Nepal: Kanti Childrens Hospital
5 New RMF-Supported Medical Staff Members: Q1 2017
June 12, 2017
Ganesh Shrestha and Pragya Gautam
Summary of Activities
Kanti Children’s Hospital provides free health services to financially challenged patients, there are always constraints with regard to the availability of funds, which makes it challenging to provide medical support to every child that is referred to the hospital. Recently, the hospital development board decided to upgrade the Intensive Care Unit (ICU) from 8 beds to 52 beds. The hospital has also started a triage area in the Emergency Unit.
Shortly after the April 2015 earthquake, Real Medicine Foundation started its support of Kanti Children’s Hospital by donating $408,000 worth of medicines, medical supplies, and laboratory supplies. RMF also 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 expanded its support to Kanti Children’s Hospital, and is now providing the hospital with 3 Medical Officers and 2 Registered Nurses. RMF’s Medical Officers are working in the CICU (Central Intensive Care Unit), and the Registered Nurses are working in the emergency triage area.
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Dr. Angel Shrestha
New Medical Officer
Dr. Angel Shrestha is a pediatrician registered with the Nepal Medical Council. As an RMF Nepal Medical Officer, she serves in the ICU of Kanti Children’s Hospital, Kathmandu. She completed her MBBS degree at Xi’an Jiaotong University, Shaanxi, China in 2009 and earned her master’s degree in pediatrics (MD) at the same university in 2016.
After completing her MBBS degree, Dr. Angel worked as a medical officer at Samudaik Hospital, Gongabu in the emergency department; at Astamatrika Polyclinic, Dhobighat; at B & B Hospital, Gwarko in the anesthesiology department; and at Nidan Hospital, Pulchowk for 2.5 years.
Dr. Anisha Shakya
New Medical Officer
Dr. Anisha Shakya is a medical doctor registered with the Nepal Medical Council. She completed her MBBS degree at Weifang Medical University, Weifang, Shandong, China in 2016. During her one-year rotational internship in Weifang Medical University’s affiliated hospital, she worked in various departments. Dr. Anisha is meticulous, disciplined, and polite and soft in nature.
She also has experience working with medical IT and PowerPoint. Currently, Dr. Anisha works in the CICU of Kanti Children’s Hospital as an RMF Nepal Medical Officer. In her free time, she likes indoor, as well as outdoor activities, literature, dancing, and travel.
Dr. Saraswati Parajuli
New Medical Officer
Dr. Saraswati Parajuli is a medical doctor registered with the Nepal Medical Council. She completed her MBBS degree at Guangzhou Medical University, China in 2016. Dr. Saraswati was a scholarship winner and received the honor of 2016 Excellent International Graduate of Guangzhou Medical University. During her one-year internship at Guangzhou Medical University’s affiliated hospital, she worked in the departments of internal medicine, surgery, gynecology and obstetrics, emergency medicine, neurology, radiology, anesthesiology, ENT, ophthalmology, and dermatology. She also has experience working at Awon Clinic, Kalimiti for several months and has participated in some of the health camps organized by non-governmental organizations.
Dr. Saraswati began working at Kanti Children’s Hospital in the general ward, and is now working in the CICU as an RMF Nepal Medical Officer.
New Registered Nurse
Sita Gurung is a registered nurse who hails from Manang, a mountainous district of Nepal which is difficult to access. Prior to passing her Proficiency Certificate Level (PCL) in Nursing, Sita also completed a Community Medical Assistant (CMA) course. She worked as a staff nurse at the District Health Office of Manang, providing various health services to the local residents.
Sita is now an RMF Nurse working at Kanti Children’s Hospital, Kathmandu. She is stationed in the triage area of the hospital’s Emergency Department, where she receives the sick children, assesses their condition, and classifies the urgency of their case: requires immediate medical action for survival (code red), sick but not life-threatening condition (code yellow), less severe condition that can wait awhile (code green), or dead on arrival (code black), and sends the patient to the respective color zone for treatment.
New Registered Nurse
Nirjala Bhattarai is a registered nurse who hails from Kathmandu. She completed her Proficiency Certificate Level (PCL) in Nursing at the Manmohan Institute of Health Sciences in 2015 and volunteered in the Emergency Department of Kanti Children’s Hospital for 6 months before joining RMF’s team.
Nirjala now works as an RMF Nurse in the triage area of the Emergency Department at Kanti Children’s Hospital. She receives the children at the Emergency Department, assesses their condition, and classifies the urgency of their case: requires immediate medical action for survival (code red), sick but not life-threatening condition (code yellow), less severe condition that can wait awhile (code green), or dead on arrival (code black). She then sends the patient to the respective color zone for treatment.
Continued Long-Term Support
RMF will continue our long-term support of Kanti Children’s Hospital. Our current support consists mainly of human resources, but we are also strategically providing the hospital with funding for necessary equipment, facilities, and are looking into affiliation with international hospitals.
With this in mind, Kanti Children’s Hospital has formally requested that RMF increase its support for the expanding ICU department:
- ICU beds for the CICU (Central Intensive Care Unit)
- Fully equipped cardiac catheterization laboratory
- Additional staff for the CICU and emergency triage area
- Financial support for children’s first phase treatment
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
Click to enlarge
During the month of March, 64 patients were admitted to the Kanti Children’s Hospital ICU.
Lok Bahadur Syantang
Age: 2 Months
On Monday, March 20th, 2017, a chubby 2-month-old baby boy named Lok Bahadur Syantang was brought to Kanti Children’s Hospital ER by his parents, who are from Hetauda. He was having difficulty breathing. It was immediately obvious that Lok Bahadur needed immediate advanced care, and thus he was quickly moved to the Pediatric Intensive Care Unit (PICU).
The team of doctors, including RMF Medical Officer Dr. Angel, rushed to assist the patient. Lok Bahadur was in distress. During the thorough check-up, we learned that he had been having difficulty breathing for 10 days, and his condition had become steadily worse. He also had a fever and cough for the past 8–10 days. Lok Bahadur’s breathing was fast (respiratory rate: 64 breaths per minute). Marked chest retractions and nasal flares suggesting that he was struggling for each breath. Routine laboratory investigations showed that his white blood cell count (WBC) was very high (54,000/cm), and the chest x-ray showed severe pneumonia in both lungs. Without oxygen, he was not able to maintain a normal oxygen saturation level (only 40%). He required a high level of continuous oxygen supply. We could not delay any further procedures and needed to relieve the baby’s pain; he was shifted to our PICU immediately.
Lok Bahadur’s weight was 5 kg. The team intubated him promptly at about 10:00 PM, and he was kept on a mechanical ventilator. He was sedated, and his intravenous antibiotics were upgraded. The youngest child of a poor, farming family of 5 with two elder siblings, Lok Bahadur was fighting for survival. During the course of treatment, his condition worsened initially. There were persistent signs of deterioration, such as generalized swelling of his whole body, gastrointestinal bleeding, left lung collapse, and collection of fluid in both lungs. Lok Bahadur had to be re-intubated about 3 times, and a blood transfusion was given. The worried, loving parents of this very sick child could not pay for any of his treatment, so the hospital, with RMF’s support, provided all medications for free for his further management. Gradually, after a week of treatment on the mechanical ventilator, there were subtle improvements. With constant monitoring, prompt management, and supportive care, he finally came off of the ventilator after a total of 17 days.
Currently, our sweet Lok Bahadur is active, playful, and has started to recognize the ICU team, as he smiles at us during each interaction. He still has a cough and is being treated with oral antibiotics.
Baby of Goma Adhikari
Age: 2 Months
On April 7th, 2017, the 2-month-old baby girl of Goma Adhikari was brought to the Emergency Department of Kanti Children’s Hospital by her parents, who are from Gorkha. They reported that the baby had a fever and loose stool for 2 days, and difficulty breathing for 2 days. On presentation, the child looked ill. She was in distress and could not maintain a normal level of oxygen saturation (her saturation was 50%–60% vs. the normal 90%–100%). The team of doctors, including RMF Medical Officer Dr. Saraswati Parajuli, managed the case immediately. They found that the baby was breathing rapidly and was in distress, so they quickly admitted her to the PICU (Pediatric Intensive Care Unit).
The baby received first-line antibiotics for 2 days. Because there were no signs of improvement, her antibiotics were upgraded to second-line and third-line, respectively. Doctors did an arterial blood gas analysis, and the results showed severe metabolic acidosis. The baby was also gasping for breath (irregular respiratory pattern), so she was intubated and kept on a mechanical ventilator. The baby’s condition was deteriorating despite extreme efforts; none of her tests were within normal range, the ventilator was on its maximum setting, and there were still no signs of improvement. The baby’s parents were counseled about her condition, but they refused further treatment and told doctors to take the baby off of the ventilator.
The baby was extubated per her parents’ wishes and was given headbox oxygen. Her breathing was labored, and her respiration pattern was not normal; the baby was fighting for her life, and her vitals were unstable. The doctor continued treatment from the hospital supplies, and the baby gradually began showing signs of improvement. The parents were told of the baby’s improved condition, and they were convinced to allow further treatment. After seeing the child’s improving condition, they agreed to do what was needed. Now baby is doing well. She has started having a social smile and is active and playful.
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