Reality

Post date: Oct 23, 2011 6:48:54 AM

"A bit of an update from here. I've been working with IFCH to get ventilated kids better. Unfortunately, they all come quite VERY sick and have been expiring despite efforts here. Many times they have come from 6-9hrs ground transportation through twisty windy uneven roads littered with potholes on the 'nice' stretches of road. And they come to this hospital after they arrive at the only government pediatric hospital. Usually by that time, their tube has been dislodged and they are looking quite poorly. (ie. gastric distention, gasping, with SpO2 at most 75%.). It's quite depressing here feeling like you're at the end of your rope all the time.

I've shifted to Dadeldhura, Far West Region of Nepal. A beautiful place, but medically strained. Doctors process anywhere from 100-200 patients in out patient. Went there on a capacity building mission to implement bubble CPAP. There was a 29WGA kid that was born the 2nd day I got there, So we setup the system. Child was delivered early after mom was bitten by a snake and went into early labour. No  other maternal history. Bubble CPAP with 100% O2 was applied to a grunting baby knowing the limitations and risks. ABx started. Day 2 baby was more active and feeding began. Day 3 patient looking slowly became flaccid, respiratory effort weaker, feeds stopped, ABx added, but (Vancomycin not available). That night, we ran out of O2 and the baby expired within 30min. Parents were extremely grateful for the efforts of the hospital. It's pretty sad to have to witness this cause had this kid been born in a developed country this kid would have probably survived.

The good news is that we've created another system that doesn't use oxygen to drive the bubble CPAP. I'll upload the video when I get back to KTM. The doctors there have been trained and in my opinion understand the setup. I made one of them setup the entire thing.

I'm leaving a guideline with them with more suitable candidates for using Bubble CPAP. If people want to look that over when it's done that would be awesome...

Other activities included re-arranging the anesthetic cart for their gyne and ortho camp that is running for about 3wks now... Re-organizing the minor operation theatre and operation theatres. As well as creating a neonatal emergency kit including advanced airway and IV start kit with drugs. Inservicing done for all medical officers and sisters (ie. nurses)

anyway, will be off to learn a bit about bamboo for a week and to visit some friends before returning to Kathmandu to do more teaching at TUTH, KMC and IFCH"

Eric