Christmas appeal 2019: help us improve access to surgical care for children with inguinal hernia in Nepal
Our impact is global
Ensuring safe, timely surgical intervention worldwide is vital in reducing death and disability from operable conditions. The RCS community have been involved with surgical work globally in resource-poor areas for over a century and we continue to grow and increase our impact in some of the less privileged parts of the world.
Access to safe surgery for children
Inguinal hernias in children are one of the most common surgically treatable conditions due to failure of an opening in the groin to close before birth. This can result in bowel obstruction. They usually require semi-urgent repair in high-income countries but many of these hernias go untreated in Nepal because of a lack of access to safe surgical care, resulting in lifelong disabilities or premature deaths.
Paediatric surgeons in Nepal number less than ten and serve a population of almost 29 million of which approximately 40% are children. They face the impossible task of treating all 5% of the children that present with this condition. To worsen the matter the majority of these specialists are based in the capital city Kathmandu. In Nepal, a child may wait over two years for what is considered an easily accessible operation in the UK. In too many cases they do not receive the operation at all.
Paediatric Inguinal Hernia Project
This Christmas the Royal College of Surgeons (RCS) has teamed up with Health Partnership Nepal (HPN) to improve access to treatment for this condition. Together we will train doctors in rural Nepal to perform safe surgery for children who would not otherwise have access to curative treatment.
Each year, a rural hospital will diagnose 100 children with inguinal hernia. A hidden number of children die from complications of inguinal hernia because most families cannot afford or access surgery to cure this condition.
Nepal has challenging hilly and mountainous terrain causing barriers to access healthcare, which is based in the main cities. It can take several days by road to reach Kathmandu from remote villages.
Jessica Ng, Shabnam Parkar and Zahid Mukhtar
Ms Jessica Ng, Ms Shabnam Parkar and Mr Zahid Mukhtar will lead the paediatric inguinal hernia project training in both design and delivery. Ms Ng is a Paediatric Surgical Registrar training in London. She helped set up the HPN charity as a medical student in 2010 and to date continues to lead and co-ordinate clinical and training projects in Nepal. Ms Parkar and Mr Mukhtar are consultant Paediatric Surgeons at St George’s Hospital, London. Ms Parkar has been involved since 2011 during her paediatric surgical training and remains part of the leadership team at HPN. Mr Mukhtar has been the charity’s senior surgical lead since 2010.
Tried and tested
We know this works. After establishing a link with Charikot Hospital in May 2017, HPN returned to this rural region in May this year with a team of four UK surgeons. In just two days they were able to deliver the pilot inguinal hernia project.
One senior Nepalese rural doctor was the main trainee with an existing skill set including delivery by C-section, fracture management in adults and children as well as being the hospital’s physician. An additional four rural doctors also received training and assisted during surgery.
Teaching included a workshop on inguinal hernias in children and their care both outside and inside the operating theatre. Six children ranging from two to seven years old with inguinal hernia were selected in advance to receive free surgical treatment by UK paediatric surgeons and Nepalese doctors. During these live operations, the Nepalese doctors were trained to perform inguinal herniotomy under regional anaesthesia and sedation. At the end of training, the main trainee was competent in performing this operation independently. All children were discharged the next day and at three-month follow up, there were no complications.
You can ensure this surgery reaches more children
Following the success of the pilot in May, our Christmas appeal will fund expansion of the existing pilot project and deliver training across the multidisciplinary team providing surgical care for children. Training by the UK team will be extended to ensure rural health professionals have sufficient time and exposure to learn how to perform paediatric inguinal herniotomy and improve all-round surgical care for children.
The project expansion will train rural doctors, anaesthetic assistants, nurses and theatre practitioners who are working permanently at three additional rural hospitals.
- Bayalpata Hospital, Achham District
- Salyan District Hospital
- Sangkhuwasabha District Hospital
Alongside Charikot Hospital, they serve a population of approximately 120,000 children.
This two-year project will consist of six-monthly visits by the UK surgical training team to Nepal. On each visit, the team will work with two rural hospitals over 14 days and includes follow up of previously trained centres to re-evaluate and further improve surgical care for children. There will be a shared learning network between the project hospitals to help develop this specific surgical service for children and the communities they serve.
After training doctors will be able to safely perform inguinal herniotomy in children, and both doctors and anaesthetic assistants will be proficient in providing regional anaesthesia and sedation for children.
The impact of this project goes beyond hernia repair in children; most centres are managing other surgical conditions such as acute fractures in children, C-sections and other emergency surgery for adults. It will ensure theatre practitioners reach a high standard of all-round surgical care and will have a positive effect on ward nurses who look after children before and after surgery.
How you can help this Christmas
The risk of untreated inguinal hernia complication is 10% and of these the risk of death is 10%. Surgery can prevent this, cure the condition and improve quality of life. It will cost £16,720 for UK clinicians to train teams at four rural centres to perform this life-changing procedure.
This Christmas, your generosity to the 2019 Christmas Appeal can make safe surgery available to children in rural Nepal.