Scott’s Elective – Paediatrics at Anandaban
This week at Anandaban I have spent time with the paediatrician. I myself am interested in Paediatrics, and was eager to see what the service provision is like for children at Anandaban.
Dr Shaju is the paediatrician and in-fact the entire paediatrics department. She has been working at the hospital for a little over two years now and has numerous roles. She runs the paediatric out patients department (OPD) each day, as well as caring for any children admitted to the wards. As if this wasn’t enough, she also has the role of caring for the most acutely unwell adult inpatients. This is a significant work load for a single doctor, but definitely a rewarding position.
The paediatric OPD runs six days a week as Nepal has a one day weekend with Saturday being the holy day. As there is no booking system for appointments in OPD, it is a case of waiting to see how many patients present each day. This means that anywhere from a 5 to over 40 patients will be seen each day. Many of the presenting complaints are similar to the UK, with coughs and colds being one of the most common. However, I have noticed that many more children present with diarrhoea and vomiting, due to the poor levels of sanitation in the local villages. These children are frequently admitted to receive fluids for dehydration.
As there is no specific children’s ward, paediatric patients will be admitted to the adult wards. Either general, surgical or Leprosy. At any one time time there can be one or two children on each of these wards. This is very different to back home, where children’s hospitals are often entirely separated from adult units. Here at Anandaban they simply do not have the facilities or space to have a specific children’s ward. Although, with the construction of the new trauma centre, they are hoping to create space for a children’s ward. This will be located where the surgical ward currently is.
While many of the children do not seem to mind being on adult wards, I think the difference is most noticeable on the Leprosy wards, where patients stay for months at a time. Here, there are a few young girls between the ages of 11 and 14. I find the most challenging thing is to see their parents only able to visit in the evening after work, as there is no way for them to get time off to be with their children. While the girls are very well looked after, by both the nursing staff and other patients, I can only imagine how difficult this must be for families.
The final role of Dr Shaju is to manage the acutely unwell adult patients. I found this a bizarre role for the paediatrician. Though due to the irregular and sometimes small number of children present, it allowed her a greater number of patients to see. At present, many of the acutely unwell patients are referred to larger hospitals with more advanced facilities. This will change with the addition of the new trauma centre as this will include an Intensive Care Unit. She did explain that when it is complete, they will need more staff to cover the increase in patients.
It was amazing to hear how the paediatrics department has developed over the last few years and their plans for the future. Though exciting, the job is not without it’s pressures. Namely being the only paediatrician in a growing hospital. But I can certainly see the appeal of such a job in the future.