Posted by Dan Schwarz, following conversations with Ruma Rajbhandari
In a blog post last month (“Severe Storms in Achham”), we related the story of a two year old girl who had suffered a traumatic head injury after falling from a height of one storey. At the time, we were happy to report that, despite an initially concerning presentation, the girl did very well and was able to be sent home two days later in good condition.
Unfortunately, this is not always the case. In Achham, due to the extreme lack of medical resources, our staff at Bayalpata Hospital are frequently faced with difficult life-and-death decisions, but do not always have the necessary tools to deal with these problems appropriately. The recent misfortune of a local boy exemplifies these struggles.
On November 15th, a four year old boy was brought into the Hospital following a fall from a height of nearly three stories. Despite having been brought immediately to the Hospital by his father and aunt, he was barely arousable on arrival, with significant swelling over his face and right eye. Even more concerning, his left eye showed signs of high pressure inside his skull (which can be common with head trauma), a very dangerous condition that can lead to severe neurological damage if not rectified immediately. Unfortunately, given the lack of neurosurgical services at Bayalpata, our staff quickly exhausted their limited medical treatment options, realizing that a higher level of care was quickly necessary.
The following is paraphrased from conversations with Ruma Rajbhandari, MD, who saw the patient at Bayalpata Hospital.
“…[but] what he really needed was a CT scan and a neurosurgeon. We advised the family that we had done everything that we could at the hospital and that the boy needed further care at an institution that could provide neurosurgery. Unfortunately, the closest neurosurgeons in the country live in Kathmandu which is a day and a half away by bus. The other closest neurosurgical facility to Achham is in Lucknow (India) which is a 2 day trip away. In cases like this where neurosurgery is required, it is imperative that it be done quickly, within the first 24 hours to prevent further neurological damage. The costs of such a trip including the medical costs of surgery likely means the family will go through its entire life savings and have to take out significant loans.
As doctors working at Bayalpata Hospital, we are faced with a serious moral dilemma. Should we refer the child to a higher level of care when we know such care is extremely difficult to reach both physically and financially? In most cases of such head injury, because of the long duration to reach a surgical facility, the child either gets better or dies on the way to the facility.”
Following discussions with our staff, the boy’s family made the difficult decision to take their son to Dhangadi, a 10-hour drive through mountainous terrain, where there is another hospital. Knowing full-well that there likely will not be sufficient neurosurgical care in Dhangadi either, they nonetheless found a jeep in the middle of the night, and went out in pursuit of anything they could find that would be better than what we were able to offer them.
At the moment our staff at Bayalpata Hospital has not received any further information regarding the boy’s condition. We will update this blog when we hear further.
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We thank you, our supporters, for helping us to provide the important and often life-saving health care services that we are able to. Nevertheless, as our staff grapple with difficult choices like this one, we recognize our moral obligation to continue striving for higher standards of both medical care and quality of life for the communities we serve. We believe fundamentally in the right of health for all people, and we thank you as you continue to support us in our work for health equity in Nepal.