AMPATH Nepal Collaboration Improves Emergency Care for Children
A desire to build a brighter future for children around the world has brought together doctors from New York and Nepal to expand pediatric emergency medicine training through the AMPATH Nepal partnership.
“Every parent just wanted their kid to be happy and healthy. I think that is the thing that can unite us. Whether it is a child in New York or in Brazil, or in Botswana or in Nepal--every parent just wants more for their kid than what they had,” said Morgan Bowling, DO, assistant professor of emergency medicine at the Icahn School of Medicine at Mount Sinai in New York City.
Dr. Bowling and Anish Joshi, MBBS, MD, assistant professor in the Department of Paediatrics at Dhulikhel Hospital and Kathmandu University School of Medical Sciences in Nepal, received one of the first four AMPATH Nepal pilot grants for $15,000 last year. The project aims to improve emergency medical preparedness and childhood treatment in Nepal. The activities include a needs assessment, training through the American Heart Association’s Pediatric Advanced Life Support (PALS) program and simulation training to improve care for critically ill and injured children in Nepal.
Dr. Bowling, Dr. Saracino, Dr. House and Dr. Langer in Nepal
“These efforts aim to drastically enhance the quality of emergency care for children,” said Dr. Joshi. “We’re focused on improving the readiness of emergency medical providers in Nepal through targeted simulation education curriculums and by implementing new protocols, training staff and acquiring advanced medical equipment. Ultimately, this will lead to improved survival rates, better health outcomes and faster response.”
The AMPATH Nepal partnership includes Dhulikhel Hospital, Kathmandu University School of Medical Sciences and Mount Sinai as the lead partner for the AMPATH Consortium of 16 universities around the world. Dhulikhel Hospital is Nepal’s pioneer community service hospital founded with the mission of providing quality health service to the poor. It is a tertiary hospital with a catchment population of 2.5 million and serves as the teaching hospital and academic base for the Kathmandu University School of Medical Sciences. The hospital also runs 18 rural community-based health facilities.
The grant and collaboration came at an ideal time as Dhulikhel Hospital just finished construction on the first phase of a dedicated pediatric hospital. While the new facility has dedicated space for a pediatric emergency, the facility is not yet equipped and none of hospital’s clinicians were certified in PALS.
“Pediatric emergency care is relatively new in Nepal, and we are still in the process of developing the infrastructure, training and protocols needed to meet these challenges,” said Dr. Roshana Shrestha professor and head of department of general practice and emergency medicine at Kathmandu University School of Medical Sciences and Dhulikhel Hospital. “Recognizing the gaps in structured emergency services for children, our team at Dhulikhel Hospital collaborated with AMPATH (partners) to integrate evidence-based practices and enhance the capacity of our healthcare system. The opportunity to work with a multidisciplinary team committed to this goal was both inspiring and aligned with my professional mission.”
After months of conversations with the team in Nepal to understand their needs, Dr. Bowling travelled to Nepal with Mount Sinai pediatric emergency faculty member Christine Saracino, DO, and pediatric emergency fellow Samantha Langer, MD. They brought several large suitcases full of manuals, medical training manikins, CPR feedback devices, expired medical supplies for training and even homemade skin to practice suturing.
“I didn't quite appreciate the expense of this equipment, so we had to be very creative and frugal because we had a very small budget,” Dr. Bowling said. “So we actually made fake skin. It's incredibly expensive to purchase, so good old YouTube! One weekend I had to work, and my partner stayed at home and made several pieces of fake skin. I came home from a 12-hour shift and our kitchen table had turned into quite a science experiment.”
Dr. Bowling leaned on the experience, support and advice from her mentor Rose House, MD, MS, while preparing for the trip and training. Dr. House is associate professor of emergency medicine and pediatrics at Mount Sinai and has been the AMPATH Nepal Partnership Director since 2022. She lives and works most of the year in Nepal and started the first emergency medicine fellowship in Nepal.
While in Nepal, the team trained 20 doctors including residents, house staff (new doctors) and faculty on the PALS course. Approximately 40 people participated in the simulation training including medical students, nurses, nursing students, and residents and house staff from both pediatrics and emergency medicine.
The simulation scenarios requested by the team at Dhulikhel Hospital were tailored to some of the most common situations experienced in Nepal including:
Respiratory distress because conditions such as COPD, emphysema and pneumonia are common even in children due to poor air quality
Pre-term labor and maternal mortality are also major challenges
Pesticide (organophosphate) poisoning because adolescents try to harm themselves by taking the pesticides
Seizure disorders
“Simulation-based education is a proven mechanism to help prepare clinicians to respond to critical pediatric emergency cases,” said Dr. Joshi. “The response from healthcare providers at the hospital has been overwhelmingly positive. Many of my colleagues have expressed enthusiasm about the simulation-based education, new training programs and protocols. It has improved their skills, knowledge and confidence levels to manage pediatric emergency cases. They appreciate the focus on continuous professional development and the benefits it brings to patient care.”
Added Dr. Shrestha, “They also appreciate the collaborative approach, which values their input and experience. The training sessions and capacity-building activities have boosted morale and strengthened teamwork across departments.”
Dr. Bowling emphasized that establishing a standard of care for children in emergency situations regardless of where they live in the world is the ultimate goal. “It’s really about the ABCs—airway, breathing and circulation. Those basics save lives, and especially children’s lives, which is why we’re doing this.”
In addition to planning future trainings, the pediatric emergency partnership is also focused on raising funds and obtaining approval to start a pediatric emergency fellowship which would be the first of its kind in Nepal and only the second in Asia. Funds raised would support a small stipend for the fellow, travel expenses and fees for participation in some of the premier pediatric emergency trainings offered by other universities.
The team envisions an 18-month fellowship that would include remote training with the fellows at Mount Sinai as well as an opportunity for the fellow from Nepal to travel to New York for a one-month observership to both learn and teach fellows at Mount Sinai. “I think it would just be tremendous what we could teach the fellow, and what the fellow could teach us about practicing in a community or a lower resource area,” said Dr. Bowling.
The fellowship would include blocks of time for research and quality improvement initiatives and the fellow would spend time in rural Nepal clinics to both learn and teach. If approved, the inaugural fellow would also become a PALS instructor to make the project self-sustaining.
True to AMPATH’s mission, research is a fundamental part of the collaboration. “There are multiple novel components to this partnership, so there are many opportunities for publication,” said Dr. Joshi. “The case-based simulation curriculum including the pre- and post- surveys and assessment tools will ideally become a good resource for research and publications.” The project has already presented an oral presentation at the International Meeting for Simulation in Healthcare (IMSH) conference in Orlando and the team is working on a manuscript.
“The AMPATH partnership is special because of its collaborative approach, shared commitment to community health, access to international expertise and resources. This partnership not only elevates the standard of care at Dhulikhel Hospital but also sets a precedent for future collaborations aimed at improving healthcare across Nepal,” he concluded.
