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 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.
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.
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.
Pediatric Intensive Care-194
Surgical Intensive Care-103
Emergency Unit Triage-480
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.