Local heroes create ICU in Nepal

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Graphic created by Katie Rearden

With 196 countries in the world, most Americans have probably never heard of the small country of Nepal. Located just above the country of India, housing the notorious Mount Everest, Nepal is a poor country with limited resources.

Even though Nepal is on the other side of the globe, it has a special connection for one local Springfield family.

While doing her fellowship at Washington University in St. Louis in 2002, Dr. Sangita Basnet Koirala decided she wanted to build an intensive care unit (ICU) in Nepal. Basnet, who was born and went to medical school in Nepal, moved to the United States in 1993 in order to complete her medical fellowship.

Basnet had always wanted to help Nepal in some way, and she decided the best way to help would be to use her specific skill set as a doctor.

“It’s a very poor country obviously; Nepal is very poor, one of the lowest 10 poorest countries in the world. So, obviously the main thing for healthcare there is preventive care, which the general population of Nepal really needs,” Basnet said. “Children die because of critical illness in Nepal all the time and it starts with a primary care problem. Eventually, malnutrition, malaria or anything like that, eventually becomes a critical illness before they die. People need to know about how to manage critical illness and how to take care of very critically ill patients. Then, they can prevent it.”

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An intensive care unit patient room funded by the Koirala family – photo courtesy of Dr. Basnet

Even though there are some ICUs in Nepal, they are nothing like those in the United States. Most of them are very small, and lack doctors and other medical professionals trained in critical care. When children get sick, they can get very sick very quickly, so most of the ICUs were built out of necessity because of the high burden that critical illness has in Nepal.

“You can’t open a six bed ICU and expect to solve a lot of problems in the country. So this is more of awareness and education type of ICU in addition to managing critical care,” Basnet said. “It’s a very small ICU. The goal is to teach them critical thinking, what we call critical thought processes. So they can use that critical care thinking to manage illness so kids do not go to that extreme level that they have to go to the ICU.”

Basnet conducted a study, and found that 17 separate hospitals in Nepal have created ICU facilities over the past five years.

Although Basnet first had the idea to build the ICU in 2002, the preparation process began in 2006 and, by 2009, the ICU was completed and ready to open. The ICU had to be designed and the placement of necessary items such as beds, monitors and headers had to be decided and laid out as well. In addition to all of the background work that had to be done, a protocol and pharmacists protocol had to be created in order to fit that specific ICU.

“We took about 22 volunteers from all over the world, not just from the United States, but also from the Netherlands and other places also wanting to go to Nepal to treat people over there. They were not just physicians, they were nurse educators, nurses, pharmacists, respiratory therapists and physicians and all of those kind of took turns to go there two to three weeks at a time. We developed a curriculum so everybody knew what they were supposed to teach,” Basnet said.

The staff went on a rotating basis. At one time, there were about six or seven physicians, many nurses, two pharmacists and one respiratory therapist. In the end, 60 physicians and 100 nurses were trained, and after three months of training, the ICU unit officially opened.

One year after the ICU opened, Basnet conducted a retrospective review with data including who was admitted into the ICU, along with other data such as their conditions. She has not conducted another retrospective review since then, but hopes to do another one soon.

Sadly, Basnet found that 26% of people died while admitted in the ICU. She also found that the most common reason why people were admitted into the ICU was due to septic shock.

Septic shock is a condition where the heart, liver, lungs and other organs become damaged after a patient goes untreated. It happens when an infection gets into the bloodstream and blood pressure drops and heart rate increases. It is most common in people who are either very young or very old.

Basnet visits Nepal every few months and helps to manage the ICU. Both of her children, Sajan and Sameena Koirala plan on pursuing careers revolving around health or medicine. Sajan is planning on getting his Masters in Public Health and began school at Tulane University in mid-August and Sameena is currently a senior at SHS, but later plans on going to medical school.

It clearly takes a very strong person to recognize a big need and carry out a huge project to fulfill that need. The work Dr. Basnet has done has saved countless lives, and she has made a monumental difference in the lives of many Nepali people.

 

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