Posted by Piali Mukhopadhyay and Astha Ramaiya
Nyaya’s medical team has encountered a substantial number of fall injuries over the course of its operation in Sanfe Bagar and now Bayalpata Hospital. Such injuries are common in Achham due to the mountainous geography and poor road infrastructure. Most residents must navigate the challenging terrain on a daily basis, walking along steep hillsides and frequently carrying large loads of firewood or other supplies strapped to their backs. Children also suffer falls, often from playing in precarious locations or traveling long distances for the purposes of school or household chores. Bone and other injuries that result from falls can cause life-long disabilities if not addressed in a timely fashion. Because of the severe paucity of health facilities in this area, many patients with fall injuries do not have access to the services that they critically need to recover. In fact, the most common reason our clinical staff refer patients to other medical facilities is fall injuries.
The difficult terrain is a leading cause of fall injuries in Achham.
A nine year old male arrived at the hospital today with a severe head injury, resulting from a fall. The boy was carried from a village that was two hours away from Bayalpata Hospital. The child had blood coming out of his ears and nose and was unconscious with his eyes rolled up. Relatives reported that he had fallen from a height of approximately four feet and landed on his head. Given the nature of the injury, Nyaya’s medical team realized immediately that a CT scan was critically needed to detect which part of the brain had suffered trauma. Because Bayalpata Hospital is not equipped with such a scanner, staff were unable to provide the necessary care.
The only action that could be taken was to place the child on antibiotics to prevent infection. He was referred to a hospital in either Kathmandu or Lucknow for further care. Unfortunately, the prognosis for this boy is not promising, as the cost of transportation to these locations is likely prohibitive for his family. In general, facilities for supporting complex medical procedures such as CT scans are not available in the Far Western region of Nepal. Even for basic management of broken bones, the closest facilities are in Dhangadi or Doti, both 10-15 hour drives from Bayalpata. As mentioned above, the associated financial cost of transporting patients to these locations is often impossible for families to shoulder.
While Bayalpata Hospital will most likely not be equipped with a CT scanner in the near future, a critical expansion step will be to develop basic surgical capacity in the next two years. This will allow our clinical team to manage patients with broken bones resulting from fall injuries, as well as to offer other commonly-required procedures such as appendectomies and cesarean sections. In the interim, Nyaya is grateful for the donation of an ambulance from the Indian Embassy in Kathmandu. While we are in the process of expanding our own capacity at Bayalpata Hospital, this vehicle will enable us to transport emergency patients to other facilities that can provide necessary services.
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