In September, an article was published in the well-respected journal Pediatrics entitled “Challenges in setting up pediatric and neonatal intensive care units in a resource-limited country” which detailed the planning, implementation, and ongoing maintenance of Patan Hospital’s neonatal and pediatric intensive care units (NICU and PICU). Patan Hospital is one of the leading hospitals in Kathmandu, Nepal. The article discusses the authors’ experiences from 2006, when discussion of developing the NICU and PICU first began, through the implementation in 2009, to the ongoing operations and challenges they still face in the delivery of care in 2011.
The article addresses broad questions including the financing of such projects, the challenges of limited human resources, and ongoing training with transient staff. The authors also describe the challenges of providing high-level care services in a fee-for-service healthcare environment where the majority of patients live below the poverty line. It also discusses more specific questions, including the number of square feet allocated to ICU beds in resource-rich versus resource-limited areas, the challenge of developing a “culture of implementation of infection-control strategies, critical thinking and individual accountability” in medical environments without such, and limiting factors such as managing increased intracranial pressure with only fundoscopic examination capacity.
Basnet, Adhikari, and Koirala’s article is an excellent piece, offering insights into the implementation of intensive care units for practitioners in Nepal, and in similar resource-limited settings around the world. The global health and implementation science fields are still quite young, but work such as this promises to be integral to the development of a better understanding of such challenges. Through this and similar work, best practice models will ultimately be developed to address these issues and promote the best possible care for patients globally.
Nyaya is indebted to the authors for allowing us to share their article. We encourage our readers to learn from their experience as we have.
Ryan Schwarz, MD, MBA, is the Vice President of US Operations for Nyaya Health. He is currently a resident in the Harvard Brigham and Women’s/Children’s Hospital Medicine-Pediatrics Residency program.