February 8, 2017

Child Care

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Child Inpatient Department

 

The Child Inpatient Department was established in 2005 as it was realised that the needs of children are very different to those of adults. The department treats mainly malaria, acute respiratory infection, and diarrhea.

 

 

Child Inpatients (Child IPD)

Established in 1999, the Medical IPD was a combined service for both adults and children. Among children, malnutrition is also a common case, and this was one of the leading reasons for the development of a separate Children’s IPD in 2005; children with weakened immune systems needed to be separated from patients with contagious illnesses.

The most common cases seen continue to be malaria, acute respiratory infection, and diarrhea, with a continuing increase in the number of chronic cases being seen at the clinic, including cancer, sclerosis, hypertension, nephritic syndrome, and heart disease.

To find out more about our Inpatient services, please see Adult IP

Child Outpatient Department

 

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.

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.

The department has expanded to cover referrals for patients to Mae Sot Hospital and Chiang Mai Hospital for cases that the clinic cannot treat. Thishas 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.

Vaccinations

All babies born at the Clinic, or those registered with the Clinic within two weeks of birth, are offered a free Hepatitis B vaccination. The vaccinations offered by Mae Tao Clinc are the same as those received by Thai children, and in 2010, 6731 doses were administered.

 

Although the Child OPD officially opened in 1998, its vaccination programme began as early as 1995. As part of Maternal and Child Health services, every Saturday the vaccination programme was run. For two days each week, sessions were held for antenatal care and family planning.

Since April 2009, MTC has been conducting a successful initiative for universal Hepatitis B vaccination for newborns. For babies born at the clinic or those registered with the clinic within two weeks of birth, a free Hepatitis B vaccination is provided.  Although universal Hepatitis B vaccinations have been offered in Thailand for more than ten years, MTC patients have been typically unable to access this coverage.  This has resulted in prevalence among MTC’s antenatal care clients of 8% to 10% for many years.

The vaccinations offered by MTC are the same as those received by Thai children, and in 2010, 6731 doses were administered, nearly double that from 2009 (3841 doses). To gain immunity, each child must complete the three-dose course.

Immunisation

This programme is supported by the Thai Ministry of Health, as MTC follows the Thai EPI programme. The immunisation programme offers services to children in the clinic, to students in the school, to pregnant women, to injured adults and to our health workers. The coverage is difficult to estimate as our population is mobile and receive vaccinations from various places. BCG and Hepatitis B vaccines, provided just after the birth were given to 97 % of babies born in our reproductive health department. Access to immunisation inside Burma is difficult due to the cold chain limita ons. The HSS project will attempt to improve this with assistance from UNICEF. Sadly, we are still seeing children suffering from vaccine preventable diseases such as tetanus. In September 2016, an outbreak of Japanese Encephalitis occurred in Karen State. In response, a campaign was organised to vaccinate children from Burma. In 2016, 5,563 JE vaccine doses were given.