28 May, Dolakha

Arun Bhattarai, Binod Dangal

In early January 2020 first case of COVID-19 was detected in China. Since then disease gradually spread worldwide and was finally declared pandemic by WHO in March 2020.  Similar to rest of the world, Health care system of Nepal was also facing herculean task in managing the cases of newly discovered disease. As most of the health resources in Nepal were busy managing COVID cases, majority of hospitals were lacking in non-COVID case management. Many patients are afraid to seek medical facility even in the capital city and are forced to live with the underlying disease other than COVID.

During the time of second wave of COVID, MD Residents from Bir Hospital and Kathmandu Medical College are posted in Charikot Hospital, Dolakha. Though it is only 50 bedded hospital, surprised to see every cases being managed so systematically with protocol based handbook. Along with management of COVID cases of whole district, hospital was providing other care focusing on non-COVID as well. Not only emergency surgeries like appendectomy, cesarean section, fracture fixation etc, but other elective surgeries are also performed.

A lady with chronic Pelvic Inflammatory Disease

46 years lady with chronic lower abdominal pain and vaginal discharge visited many hospitals for treatmentof chronic pelvic inflammatory disease. She is managed medically in different settings. As she is from rural part of Dolakha, she has to spend extra amount to seek medical facility during lockdown. She was starting to get depressed because of pain and frequent hospital visit. But unlike other hospitals, hospital offers admission in Charikot Hospital for definitive management. Hospital performs Antigen test for COVID and on the very next day she underwent successful surgery (Hysterectomy) with good outcome.

When so many hospitals had refused the surgery, her family were very happy with the entire service provided by Charikot Hospital which was even free of cost. The joy in the face of lady after receiving treatment was so immense.

Pic 1. Lady after successful hysterectomy

A boy with acute appendicitis

A young boy of 15 years with severe abdominal pain and fever presented at hospital emergency. On examination and investigation, he was found to have acute features of appendicitis. With proper counseling, he underwent open surgery and was managed in non-COVID bed for few days. With his good recovery, he was discharged after 3 days.

Pic 2: During and after surgery of a young boy.

An elderly male with irreducible hernia

68 years old male from Sindhupalchok presented with severe painful left sided groin mass for 24 hours. He was found to have irreducible inguinal hernia. He underwent emergency hernia repair under spinal anesthesia. 

Other Cases Management:

Charikot hospital being a CEONC site, the team is handling 5 maternity cases including C-Section. One of the recent example is for placenta previa where CS was performed successfully. Other numerous cases are also being managed. Handling of medical cases includes mental health, safe abortion, TB/HIV/Leprosy and non-communicable diseases. Continuation of CME (Continuing Medical Education) classes with hands on sessions were another unique feature of this hospital to transform rural health care.

All patients are so grateful to the hospital as non were being refused treatment in such a hard time which was always free of cost. It is great opportunity to learn how systematically such a small hospital can cope with both COVID/non-COVID patients.

Note: MD Residents involved during the posting were: Dr Arun Bhattarai (Resident of NAMS), Dr Sujan Pandey, Dr Khusbu Jha. The hospital is managed under the leadership of Dr Binod Dangal (MDGP/Hospital in-charge).

Thanks to all the staff involved during the cases management.

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