Child Protection, Recognition and Response’

‘Child Protection, Recognition and Response’ a 2 days Training course organized at Kanti Children’s Hospital, Kathmandu

Dr R Chapagain, Consultant Paediatrician, Kanti Children Hospital, Kathmandu

Dr D Upadhyay, Consultant Paediatrician, Community & Child Health, North Cumbria Integrated Trust, UK

Background: The Child Protection: Recognition and Response (CPRR) Course was developed by the Royal College of Paediatrics and Child Health (RCPCH), Advanced Life Support Group (ALSG) and National Society for the Prevention of Cruelty to Children (NSPCC), UK in mid-2000.  This one day child protection training course is designed for healthcare professional including doctors and nurses and is run in several centers in the UK as well as in some overseas countries including Nepal. The aim of the course is in Nepal

1. To raise awareness of child abuse and neglect in Nepal. 

2. To encourage effective response including referrals to the appropriate agency.  

3. To support the development of a multiagency response in the Nepalese context when child abuse is suspected

This report is a summary of training at the Kanti children’s  Hospital on 9th  and 10th December 2021 .This is  a part of an ongoing child protection training programme supported by So the Child May live (STCML) and Health Exchange Nepal ( HeXN) UK and organized by Nepal Paediatric society (NEPAS) and Paediatric Nursing Association Nepal (PNAN). It is aimed to increase the awareness of child safeguarding among doctors and nurses mainly working with the children and the young people.

NEPAS had developed a manual with reference to RCPCH module which is being used for this course.  These session were organized by Nepal Paediatric society (NEPAS) and Paediatric Nursing Association Nepal (PNAN). This course is aimed for the pediatricians, nursing staff, post graduate residents and post graduate nursing students   working in Paediatric OPDs and Wards of the different hospitals of Kathmandu and Dhulikhel.

 The workshop/Training was financially supported from ‘So  The Child May Live (STCML)’ and the ‘Health Exchange Nepal (HExN)’ UK. The local arrangements and resource people were managed from Nepal Paediatric Society (NEPAS), Paediatric Nursing Association Nepal (PNAN) and Kanti Childrens Hospital

Facilitators: Dr Deepak Upadhyay, Consultant Paediatrician, UK.

The NEPAL team

·         Dr. Ram Hari Chapagain,  Consultant Pediatrician, KCH/ Associate Professor NAMS /course Director

·         Dr Samana Sharma, Consultant Paediatrician,  Sreecheer Memorial Hospital,   Banepa

·         Dr. Smriti Mathema,  Assistant Professor of Paediatrics,  Kathmandu Medical College

·         Dr. Jasmeen Maa: Consultant  Child Psychiatrist, Kanti Children’s Hospital

·         Advocate  Mr. Kedar Chalise,  NCRC ( national council for Right of children), Nepal

·         Ms. Apsara Pandey, Associate professor, Nursing Campus, TU

·         Dr Moon Thapa , HOD and Associate professor,  Nepal Army Hospital

·         Ms. Sita Karki, Associate Professor,   KU school of Nursing

·         Dr Anshu Jha  , Consultant Paediatrician, Kanti Childrens Hospital

Course:  Twenty five participants each day (total 50) took part as trainees consisting of pediatricians, Paediatric nurses and resident doctors from Kathmandu Medical College, Kanti Children’s Hospital, NAMS, Nepal Army Hospital, and Dhulikhel hospital.

The pre training meeting (virtual) of the faculties\ facilitators was hold 2 day prior to the training date. The faculties discussed the content as well as few additions to the training materials. On the 9th December 2021 Dr Ganesh Rai, President of NEPAS and Dr Deepak Upadhyay joined and the faculty meeting took place at 9.00 AM and the training started on time.

Feedback/Recommendation from trainees and the trainers: This training is good and gives holistic idea of Child protection in Nepal with global prospective. NEPAS has to take lead role in distribution of this material and also for the continuation of training. The training was highly valued by the trainees. The materials will be useful resources for the training conducted by the government agencies. Till now, the Government, medical universities, NMC and other organization were the potential parties to use this training module.  We should incorporate this material in Nepal Health Training centers and Ministry of women and children’s for wide acceptance and for intensification in large scale, till the government institutions, medical and nursing universities own and recognize this training.

Conclusion

This joint program highlights an example of effective collaboration between professionals from high –income and low-income countries for the best interest of children worldwide.  The aim was also to identify the Named doctors and nurses in each hospital which has been achieved in many centers. It also aims for the establishment of an effective multi-agency referral and management pathways for the children presenting with suspected abuse or neglect.

HExN LEJOG 22 by Jeremy Ward

After travelling down to Penzance we kicked off with an afternoon spin of 24 miles to Land’s End and back. The next 2 days heading east through the repeated hills of Cornwall and Devon were 2 of the hardest of the whole fortnight, with one seemingly endless 10 hour day.

We were relieved to then hit the flat Somerset plains along to Portishead just outside Bristol. Although we had the relief of flat terrain we were against a strong easterly wind which made it hard going.

From there we headed across the Avon valley, Gloucestershire and up to Worcester, spending the night in the Premier Inn which looks over the county cricket ground. Still long days but easier rolling countryside.

We continued north over the rolling plains of middle England, through Staffordshire and Shropshire into Cheshire. It was quite emotional coming into familiar territory – past the salt mines in Northwich, through Warrington, Newton-le-Willows and Wigan up to Chorley where I popped into to see my very supportive colleagues who were running a basic surgical skills course for our ACPs. Janet, an old cycling friend and retired midwife, joined me from there to Longridge on the way home.

From here north we were lucky to be joined by several friends for varying lengths of the journey. Rob Trundle took us from Garstang to Carnforth and old friends Mike and Corinne Woodbridge from there up to Kendal. As I climbed up Shap I was delighted when a car pulled up and Tom Owen hobbled out of it to say hello, his leg in a boot supporting a torn gastrocnemius!

We had a very fast (if cold) journey north from Penrith up to Moffat and then up to the east side of Glasgow (difficult traffic on a Friday afternoon) before reaching Stirling where we stayed with Martyn and Fiona, friends of old. Martyn was joining us for the rest of the trip to the north coast.

The following morning we had our only street crowd send off, organised by Fiona as well as much-appreciated donations. We were also joined by Ranald MacDonald for this leg which took us up to Crieff, Aberfeldy and Pitlochry. These last 5 days in Scotland were some of the most memorable of the trip. Despite climbing to the highest altitude of the trip, Drumochter Pass, the day from Pitlochry to Aviemore was probably one of our easiest.

From there we were joined by Ken Walker, a friend who has worked in Nepal, who was our last domestique! After lunch at his house in Inverness he took us to the Cromarty Firth where we spent the night at a B&B full of character in Alness.

Poor weather early on the following morning saw us over the Struie hills to the Kyle of Sutherland but as the weather brightened the rest of the day brought some of the best cycling of the whole trip. We cycled up the River Shin to lunch in Lairg and then cycled 40 miles along an incredibly remote single track road through increasingly dramatic scenery to our first sight of the north coast of Scotland at Tongue.

We left early the following day (our last) with mixed feelings as we came to the end of the expedition. Initial bad weather meant a miserable 3 hours along more big downs and ups across the glaciated valleys that run into the north coast. However things had brightened by the time we reached Thurso where we had to say goodbye to Martyn before he caught his train home. It was bright and sunny as we cycled the last 20 miles to our destination, coming down the hill into John O’Groats at about 2.30pm. Total distance almost exactly 1000 miles.

It is not quite the godforsaken place it used to be – the development of the NC500 has led to more facilities, albeit commercialised. However, after a drink at a local bar we were pleased to be able to hop onto the foot passenger ferry to South Ronaldsay where we met John and Ruth and headed up to Kirkwall for a couple of nights in Orkney, a different place altogether!

Kirkwall was a great place to relax and unwind. We went over to Stromness and the Stones of Denness and Ring of Brodgar, so Tully was able to see just a little of what Orkney has to offer. After 2 nights Tully flew down to London to head back to Cayman, a different island altogether, while I headed south with John and Ruth who were good enough to let me off at North Queensferry to get the train home.

This was a trip I used to dream about as a child and I appreciate having had the opportunity to complete it in aid of HExN. Although hard work at times, the whole expedition was a great experience and it afforded me the chance to renew old friendships as well as develop new ones, both on the road and during evenings when friends came to meet us.

At the time of writing, we have received donations of up to around £7,500 and hopefully there is more to come. We are incredibly grateful to everyone who has donated to Health Exchange Nepal over the last few months – the health service and medical training in Nepal are in dire need of help and this will help us get going again after the pandemic.

You can donate to my JustGiving page by clicking here: https://www.justgiving.com/fundraising/jeremyward14?utm_source=Sharethis&utm_medium=fundraising&utm_content=jeremy-ward14&utm_campaign=pfpemail&utm_term=574bc62d78464874a2e817bf8f0204e2

Thank you

Jeremy Ward Cycling

I will be cycling from Land's End to John O'Groats with my friend Graham Tully this spring to raise money for Health Exchange Nepal (HExN).  This is a completely self-funded expedition with no external support, so every penny donated will go directly to HExN to support our work.

HExN promotes the exchange of knowledge and support between Nepal and the UK. HExN has been providing educational and clinical support to Nepal in various forms, including running courses and conferences in Nepal to supporting Nepalese health care professionals who train in the UK. This is crucially important as Nepal is the poorest country in Asia, with a desperate need to improve healthcare.

We also supported relief funds after the devastating earthquakes in 2015 and provision of medical equipment in the Covid19 pandemic.  

Your support is greatly appreciated.

https://www.justgiving.com/fundraising/jeremy-ward14

Thank you

Jeremy Ward

NLS Update 2022

Update to NLS instructors in Nepal about recent changes in guidelines. Preseneted by Madhavi and moderated by Anil.

• In management of the umbilical cord, clamping after at least 60 seconds is recommended, but if this is not possible cord milking is an option in babies > 28 weeks gestation.

• In non-vigorous infants born through meconium, immediate laryngoscopy with or without suction after delivery is not recommended.

• Laryngeal mask may be considered in infants of ≥ 34 weeks gestation (>~2000g) if face mask ventilation or tracheal intubation is unsuccessful.

• If there is no response to initial inflations despite an open airway, consider increasing the inflation pressure.

• A starting pressure of 25 cm H2O is suggested for preterm infants < 32 weeks gestation.

• Initial delivered oxygen concentration depends upon gestation:

  • ≥ 32 weeks gestation - 21% oxygen

  • 28-32 weeks - 21-30% oxygen

  • < 28 weeks - 30% oxygen.

• In babies < 32 weeks, delivered oxygen concentration should be titrated to achieve saturations of > 80% at 5 minutes.

• Intraosseous access is an alternative method of emergency vascular access if umbilical access is not possible.

• Both initial and subsequent IV/IO adrenaline doses are 20 micrograms kg-1 (0.2 mL kg-1 of 1:10,000 adrenaline (1000 micrograms in 10 mL)), in the absence of a response to CPR give repeat doses every 3-5 minutes.

• Stopping resuscitation should be considered and discussed if there has been no response after 20 minutes and exclusion of reversible problems.

Charity Donation

I was overwhelmed to receive a donation for our charity from Mrs Norah Beach. She is a sweet old lady who has been my patient for a long time. Last time when she was in the clinic, one of the nurses told her about HExN charity. I told her that I was originally from Nepal and gave her our leaflet to explain our work. Today suddenly, I got a call from discharge lounge to come and see her. She gave me a cheque for £100 which I believed is valued relatively more than any other big donations. Long live Britain Nepal friendship.

School eye screening

HExN was delighted to support Dr Sangeeta Shrestha and her team to conduct two days eye screening program on 23 & 24 Dec 2021 in Ganesh Secondary School, Budhanilkantha, Kathmandu. Their team screened 362 students out of which 64 had refractive errors, which with correction will enable students to see better and help concentrate on studies. They also found other problems in 12 students.

Child Protection Recognition and Response (CPRR) Course, Nepal

Dr Deepak Upadhyay

The Child Protection Recognition and Response (CPRR) Course, designed for healthcare professional   was developed by the Royal College of Paediatrics and Child Health in the UK in response to the recommendations from Lord Laming Enquiry in 2003. In spring of 2016, a 4 days CPRR course was held at Kanti Children Hospital, Kathmandu delivered by the visiting Paediatricians and Nurses from the UK. The aim was to raise the awareness of child abuse and neglect, to encourage effective response including referrals to the appropriate agency and to support the development of a multiagency response in the Nepalese context when a child abuse is suspected. Since then a number of courses have been held between 2017 and 2019, led by the local doctors and nurse at Kanti Children Hospital, with support from the visiting UK Paediatricians & nurses. Between 2019-2021, with restrictions due to Covid-19, a series of virtual (ZOOM) CPRR courses were organised for the Paediatricians and Nurses from the regional and Zonal Hospitals of Nepal.

The course was rated highly from the participants, and subsequent stakeholders meeting was attended by the Ministry of Health representative, UNICEF, CWIN, Police department, local Journalist s and was successful in escalating this issue to the Government and non-Government stakeholders. There has been ongoing collaboration between the Nepal Paediatric Society and Nepal Paediatric Nursing Association and Child Rights group of Nepal.

These courses have been funded by two Nepal focussed charities, So The Child May Live (STCML) and Health Exchange Nepal (HExN), UK.

What we have achieved

1.       More than 150 doctors and nurses have been trained, including a dedicated pool of trainers to take this work forward.

2.       Two Senior Paediatricians from Kathmandu have taken part in Advanced child protection training programme at Alderhey Children Hospital, UK with huge impact on the progress of this project.

3.       Two Nepal focussed Charities in UK, ‘So The Child May Live’ and ‘Health Exchange Nepal ’ have agreed to fund this project for further 3 years with the aim for continuing training of the doctors and nurses from the Hospitals in 7 provinces of Nepal.

4.       The project has helped to identify the designation of Named doctors and nurses in participating hospital, and establishment of effective multi-agency referral and management pathways for the children presenting with suspected abuse or neglect.

5.       The project showcases an example of effective collaboration between professionals from high-income and low-income countries for the best interest of children worldwide.