Project Description

Project ID

08PH002

Project Type

Fund Raising Project

Project Title

Equipment for Pediatric and Neonatal Intensive Care Units (ICU) at Patan Hospital

Project Summary

Nepal is the 12th poorest nation on earth with an annual per capita income of $241 and a very high infant mortality rate. There are no pediatric or neonatal intensive care units, resources or trained manpower in Nepal for poor children; hence, they die of extremely treatable but serious illnesses.

The Nick Simon Foundation of New York is building a maternity hospital that will have spaces for pediatric and neonatal intensive care units. A team of volunteers consisting of doctors, nurses, pharmacists, and respiratory therapists from United States developed a project to aid in the establishment of the PICU and NICU. They have the experience, skills, and heart for such a task. They need only the charitable donations of equipment, supplies, and funding to offset the costs for what is not provided.

By the end of the project, there will be a fully functioning, well-equipped PICU and NICU, with well-trained manpower taking care of critically ill children in Nepal, resulting in improved quality of care and decreased morbidity and mortality.

Location

Patan Hospital, Lalitpur, Kathmandu

Time Frame

Spring 2009

Institution

Patan Hospital
G.P.O. Box 252
Kathmandu, Nepal

Contact

Neelam Adhikari, MD
Chair, Department of Pediatrics
Patan Hospital
G.P.O. Box 252
Kathmandu, Nepal

Telephone:  (011-977-1) 5522266, 5522278
Email:  neelamadhikarigmail.com

ANMF/Nepal Project Manager

None

ANMF/America Project Manager

Sangita Basnet, MD
SangitaBasnetanmf.net

Project Description

Objectives

Help establish Pediatric and Neonatal ICUs in Nepal (Patan Hospital).

1. Train appropriate manpower
2. Gather appropriate equipment

About Nepal

Nepal is a landlocked country (between India and China), approximately the size of Illinois. However, it has an extremely diverse topography, with the Himalayas in the north, the plains in the south and everything else in between. It has every season, flora and fauna that can be found on earth.

The main problem has been its intense poverty. Kathmandu, the capital, is influenced by the West, but otherwise, Nepal may be over one hundred years behind in development, as compared to the US. This great poverty and bad governance has produced a 10 year-old insurgency, which has moved the development process further behind. As in every civil war the population that suffers the most is the littlest victims: the innocent children. Fortunately the dreadful war may be ending with the recent declaration of a ceasefire, the start of peace talks. Everyone, including the insurgents, is looking forward to resolving the conflict and maintaining peace.

Health Care in Nepal

Like everything else, health care delivery is very under developed. Kathmandu has a surplus of doctors, but outside Kathmandu, doctors are a rarity. Children die of diarrhea/dehydration, respiratory illnesses and malnutrition. WHO provides immunizations. There are only a few pediatric sub-specialists in Nepal.

Patan Hospital is a busy, 334-bed mission/government hospital located in Kathmandu, Nepal. Each year there are over 300,000 outpatients and 16,000 admissions. Many of these patients come from the far corners of Nepal. As well as being one of Nepal s largest hospitals, Patan Hospital is known as a charity hospital where no patient is turned away for any reason. Patan Hospital has a staff of over 65 doctors. The hospital is involved in training on a number of different levels, including postgraduate training in Pediatrics. At present there are 30 postgraduate interns and residents working in Patan Hospital. The hospital puts a high emphasis on training staff for outlying hospitals, such as its programs in MD GP (General Practice equivalent to Family Practice in USA), anesthesia assistant, nurse midwifery, and ultrasound.

Pediatric and Neonatal Critical Care in Nepal

The pediatric population makes up a significant number of patients in Patan Hospital. A wide variety of conditions are seen and treated, including a large number of critically ill children. These children are admitted to the adult ICU. In fact, there is only one facility designated for pediatric critical care in Kathmandu valley. This unit has only four beds and is ill-equipped, without appropriate equipment for the proper management of seriously ill children. Similarly, there is one 4 bed neonatal ICU in Kathmandu providing service to the general population. This facility also lacks proper equipment and trained manpower. There are no pediatricians and paramedical staff appropriately trained in the care of critically ill children in all of Nepal.

Data from Patan Hospital

Collected from discharge register, mortality file of the last 52 months

There were 9574 total pediatric and neonatal admissions, averaging 185 per month. Majority population was under 5 years, almost one third were neonates. In the pediatric population, the commonest condition was pneumonia. Others were diarrhea/dehydratrion, enteric fever, protein/energy malnutrition, enteric fever, meningitis, tuberculosis, bronchial asthma, urinary tract infections. On an average, there were about 7 deaths per month, mainly due to sepsis, followed by congenital heart disease, meningitis, hepatic failure, shock and pneumonia.

Over half the deaths were in neonates and infants less than 1 year of age. Over 7 patients a month left the hospital because nothing further could be done for treatment and survival (hospice care or management in other institutions). Data was lacking in these patients and neonatal follow-up (i.e. after newborns left the hospital).

Perinatal data

There was, on an average, over 7,000 deliveries per year, almost 600 per month. 15% of total live births were admitted Most common neonatal admission was for preterm delivery/ low birth weight, followed by sepsis, pneumonia, birth asphyxia, hyaline membrane disease. 8% of the newborns were born preterm and 13% had low birth weight

 Mortality data in neonates

• still births 1.5%
• Almost 50% of babies born 28-30 weeks gestation died.
• 2% neonates died within 7 days of birth and additional 2% died within 28 days.

For these reasons, we feel there is an acute need for the establishment of small pediatric and neonatal intensive care units. A lot of mortality and morbidity could be avoided and prevented. With the help of Mr. and Mrs. Simons from USA, a 150 bedded maternity ward with special care nursery and neonatal intensive care is being built. At the same time, a 6 bed PICU, a 6 bed tertiary care NICU and a large nursery is also planned. The physical structure is due to be completed and handed over early 2009.

Project Description

Help establish a Pediatric ICU in Nepal (Patan Hospital).

1. Train appropriate manpower

Managing critically ill children requires a team effort. This being a highly specialized field, we will need trained paramedical staff, nurses and pharmacists, in addition to physicians. This is the only way we can make a difference in the care of our children. We have a number of dedicated physicians, nurses and pharmacists from the United States willing to volunteer their valuable time to train our medical personnel here in Nepal. The healthcare of Nepal will benefit immensely from this project. The quality of care for critically ill children will improve dramatically. We are confident that the morbidity and mortality will decrease. More medical staff will be trained.

2. Help gather appropriate equipment

What we lack is appropriate equipment. We have volunteers from North America eager to help this poor country but we cannot work or train in a Intensive Care Units without equipment to support us. We will need basic necessary equipment for a 6 bed pediatric ICU and a 6 bed neonatal ICU.

Goal

Starting June 2009, a team of volunteers from USA, including pediatric intensivists, neonatologist, two nurses who specialize in pediatric and neonatal intensive care, two pharmacists and respiratory therapists will be traveling to Nepal on a rotating basis for three months to train the staff there, by conducting lectures and seminars based on a need-based curriculum. They will also work in the newly established PICU and NICU, helping to take care of critically ill children and babies while providing practical training. The volunteers will create a Protocol Handbook for the PICU and NICU in Nepal for continuity of appropriate management. After the training session is over, they will also be available to consult any management issues that may arise in the PICU and NICU in Nepal.

As the need may arise, we hope to continue this by recruiting volunteers from the United States and other parts of the world to visit Nepal to conduct seminars, CME and lectures. We will also arrange for volunteers to work, on later dates, in the PICU and NICU in Nepal, providing care and practical on-site training.

VOLUNTEER INSTRUCTORS:

A. Intensivist

1. Sangita Basnet, MD, FAAP, Assistant Professor, Southern Illinois University, School of Medicine, Springfield , Illinois
2. Saraswati Kache MD, Assistant Professor, Stanford University, School of medicine, Palo Alto, California
3. Jason Katz, MD, Miami Children s Hospital, Miami, Florida

B. Neonatologists:

1. Theresa Grover,MD, Associate Professor, Denver Childrens Hospital, Denver, Colorado
2. Daniel Batton,MD, Professor, Southern Illinois University School of Medicine, Springfield, Illinois

C. PICU Nurse Team:

1. Michele Avila-Emerson, RN, CCRN, CCNS, CPNP-AC, Pediatric Cardiac Intensive Care Nurse Practitioner,  Lucille Packard Children s Hospital at Stanford Hospital & Clinics, Palo Alto, California
2. Vanessa Mendoza-Darrell,  RN, MSN Throughput Manager, Children s Hospital Central California, Fresno, California

D. NICU Nurse Team:

1. Jennifer Norgaard,RN, MSN, Clinical Nurse Educator, Neonatology, Children s Hospital Central California,  Fresno, California
2. Leslie Williams, RN Clinical Supervisor, Neonatology, Children s Hospital Central California Fresno, California
3. Titia Boers, RN, Pediatric Intensive Care Unit Staff Nurse, Wilhelmina Children s Hospital-Netherlands

E. Pharmacists:

1. Mary Ghaffari, Pharm.D, Critical Care Clinical Pharmacist, Community Regional Medical Center, Fresno California
2. Kelly Kopec, Pharm.D Clinical Assistant Professor, Department of Pharmacy Practice, UIC College of Pharmacy, Chicago

F. Respiratory Therapist

1. Beth Lenore Care, RCP, Retired from Lead RCP, Children s Hospital Central California,  Fresno, California

Results

By the end of three months, we expect to have fully functioning PICU and NICU with appropriate, well-trained manpower that can take care of critically ill children in Nepal. We expect these units to expand, eventually, to accommodate more children and neonates, as the need arises.

We will have a library of reference materials and protocol handbooks for the continuing proper care of children and for self learning for the medical staff. We hope to arrange for experts to visit Nepal in the future for further training of staff and working in the PICU at Patan Hospital.

Material Requested

ITEM	No. of units
Ventilators	6
ABG/electrolyte machine	1
Monitors and probes (EKG probe, CVP probe, Respiration Probe, Blood pressure, Art line Probe, Pulse Ox Probe)	14
Cardioverter/Defibrillator	1
Portable EKG	1
Portable X-Ray	1
Portable Echo	1
Overhead warmer	14
Infusion Pumps	20
Syringe Pump	20
Procedure Trays (Central Caths, Chest Tube Pig tail kits, Lumber puncture)	Different sizes
Intubation Equipment (Larngoscopes, ET Tubes, Suction Catheters)	Different sizes
Photo therapy units	10
Isolettes	15
Non-invasive BiPap	2
Miscellaneous
Guide wires
Otoscopes/ophthalmoscopes	2
Glucometer	3
Oxygen delivery devices
Foley catheter
Hematocrit centrifuge	1

Training Requested

Yes

Advisors/Instructors Requested

Yes

Travel/Expenses Requested

Yes

Grants/Stipends Requested

No

Other Items Requested

None

Total Funds Requested

US $666,800

Budget

TOTAL Budget request: US $666,800

Equipment and Price Listing for Patan Hospital PICU/NICU (in US$):
ITEM	No. of units	Amount (US$)
Ventilators	6	96,000
ABG/electrolyte machine	1	16,000
Monitors and probes (EKG probe, CVP probe, Respiration Probe, Blood pressure, Art line Probe, Pulse Ox Probe)	14	154,000
Cardioverter/Defibrillator	1	6,000
Portable EKG	1	4,500
Portable X-Ray	1	39,000
Portable Echo	1	47,000
Overhead warmer	14	63,000
Infusion Pumps	20	26,000
Syringe Pump	20	26,000
Procedure Trays (Central Caths, Chest Tube Pig tail kits, Lumber puncture)	Different sizes	31,000
Intubation Equipment (Larngoscopes, ET Tubes, Suction Catheters)	Different sizes	3,300
Photo therapy units	10	30,000
Isolettes	15	45,000
Non-invasive BiPap	2	46,000
Miscellaneous		31,000
Guide wires
Otoscopes/ophthalmoscopes	2
Glucometer	3
Oxygen delivery devices
Foley catheter
Hematocrit centrifuge	1	3,000
Total		$666,800

Additional Information

None

Project Status

9/1/08	Request received by ANMF/Nepal
9/16/08	Project approved as a Fund Raising Project by the Board
3/8/09	Update from Dr. Sangita Basnet. $300,000 received from Simons Foundation.