NGO health providers - Reflections from the Siddhi Memorial Hospital in Nepal
DOCTOR Sarita Khaiju, working the night shift in the emergency department, sweeps the crying baby up in her arms.She knows exactly how to soothe him. After all, this is her son.He was sleeping in a side room as she did the 8pm to 8am shift at this hospital in Nepal.The cries of a sick child have woken him up and his eyeliner - a traditional beauty mark - is starting to run.
In this department, like in the rest of the hospital, it's the informality that strikes you. Mums breast feed at the doctors’ counter. Medical notes are written up publicly. Staff and patients talk as equals, not like Gods and mortals.
Dr Khaiju works at the Siddhi Memorial Hospital in Bhaktapur, a small city in the Kathmandu Valley. The town centre is a world heritage site on the tourist trail though the tourist shops are deceiving. This is the most developed part of the country but it is still one of the poorest nations in Asia. Poverty, in the form of children playing in rubbish and pensioners selling handfuls of vegetables by candlelight, is literally at the hospital gates.
Dr Khaiju's first patient is a distressed girl with a fever and a temperature of 102c, carried in by a worried mother. Dr Khaiju suspects pneumonia - the leading cause of infant death in the district - and asks for an x-ray. But the little girl won't stay still. She has to be held down by her parents, who stay in the room for the exposure to radiation. The protective lead aprons, donated second hand, are too cumbersome for many Nepalis nurses and parents to wear, when the average female height is only 4ft 11.5ins. The machine itself is 11-years-old. The hospital is trying to source a donation for a digital x-ray machine, particularly to help diagnose the respiratory conditions.
Siddhi is run by a not-for-profit foundation and it provides low cost or free care to women and children. Most of the doctors are women and all the nurses are female. Like the majority of the hospital's facilities, the emergency department was built thanks to foreign donations, in this case the Noble House Foundation in The Netherlands.
"Many of our patients are low income people who work at one of the brick factories," says Dr Khaiju. "They earn around 200 - 300 rupees a day (£2.50) depending on how many bricks they make. They come here because they know we have charity care for poor people."
The girl's x-ray results come back and pneumonia is confirmed. She is again held down while she is cannulated for treatment with the antibiotic cefotaxime and admission to the children's ward.
A baby comes in with infantile colic, then a 17-month old girl is brought in with abdominal pains that are diagnosed with Acute Gastroenteritis. The fatal threat from diarrhea has been greatly reduced by information campaigns though it is still the second leading cause of infant mortality in the district. Dr Khaiju says: "In remote places, where there's no doctor, it can still be endemic."
The problem is that because of the distances, and parents fears about hospital bills, simple illnesses can be left until the point where they become acute. Dr Khaiju remembers one case, around six months ago, where a couple traveled by foot and bus over one and a half days from a remote village with their sick 10-year-old son. He was unconscious and suffering from seizures by the time he arrived. After treatment with an anti-pyretic medicine was transferred to another hospital with suspected meningitis, where his condition improved.
This night moves on, and so does the trickle of parents and children. They're usually greeted with a friendly 'Ke Bhayo?' ('what happened?') as they push open the door. Between midnight and dawn it is a typical mix - nasal blockages, two cases of Acute Gastroenteritis, a lower respiratory tract infection, and a urinary tract infection. The record books shows night-time is also a time for some desperate people, with still born foetuses and incomplete abortions.
During the majority of the year the emergency unit has around 25 cases a day. But from May to August, during the build-up to the monsoon and its arrival, that doubles as the hot, humid air brings stomach upsets. The emergency unit is more like a primary care department than a western accident and emergency department. Major injuries and complex cases are sent eight miles away to Kathmandu by ambulance. Some emergency surgery is carried out, like cesearean sections. The hospital has a neo-natal intensive care unit but the ventilator has not yet started operations due to technical problems.
Nepal's Government has introduced free care but many people consider their hospitals unreliable and inadequate so turn to NGOs like Siddhi. The emergency care is based on skilled professionals doing the art of the possible with the equipment and resources to hand - sometimes the equipment is excellent, at other times it is a stopgap. When the power went minutes before an emergency caeserean section, due to the inevitable power cuts, it was just a case of firing up the back-up generator.
The make-do and mend approach does not seem to worry the patients, who seem used to the informality. After all, they are getting access to treatment that neighbours just a few miles further into the hills can only dream of. "The villagers are unsure about coming, but when they do they are so happy there's a hospital like this that can provide charity care,” says Dr Khaiju.