Nepal: Kanti Childrens Hospital
Doctor Added to RMF Medical Team: Q4 2018
April 15, 2019
Ganesh Shrestha and Pragya Gautam
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. 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.
- Dr. Sanish Manandhar joined our team as an RMF Medical Officer at Kanti Children’s Hospital.
- Medical staff members supported by RMF Nepal have continued to serve at Kanti Children’s Hospital.
- RMF continues to support a blood bank, lodging, food, transportation, medicines, laboratory services, and other necessities for needy patients and their families.
Dr. Sanish Manandhar
New Medical Officer
Dr. Sanish Manandhar is from the historic town of Sankhu in Kathmandu. He completed his MBBS at Kathmandu University, Nepal Medical College in 2017. While in medical school, Dr. Sanish gained a wide range of experience at different medical institutions. He participated in health camps in Sindhupalchok after the 2015 earthquake, as well as many other health camps.
Dr. Sanish now works as an RMF Medical Officer in the surgical department of Kanti Children’s Hospital. His main responsibility is providing surgical treatment for the patients, but he also reports to RMF Nepal regarding patients’ diagnoses and treatment.
620 Patients Treated
From October to December 2018, a total of 620 patients were admitted to and treated in the Medical ward. Children under 1 year of age had the highest admission rates, followed by children 6–12 years of age. The most common conditions treated in the Medical ward were cardiovascular, followed by respiratory diseases.
399 patients out of 620 were male, which shows that the male admission rate was approximately 1.5 times that of female admissions. This could indicate that parents are more likely to engage in health seeking behavior for boys, or it could imply that boys face greater vulnerability to diseases.
480 Patients Assessed
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.
RMF nurses triaged a total of 480 patients, with 182 code reds and 298 code yellows.
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
Anshika Mishra, an 8-month-old girl, was admitted to the Emergency Department with non-bilious vomiting for 4 days, as well as abdominal distension. She had also been passing stool containing blood and mucus for 3 days.
RMF Medical Officer Dr. Sanish provided the surgical consultation for the patient. A rectal examination revealed signs of intussusception, a type of intestinal obstruction, leading to a provisional diagnosis. All baseline laboratory investigations were sent, and an abdominal and pelvic ultrasound was done. The results of the ultrasound also suggested intussusception.
Anshika was admitted, and surgery was planned on that very day. Once a blood transfusion was arranged, the patient was shifted to the Operating Theatre, where an exploratory laparotomy (an investigative surgical procedure) was performed. An Ileoileocolic intussusception was found and manually reduced, and an appendectomy was also performed. All three surgeries went as planned and were performed successfully.
Anshika was then transferred to the Surgical ICU. Her postoperative days were uneventful, and once she started eating, she was transferred to the Surgical ward on the 5th postoperative day. She was soon discharged with oral medications. Anshika’s parents were glad to have their daughter treated at Kanti Children’s Hospital, happy about the successful operations which saved their child’s life, and grateful to all the hospital staff.
Kriti Maya Magar
Kriti Maya Magar, a 1-year-old girl, was admitted to the Medical ward with a diagnosis of global developmental delay (GDD) with left-sided hemiparesis, or weakness on one side of the body. She was well until one day prior to admission, when she developed a high-grade fever and abnormal body movements, including the rolling of her eyes and salivation during the febrile episode. As a result of her condition, Krita’s parents took her to the nearest hospital, and she was referred from there to Kanti Children’s Hospital.
After stabilizing the child in the Emergency Unit and keeping her under observation for 24 hours, hospital staff transferred Kriti to the Medical ward. RMF Nurse Rusa attended the case and also thoroughly answered questions for Kriti’s parents. At the time of admission to the Medical ward, Kriti was weak and required oxygen inhalation.
She was kept under close observation because she had a history of seizures. During hospitalization, Kriti had 3 more seizures, which were immediately managed by hospital staff. Her parents were continuously informed of and counseled on the condition of their child. When Kriti’s condition improved, she was discharged and advised to visit the neurologist for a thorough consultation and further treatment.
Jenisha Bhat, a 4-year-old girl, was admitted to the Medical ward. According to her caregiver, Jenisha was well until 8 days prior to admission, when she developed a fever (temperature not recorded) abdominal distension, and generalized swelling of the body.
RMF Nurse Rusa received the child during admission and noted that her condition was very poor. When her laboratory tests were done, Jenisha tested positive for scrub typhus, and her treatment was planned accordingly. The Department of Epidemiology was informed about the case, and records were kept. Jenisha’s parents were advised to maintain hygiene in the home in order to prevent rodents, which are the carriers of the ticks that transmit scrub typhus to humans.
Shriya Deula, an 11-year-old girl, was admitted to the Medical ward with a diagnosis of disseminated tuberculosis. According to her caregiver, Shriya was well until 1 month prior to admission, when she developed a cough, a sudden-onset fever that worsened at night, abdominal pain associated with decreased appetite, weight loss from 28 kg to 24 kg within a month, and vomiting.
Initially, Shriya was taken to local health facility, where some medications were prescribed, but her condition worsened. Shriya’s father then decided to bring her to Kanti Children’s Hospital. After receiving the child at Medical ward and obtaining her medical history, RMF Nurse Rusa suspected tuberculosis. Thus, she maintained all the necessary precautions and alerted the other nurses. Finally, Shriya’s AFB test results were positive, which confirmed her TB diagnosis. She was treated with antibiotics and antitubercular treatment (ATT). When her condition improved, she was discharged. Nurse Rusa counseled Shriya and her parents to strictly follow the ATT treatment instructions.
Laxman Joshi, a 6-year-old boy from Dhangadhi, arrived at the Outpatient department (OPD) on October 20, 2018 with bilateral swelling of the calf muscles and difficulty standing properly after sitting. According to his father, Laxman’s calf muscles first began to show signs of bilateral swelling 2 years ago. The condition began suddenly and worsened progressively, but his biceps muscles were not affected.
The patient had no history of loss of consciousness, acute bacterial meningitis, or surgical intervention, and no similar family history on his maternal side. Basic laboratory tests were done, such as total blood count, inflammatory markers, ECHO, creatine phosphokinase (CPK) to check for Duchenne muscular dystrophy (DMD), and a brain and spin MRI. All reports were in the normal range except for the CPK, which was prominently high, confirming Laxman’s diagnosis of Duchenne muscular dystrophy, an incurable neuromuscular disorder which mainly affects males.
At the time of Laxman’s discharge, hospital staff recommended that the child receive the necessary immunizations, including meningitis, Pneumovax, Hib, and varicella. They also suggested physiotherapy and provided some multivitamins and calcium tablets. Laxman was advised to return for regular follow-ups. Finally, hospital staff discussed the possible outcomes of the disease with Laxman’s father.