The Tokha based international hospital is taking significant strides in pediatric and neonatal surgery.
Few months ago, a baby delivered to a Nepalese couple at Duncan Hospital, Bihar, India was noted to have breathing difficulty and frothy oral secretions after an attempted breast feeding. The doctors there had tried feeding the newborn through a naso-gastric tube, but it was found to be coiled in the neck on x-ray examination.
After the baby was brought to Grande International Hospital in Kathmandu, Dr. Ashish Lal Shrestha, a Pediatric and Neonatal Surgeon, handled the case. The baby was diagnosed with a rare condition called Esophageal Atresia with an associated Trache-Oesophageal Fistula (EA/TEF-Type C). There was a blockage in the baby’s Oesophagus (food pipe) with an abnormal opening with the airway. EA/TEF is an emergency and a life-threatening condition, needing surgical management to establish feeding and to prevent lung damage from exposure to oesophagal fluids. A team of doctors, led by Dr. Shrestha, successfully operated on the baby. After a few days of operation, the baby was able to swallow breast milk without any difficulty and was subsequently discharged from the hospital after ten days. Dr. Shrestha holds a M.Ch. (Magister Chirurgie) Pediatric Surgery degree from the renowned Christian Medical College of Vellore, India having accomplished both his undergraduate training (MBBS) and Post-Graduation in General Surgery (Master in Surgery-MS) from the same reputed institute. He also holds the distinction of being the first and the only Pediatric Surgeon to own such a qualification in Nepal. Pediatric Surgery is a surgical higher specialty, a branch that deals with the surgical conditions of children from birth till 18 years age.
Dr. Shrestha says that-“Neonatal surgeries are however not free of risks. Newborns are very sensitive to temperature changes and susceptible to infections. Also, loss of lesser volumes of fluid or blood could translate into a greater deficit and cause rapid fluid shift and drastic physiological changes. All the reason why extreme care and gentleness is exercised in handling delicate newborn tissues and organs. Just as minimally invasive techniques are desirable, appropriate drug dosages, fluid volumes and anesthetic practices form the pillars of newborn surgery, needless to stress the role of a capable team of Neonatologist.
Like newborn surgery, pediatric solid tumor and cancer surgery represents another facet of Pediatric Surgery. Dr. Shrestha says,- “If diagnosed in time, childhood cancers have a favorable outcome. Most of these tumors are chemo sensitive and have a good response to chemotherapy. Also an appropriate stage wise treatment offers greater survival”- he says remembering a 4 year old boy from Chitwan treated for a Kidney tumor by him last year at GIH. Talking about general emergencies, he adds-“Appendicitis is the commonest surgical reason for children to present to any hospital emergency with sudden onset abdominal pain.” At GIH, he prefers to perform Laparoscopic operation for the same with which he says-“Children suffer less pain, return quickly to normal life, can start oral feeds soon and do not have long term complications of open surgery and get discharged within a day or 2 following laparoscopic appendectomy”. Congenital conditions of the kidneys, ureters and bladder along with external genitalia form another aspect of Pediatric Surgery called Pediatric Urology. Dr. Shrestha has successfully accomplished training in the same from Munich, Germany recently and has been delivering specialized Pediatric Urological services at GIH thenceforth.
Dr. Shrestha says –“People in Nepal are still little apprehensive about operating in children and Pediatric Surgery as a specialty is again new in Nepal. But the scenario seems to be changing”.
Having handled quite a few complicated cases over last few years at GIH, he hopes and believes that even the most complex of pediatric surgeries are not unachievable in Nepal with advancement of expertise and increasing awareness in this field.