A journey from KH to KCH

A journey from Kanti Hospital (KH) to Kanti Children’s Hospital (KCH)

The KantiHospital was established with the support of the then USSR government in the year 1963. There was a capacity of fifty beds.

There were very few hospitals in the capital city. Bir Hospital (NAMS) Maternity, MilitaryHospital, InfectiousDiseaseHospital, PatanHospital, Shanta Bhawan Missionary and T.BHospital were the only health delivering centres.

BirHospital located in the city centre was the single largest reference hospital. It small paediatrics unit was looked after by the pediatricians who were trained abroad as there was no medical school in Nepal.

After five years of successful running KH was handed over to the Ministry of health by the USSR government in the year 1968. While the government was supposed to manage the hospital the senior paediatrician voiced concerns that a separate Children’s Hospital was also needed in the country.  The government eventually agreed to the proposal and added one hundred more beds to the hospital. In the year 1970 Kanti Children’s Hospital (KCH) started providing its services to children up to the age of fourteen, however some facilities were provided to those up to the age of 18 (i.e. Oncology). From then on the hospital began receiving funds from the government; a budget which we still receive today. There are two types of payments given. ‘Regular’ and ‘Developmental’. The ‘regular’ includes the salaries and allowances of the government staff only. Whereas the ‘developmental’ incorporates funds used for general hospital upkeep such as construction, purchasing of equipment and medication.

When KCH started working we were running the hospital with old equipment installed in 1963, many of which were out of order. Markets for medical accessories and lack of trained professionals were a big problem; therefore most of the cases were diagnosed based on evidence, history and the presentation of the sick child. From then on, KCH became known as a central referral hospital as no other hospital in the valley catered for children (Except old ShantaBhawanHospital). If the child was less than 14 years old, the men working at the registration desk would direct the families to KCH.

As no other hospital accepted children, KCH was forced to expand its capacity from 150 to 190 beds. This was achieved by the used of corridors, floors and extra rooms throughout the year.

In 1974-1975 paediatric surgical services began in the old RussionBuilding (which no longer exists) by local Nepalese paediatric surgeons. Despite this, KCH was lacking in many other departments including anesthesiology, an issue still remaining today (Later Dr. Angela Barlow, Dr. Sylvia alliscon, Dr. Michael Carter, Dr. C.J. Johnson, Dr. Juliyena Freeman from UK helped to run the anesthesiology department in full capacity for five years. Then Nepalese anesthesiologist took over the activities on their own. Later, late Elliot J.Rhine Associate Prof University of Ottawa, Canada has supported the department for academic activities. IOM has started providing a seat for MD anesthesiology for the staff working at KCH.

In the year 1978-1979 the Institute of Medicine (IOM) started the MBBS programe in Nepal. The paediatric department of IOM was posted here at KCH. This was an example set-up by the paediatricians (i.e. two different ministries working together to save the lives of sick children admitted here at KCH). The student of IOM visited different hospital for practical training; KCH was the only hospital for children. Therefore from the beginning KCH has focused teaching and learning for their staff.  KCH is not a university hospital; however our goal to develop KCH as an institute of child health is on its way. At present many students come to KCH (i.e. post graduate students from IOM and NAMS, interns for peaditric and anesthesiology other technical students for lab Radiology, Nursing and hospital management). KCH also provides a Medical Elective Course (MEC) for visiting students and has been very popular among P.G. undergraduate, pre-medical, Physiotherapy and nursing students. This program was initially started in 1992.

1981-1990 personal donations of incubators, ventilators and transportation van were made from late Madam Buzak from Germany. This was when the two beded Neonateal Intensive Care Unit (NICU) was started.

After the establishment of Nepal paediatric Society (NEPAS) in 1981, KCH got  an opportunity to train its staff through different training programs conducted by NEPAS (i.e. GOBI, CDD, ARI,  Injury Prevention, Infection control, IMCI, Breast feeding Neonatal/Paediatric advanced life support  Nutrition  food program, Paediatric oncology updates (Dr. Barry Pizer, Liverpool), regular CME, out reached programs, Seva pasal (which no longer exists) and Birami kuruwa ghar (Presently looked after by Social Action Volunteers) and oncology  fund.

1984 an official visit made by late Ryutaro Hashimoto, former prime minister of Japan, became a milestone in the history of KCH. With his personal efforts KCH was lucky enough to get the 1st equipment grant aid (1986) under which all the old equipments which were installed in 1963 were replaced with new equipments and new units were added:

  1. Six more bed were added to 2 bedded NICU (even today we are running 8 beds)
  1. Four bedded Paediatric Intensive Care Unit PICU (even today we are running 4 beds). At present Neonatal/paediatric ICU are name as HASHIMOTO Intensive Care Unit.
  1. Four bedded Surgical Intensive Care Unit SICU (even today we are running 4 beds)
  1. Expanded Lab Service (i.e. Microbiology, Hematology, Bio chemestry, Emergency Lab for 24 hrs were started before this lab use to be open during the OPD hours only on working days.)
  1. Operation Theater, Radiology Department, Burn Unit, Oxygen plant (which is out of order) water treatment plant, Electricity supply, autoclave physiotherapy, Repair and Maintenance Section, Immunization and Family planning and Laundry were upgraded.

After hospital was upgraded under the help support of JICA (Japan International Co-operation Agency) we needed more trained manpower to run the hospital. The Hospital Development Board was asked to recruit the needed manpower through the hospital, due to less possibility of getting regular staff of the government KCH started to employ its own staff. (Which included doctors, nurses, paramedics, supporting and administrative staff). This brought financial burden to the hospital board to raise money for the salaries and allowances to its staff (even today more than fifty percent of the employees working here at KCH are the hospital staff). For the future expansion an the development of KCH more land was acquired from the local people for which money was provided by the government.

After the grant aid (1986) we received expert Japanese Volunteers to train our staff and in their counter part some of our staff visited Japan (sponsored and supported by JICA). Up on their return they were able to train their juniors, this is how transfer of technology began and started running the specialized service on our own.

Support by Ministry of Health and Population, Logistic Department, Child Health Division and Bal Bikas Samaj to run a diarrhoeal camp for two occasions. People became aware of ORS (Nun/Chini pani) and WHO recommended ORS packets. As we were running oral rehydration therapy (which no longer exists).

1990-2002 The people’s popular movement of 1990 re-established the multiparty democracy in the country. Since then the concept of privatization on health education and other field came in to the picture (resulting at present around 15 medical colleges “government and private” another four are on  pipe line, many private hospital, nursing homes, universities, academic centres were started in the country).

Now-there was a need to expand the hospital facilities. TUTH got another expansion project from JICA, but like in the past (when established) paediatric beds were not added to the hospital as all the paediatric department of IOM was deputed here at KCH. So when there was a need late HASHIMOTO’s effort helped KCH to receive another project to add hundred more beds to KCH, under which old termite infested Russian block was taken off and new surgical block came up with ICU, Emergency, OPDs, Laboratories, X-ray, EEG {to day we have been able to add Direct Digital Radiography from RF system Japan, co-ordinated by ADRA Nepal and CT Scan through the Ministry of Health And Population} were upgraded and renovation were done in the remaining building. More staff were added from the hospital.

Burn unit was renovated with the help support of Ms. Judy Ongg (family friend of HASHIMOTO). KCH started getting more referred  cases from different hospital which became  possible due to more  health facilities with in the government and private sector (i.e diagnosis CT scan, MRI and expanded laboratory services). We were lacking many others sub specialized paediatric services, as we were forced to refer the child to other hospital for (i.e. Orthopedics, Neurology, Cardiac Surgery, Nephrology, Dermatology, Ophthalmology, ENT, Counseling and for diagnostic etc.). This brought the concept of expanding sub-specialized services, so in the year 2002 fifty more beds were added to the hospital (i.e. oncology. cardiology and Neonatal Intermediate Care Unit (NIMCU). Even few more staff were added from the hospital board to run three hundred bedded hospital.

KCH Oncology Fund was initially started with the money provided by Ms. Carmel Dersch, UK (US$ 3844.90) in the year 1997. Before that we were treating the child with cancer in the medical ward some small support was provided through NEPAS. After the establishment of KCH Oncology fund we started running oncology ward and money was raise to the fund through visiting elective students from abroad. With the help support Ms Carmel we were able to train our nurse doctors abroad in the field of peaditric oncology and Child Development Centre. In the year 2005/2006 we were able   to get the matching fund from the health tax fund. Which we are getting even today.

Hospital feels proud to state that we are running 20 beds free of costs for cancer (beds, investigation, {CT scan within the hospital quata} Chemotherapy and other drugs are provided as per the capacity of the fund).

Likewise, KCH cardiology fund was initially started by the money provided by Prof. Dr. Anne Wedemeyer, Paediatric. Cardiologist USA who came here in 1997 and again in 1998, with her support we were able to start 6 bedded paediatric. Cardiology unit, Now Health Tax Fund has started providing Fund even for Cardiology. Our aim is to make it free ward like the oncology in very near future and have to add more beds strength; we are closely working with SAHID GANGALAL HEART FOUNDATION as they do not have paeditric beds at present.

Hospital have three types of  bedding  system, some are totally free (Oncology, Tetanus) other are partially paying (ICU’s , NIMCU, Surgical, Burns , General Medical, Annex, Observation) and paying beds includes special cabin, paying medical ward, paying surgical ward. For those being admitted in the free and partial ward hospital provides free food. For partial paying beds we asked parents to pay the hospital bills (as hospital is support to raise the money for staff) if the parents they are unable to pay, then hospital support then by every means.

To support needy patients we have HASHIMOTO TRUST FUND initially supported by late HASHIMOTO, even after his demise his families and friends has support the fund ( i.e. Laliguras Women’s Organization has also supported ). KCH oncology fund, KCH cardiology fund, Bipanna Nagarik Kosh (throuth ministry of health and population). Ambulances services are provided to transfer the patient (within the valley) to other hospital; medical shop is open around the clock to provide services.

We have some organization like Social Action Volunteers(SAV), Brahmasthani Awareness Society (BAS) running a charity shelter home for those who do not have access in the valley, Dirghajeevi  (mainly dealing with cancer cases), Child Welfare Scheme (CWS), mainly working for surgical needy parent.

Burns training in the past supported by Dr. Bianca Mathesius (Lee) and support through appeal fund has helped many patients with medicine and diagnostic facilities. At present Alder Hey Children’s Hospital, Liverpool is helping us to upgrade our services (Consultant Plastic surgeon Dr. Sian Falder, Dr. Tom Potkor, Neonatal/ Paediatric  Advance Life Support visits of staff (this was all been possible through MS Carmel). British Council, Medicine for ALL The Netherlands, Henkel KGA, Germany, Indian Embassy, UN Women’s Organization Sai Mitra Samuha, Asman has helped. UniversityCollege of Dublin, Queens Medical Collage Belfast, North Ireland has supported oncology fund. We are thankful to all of them named or unnamed who have contributed KCH.

After the amendment of rules and regulation of hospital in the year 2063 many of the hospital employees were made permanent staff of the hospital.

We are grateful to all those who have trusted KCH and all the visiting students from abroad who have come to KCH of their elective.

At Last, there are not even one thousand five hundred beds separated for children in the Country (government/ private) so the bed strength should be increased with more sub specialized services in the Centres whereas need to increase general paediatric beds in the rural part of the country. Standard treatment protocol for children might be fruitful (NEPAS could work for this as all the paediatricians working elsewhere are the members of NEPAS).

Around 40 percent population are below the age of fourteen, paediatric age group need to be revised as school going age is  sixteen, government plan is to provide free education, therefore paediatric age group should be up to sixteen and medication for children should be free “TRULY A CHILD RIGHTS “