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Child Outpatient

The Child Outpatient Department (Child OPD) provides care for children with both acute and chronic conditions; they provide nutritional status assessments and supplementary feeding programmes for malnutrition, vitamin-A deficiency and worming prevention as well as de-worming treatment, and immunisations (Hepatitis B, BCG, OPV, DPT, measles).

History

Prior to establishing the department, adults and children had been treated together, but as numbers of patients and staff rose, Child OPD was separated, whereupon staff became more specialised. When it first opened, the department had only 5 staff members and saw 30-40 patients a day. It was housed in an open area with a roof, which had only concrete floors and limited equipment. Now they have a building with tiled floors, see about 100 patients per day, have electricity, fans, a refrigerator and storage space. They have their own pharmacy, as well as desks and a computer.

Dr Cynthia visiting the Child Outpatients Department

In the first few years after the department opened, it serviced mainly children of migrant workers from Burma, who already lived in Thailand, but as the clinic has expanded and more people became aware of its services, it has increasingly seen cross-border patients. The demographic of patients in Child OPD is now about 50% from the Mae Sot area and 50% from inside Burma.

The department maintains its original focus on curative care, immunisation, growth monitoring, nutrition assessment and malnutrition, and is committed to treating the common illnesses it sees, such as malaria, pneumonia, diarrhea, and acute respiratory infections. However, the department has now added education as one of its main priorities, so that when patients leave they will be better informed on health issues. For example, the staff will tell the parents what food is best for a malnourished child, or for a breastfeeding mother. Or when a child is immunised, they will tell patients alternate places to get immunised if they can’t follow up at MTC. Ideally, patients will take this information back with them to their communities.

Data gathered from the immunisation programme and curative care records goes into reports, which help with funding, and provides a picture of the population serviced to aid research. Child OPD also shares information with Thai Public Health, which provides it with vaccines.

Mothers waiting for their babies to be seen

The department has expanded to cover referrals for patients to Mae Sot Hospital and Chiang Mai Hospital for cases that the clinic cannot treat. This has mainly been facilitated through the Burma Children Medical Fund (BCMF). This fund was set up through the clinic to finance the treatment of children externally. BCMF organises transfers for children, and a few adults, to Thai hospitals, where they can get the life saving surgery they need. These surgeries are often relatively simple and cheap, but without BCMF they would be beyond the means of most patients.

The feeding program carried out on immunisation days is a very important aspect of the work of the department. This programme provides milk powder to families with twins, children with cleft palates, and children with no mothers or HIV positive mothers. The most common illnesses the department sees are malaria, pneumonia, diarrhoea, acute respiratory infections and malnutrition.

 Challenges

One of the most trying occurrences is when parents leave their children at the clinic and never return. Also, like the clinic as a whole, the department is continually growing, and there is still a great need for more space.

Nevertheless, there have been many uplifting experiences within the department.  For instance, staff often sees young patients with heart disease, whose parents usually do not know what is wrong. They can’t get treatment or even diagnosis in Burma, and this is highly stressful for them.