Nepal: Kanti Childrens Hospital
RMF Honored By Certificate of Appreciation: Q1 2018
July 31, 2018
Ganesh Shrestha, Program Manager
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 3 medical officers and 4 registered nurses. 2 of the medical officers serve in the Surgical ICU, while 1 medical officer serves in the NICU. Similarly, 3 nurses serve in triage and 1 nurse serves in the Medical ward.
Pediatric Intensive Care Unit (PICU)
153 Patients Treated
RMF medical officers have served a total of 153 patients at the PICU of Kanti Children’s Hospital, from January to March 2018. Pneumonia and bronchitis were the most common diagnoses, as can be expected during the winter months.
92 Patients Treated
RMF medical officers have served a total of 92 patients in the Surgical ICU of Kanti Children’s Hospital, from January to March 2018.
1,075 Patients Assessed
RMF nurses serve in triage at the Emergency Department of Kanti Children’s Hospital. They assess and provide tags to the patients, mainly code red (life-threatening injuries or illness) and code yellow (moderate to serious injury/illness, not immediately life-threatening). In the first quarter of 2018 (January–March), a total of 1,075 patients were assessed. Among them, 171 were code red and 904 were code yellow.
645 Patients Treated
In the first quarter of 2018 (January–March), a total of 645 patients were admitted and treated at the Medical ward. Among them, 253 were female patients and 392 were male. 39% of patients treated in the Medical ward were female and 61% were male during the first quarter of 2018.
Handover of ICU Beds
10 Hospital Beds
On January 1, 2018, Real Medicine Foundation Nepal handed over 10 ICU beds to Kanti Children’s Hospital. A special ceremony was organized, and RMF Program Manager Ganesh Shrestha officially handed over the beds to Chairman Subodh Raj Acharya of the Kanti Children’s Hospital Development Board. The senior management teams of Kanti Children’s Hospital and RMF Nepal were present, as well as representatives of partner organizations.
Hospital’s 56th Anniversary Ceremony
On January 6, 2018, Kanti Children’s Hospital held a ceremony to celebrate its 56th anniversary. During the ceremony, Kanti Children’s Hospital presented three supporting organizations, including Real Medicine Foundation, with certificates of appreciation. This certificate of appreciation marks a milestone in RMF Nepal’s partnership with government agencies, and we are deeply honored and proud of this achievement.
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
Manisha Rana is a 9-year-old girl from Jajarkot. She was referred from Nepalgunj Medical College and arrived at the Emergency department of Kanti Children’s Hospital on the 9th of March 2018 with complaints of abdominal pain and distention for 3 days. She had multiple episodes of vomiting whatever she ate during the past 3 days and hadn’t passed stool for 2 days. On examination, Manisha’s general condition was both poor and toxic. Her blood pressure was systolic 80 mmHg and diastolic 40 mmHg, and her abdomen was distended. An x-ray of Manisha’s abdomen was done immediately, which showed multiple air fluid levels suggesting intestinal obstruction. Basic blood investigations showed that she had an elevated white blood cell count with neutrophilic predominance. An emergency nasogastric tube insertion and Foley catheterization were done.
Manisha was admitted to the Surgical Intensive Care Unit with ionotropic support and intravenous antibiotics. On her second day of admission, her blood pressure returned to normal, but her abdominal distension and pain didn’t improve. On the third day, she underwent an exploratory laparotomy under general anesthesia. Operative findings included excessively distended bowel loops with band adhesion on the small intestine. The adhesion was released, and decompression was done. Further post-operative course was uneventful. Manisha was then transferred to the Surgical ward on her second post-operative day, i.e. the 14th of March. Dressing of the abdominal incision was done on alternating days, and intravenous antibiotics were continued. On subsequent improvement, she was then discharged on the 21st of March, her ninth post-operative day.
Manisha came for stitch removal on her twelfth post-operative day at the Surgical OPD, and she was feeling well and grateful, with a happy face. She will be returning to her home in Jajarkot after few days.
– Dr. Purushottam Adhikari, RMF Medical Officer, Kanti Children’s Hospital
Dipika Sarki is a 4-year-old girl who presented at the Emergency department on the 13th of March 2018, with complaints of abnormal body movement for 2 days and fever for 4 days. Dipika is small for her age and suffers from cerebral palsy. She lives in an NCO orphanage home, where RMF nurses help care for her. According to her caregivers, the child was well 4 days ago, then she gradually developed abnormal body movement and increased in U/L and L/L. Her caregivers also gave her history of a high-grade fever with chills. The rest of the systemic examination was normal, except the CNS examination, due to her HIE C/P sequel.
Dipika was kept in the ER department and was started on IV antibiotics, fluids, and injectable phenytoin. Then the team sent all the baseline investigations for analysis. After an hour, the child was still having seizures, and we repeated the dose of phenytoin. Dipika still had recurrent seizures that were not controlled by the medication, and she developed a high respiration rate and was not maintaining sufficient oxygen saturation with a face mask oxygen supply. The team continued close monitoring of the child. As she was brought from an orphanage home, her caregiver didn’t have enough money to buy medicine.
Dipika needed ICU care, so we shifted her to the Pediatric ICU and started treatment there. On her second day of PICU admission, abnormal movement still persisted, and our team upgraded the IV antibiotics and added more anticonvulsive drugs. Later, on the third day, she was more stable. After that, IV fluids were discontinued, but she was kept on NG feeding. An eye consultation was also done, which showed optic atrophy B/L. We also did a CT scan of the patient’s head, which showed cerebral atrophy with cystic encephalomalacia of the bilateral basal ganglia and bilateral parietal lobe (sequel of old infarction).
On seventh day of PICU admission, Dipika was stable and was shifted to the General ward. As she was from an orphanage home, her medication and hospital stay were provided free of charge. Later, after the third day of her stay in the General ward, Dipika’s NG tube was removed and she started to be fed by her caregiver orally. Finally, Dipika was discharged on oral medication with physiotherapy.
Age 3 Months
Suman Tamang is 3-month-old child who was admitted to Medical ward on January 31st, 2018 with the diagnosis of AGE and severe dehydration. According to his guardian, the child was well 5 days before; then he developed loose stool, 6–8 episodes, watery in consistency, non-blood mix and vomiting, 4–5 episodes per day. Suman had no history of previous hospitalization. On admission, his vital signs were monitored: temperature 98°F, respiration 34/min., and pulse rate 128/min. An IV line was opened and Ringer’s lactate 250 ml/24 hours was administered. Suman’s mother was advised to feed him a little and practice frequent breastfeeding. She was also taught the proper way of breastfeeding. She was closely monitored and also advised to maintain hygiene and kept the child warm. IO charting was maintained at hospitalization. Injectable Taxim 125 mg IV TDS was administered and Cefixime syrup (50/5) 4 ml BD for 3 days was prescribed at discharge.
Suman was discharged on the 5th of February, with a follow-up plan as needed. At discharge, his mother was advised on breastfeeding and immunization. During the follow-up visit, Suman was found to be healthy.
Ronal is a 1-year-old boy who was brought to the Emergency department of Kanti Children’s Hospital on the 13th of February 2018. Major complaints included cough and cold, fast breathing, and intermittent fever for 7 days.
During examination, we found Ronal’s oxygen saturation was 73% on arrival (before we administered oxygen) and his respiratory rate was 68/min. He had a history of Down’s syndrome with bilateral pseudo-membranous conjunctivitis. Hence, the patient was kept on oxygen at 4 liters via face mask, and nebulized Asthalin was administered 3 separate times. Intravenous injectable Taxim 400 mg and injectable Fluclox 400 mg were also administered. Ronal’s blood was also sent for investigation and he was referred to the Pediatric ICU.
Age 7 Months
Eva Balika is a 7-month-old girl who was brought to the Emergency department of Kanti Children’s Hospital on March 7, 2018. Her chief complaints were fever for 3 days, noisy breathing, difficulty breathing, and decreased feeding. She also had been admitted to Kanti Children’s Hospital a month before.
On examination, the team observed the following:
- Temperature: 103°F
- RR: 80/min.
- Pulse: 180/min.
- Oxygen Saturation: 50/min.
In this condition, Eva was intubated and after a Pediatric ICU consultation, she was transferred to the PICU. Eva was brought from a Nepal Children’s’ Organization (NCO) orphanage, where RMF nurses help care for the children.