In Nepal, there is not enough government support for healthcare. Most people have to pay for their medical treatment. Nurses administer injections, but friends and families of patients take care of the sick, bringing food, and running out to the pharmacy for medicines. Whilst there are many trained nurses in Kathmandu, there are not enough nurses in the wards, especially in government hospitals like Kanti. Doctors in government hospitals have to survive on a salary of around Rs 15,000. It's no wonder that some doctors spend a few hours at the hospital then slip off to private practices to make ends meet.
Many of the health problems of the children at Kanti are hardly ever seen in the west, where they are detected early or are no longer prevalent. In Nepal, with its limited number of often inaccessible, understaffed health posts, conditions such as rheumatic heart disease are regularly misdiagnosed and left too late. Many of these health problems are avoidable, but when nearly half the population is illiterate, then basic knowledge about healthcare is as much the problem as anything. In Kanti, the burns ward is full of children who strayed too near the open fire that is used for cooking in the majority of village homes, and burn cases from kerosene stoves. Malnourished children are also a common sight.
There is little equipment in evidence. In the Cardiac ward, up to half a dozen children are treated for various heart conditions, mostly rheumatic heart disease. When ten-year-old Padma Tamang's heart 'crashed' (it stopped beating, though she continued breathing) there was nothing anyone could do besides watch her die. There was no defibrillator, no ECG, no child-sized masks and 10 precious minutes were wasted changing an empty oxygen tank. A little boy in the opposite bed, Gopal Chaudhary, watched quietly. The look of fear in his face spoke volumes.
About three kilometres north of Kanti is a new heart hospital, the Shahid Gangalal National Heart Hospital. Under a government assistance program, poor families who cannot afford the cost of surgery can seek free treatment for children under the age of 15. "Why can't the children with heart problems go there?" I asked. The answer is that the heart hospital can only admit cardiac pediatric patients requiring catheterisation procedures or surgery, so until the child is diagnosed and any existing infections are dealt with, he or she has to wait. Depending on the seriousness of the problem, this could be from one or two months to a year or more.
Kanti Children's Hospital needs so many things. Face masks that fit children, basic life-saving equipment and even blood, as well as well-trained nurses to monitor and perform observations. Help is also urgently needed for poor families to afford what can be expensive courses of treatment. Even giving priority to simple but essential things like clean wards is vital, which in the case of the leukaemia patients can be a matter of life or death.
Nepali charities such as Social Action Volunteers (SAV) have been working for twenty years at Kanti to help the poorest families with the costs of medicine and other expenses, including travel expenses for those from outside the valley. SAV is trying to help the poorest families, but with limited resources can only scratch at the surface of a far bigger problem.
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