There is high demand and need of pediatric surgery in the middle-lower income countries. The World Health Organization’s global burden of disease (GBD) estimates that 11% of GBD can be treated with surgical care and the highest surgically modifiable Disability Adjusted Life Years (DALY) in Asia. Different report shows around 50% of the population in low income countries have cumulative risk of 85.4% for having surgical condition by age 15.
Country has prioritized Reproductive, Maternal, Neonatal and Child Health (RMNCH) services well over a decade with international supports. Due to many circumstances like difficult geography, very low doctor patient ratio, less numbers of health care workers in the country, unavailability of specialized surgeons at remote hospitals, Nepal lacks overall access to health care and pediatric surgery at remote setting is a great concern of interest at this stage of health care system of Nepal. It is found that there are only 2 MCH surgeons and 25 pediatric surgeons in the country.
A unique model to serve for pediatric surgery is being practiced at Pashpati Chaulagain Memorial Hospitlal (Previously Charikot Hospital). MD general practitioners were initially trained by pediatric surgeons from UK in 2018 (A pediatric hernia surgery project of Health Partnership Nepal, a UK based charity organization) in collaboration with Royal College of Surgeon. After the training, MDGPs are able to continue this surgery at the same hospital and able to manage 121 pediatric hernia cases, 56 pediatric circumcision, 8 surgery for undescended testis, 39 appendectomy and 2 for intussception over 2 years. These services have provided better access to pediatric surgery to this region.
A different strategy to cover up access for the surgery is needed in the country. Strategies might be task shifting approaches to MDGPs and senior Medical Officers, increasing more seats for general surgeons and MCH pediatric surgery, organizing specific training programs focusing on managing common pediatric surgery illnesses and increasing specific infrastructure for pediatric care to every hospital.
(Note: Dr Binod Dangal, MDGP consultant leads pediatric surgery care at Pashupai Chaulagain Memorial Hospital).