Different diagnostic investigations were performed, including an MRI. The MRI clearly showed that Prem had open lip schizencephaly, a very rare birth defect that occurs in about 1 of 100,000 births in the USA. We learned that it is an incurable condition and only symptomatic treatment is possible through the use of antispastic drugs. He was prescribed baclofen tablets, 10 mg, twice daily.
An MRI is a very expensive procedure and is not available at Kanti Children’s Hospital. The MRI was performed in a private center, and all the investigations and medications were funded by RMF, as the child protection home where he lives is financially struggling. With timely medication, physiotherapy, and tender loving care from RMF Nurse Pushpa Khadka and other staff at NCO Sifal, Prem’s condition has improved dramatically.