Congratulations to Karuna, Manisha and Indira on passing their School Leaving Certificate exams. All three passed in first division and are now enrolled in plus 2 colleges. Also our TB patient has had her meds reduced for the remaining course of her treatment.
Kanti Children’s Hospital
I spent most of March and April in Kanti Children’s Hospital with one of our students. She was admitted with severe abdominal pain and fever. We initially though appendicitis, but blood test and ultra sounds ruled that out. TB was suspected and IV antibiotics administered, 5 days later after no improvement they were changed to stronger doses administered 3x a day for 6 hours, she was also being fed intravenously. The poor child was hooked up all day except when going to the bathroom. Once she could keep something down they started the TB meds which were 3 horse pills given at 6 am before food. She often threw them up and we had to try and get her to retake them within a half hour. Her first stay was 16 days out for 10, back in for 3, out for 2, back in for 18!
Unlike western hospitals all the care is given by the family and someone has to stay with the patient day and night. Nurses only administer drugs and write the prescriptions on scraps of paper to be brought to the local pharmacy. (Only once did we have to have a doctor’s signature and that was for post-op meds from the police hospital pharmacy). A complication of the TB was abdominal sepsis and the development of a large cyst in the stomach area. The hope was that the TB meds would shrink the cyst, but this did not happen she was later admitted to have the cyst removed.
Her mom is in the women’s prison in Kathmandu (this is why I am not giving her name) and had to come to the hospital to give her permission (thumb prints because she is illiterate) for the surgery. We arranged for this to take place in an office far removed from the ward so that the other patients and their parents would not know. She was accompanied by 8 police personnel and was not allowed to stay while the surgery was performed. Once they opened her up they discovered the sepsis had woven a tight tissue web around the cyst and they were unable to remove it and they just closed her backup. The surgeon’s recommendation was to just keep taking the TB meds and comeback in 6 months and try again.
I was leaving in 2 weeks and this was unacceptable to me. The TB doctors gave me the name of a gastrointestinal surgeon at another hospital, but told me not to tell them he sent me as the patient is a child and the hospital only treated those 15 and older. We met with the surgeons and they also said they did not want to operate, but would drain it if there were any problems and assured me it was safe for me to go home.
There were many nightmares associated with getting proper care and medicine for this child. Once she was cleared to return to school she was going to have to go to a TB clinc everyday to get her meds. We went the Nepali way and found someone who knew someone at a clinic and were able to get 10 day supplies.
I did the day shifts and many of the surgical nightshifts, our boys who work with our partner Art for Education and Bishal did most of the night shifts. They had to sleep in a sleeping bag on the floor on a ½” mattress and then go to work in the morning. It was a group effort to manage her care. There were some wonderful nurses and doctors and parents who also helped us along the way. My thanks to all.