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.

 

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.

In 2017, 1,396 children were admitted in the Child IPD. Of them 65% are under 5-year-old and 52% crossed the border to get treatment. Dengue fever, diarrhea, thalassemia, acute malnutrition, influenza and pneumonia together account for 64% of the diagnoses.

Achievements

We have isolation rooms for general, malnutrition, diarrhea and can separate patients with contagious diseases from patients with non-communicable diseases. The Child IPD in the old Mae Tao Clinic was often crowded, with limited space and bed numbers. Some patients even had to sleep on the floor. Currently at the new Mae Tao Clinic, the 32 beds are sufficient. Our staff can treat patients without being pressed for time. Other departments saw high staff turnover after Mae Tao Clinic’s funding crises and the more stringent policy of Thai immigration towards migrant workers in 2017, but the number of Child In-Patient Department staff has remained stable. We work with 22 staff in 3 shifts to efficiently run the department day and night. We look after around 20 to 25 children on daily basis.

Capacity

We can treat children’s diseases that are prevalent in the region, such as pneumonia, diarrhea, malnutrition and thalassemia. We have the capacity to administer a blood transfusion for thalassemia patients. The common diseases along the Thai-Burma border are caused mainly because children’s poor living conditions: caregivers have a lack of knowledge and lack of resources for good nutrition and hygiene. Consequently, many children have a weakened immune system.

 

Limitations

We cannot treat patients who suffer for acute bowel obstruction, appendicitis, severe pneumonia and heart diseases. For the aforementioned cases, we need to refer them to a government hospital, either in Thailand or Burma. Due to our limited funding, we cannot cover all referral costs. Either we support 3,000 THB for the patients who cannot afford referral expenses, or we refer the case to one of our partner organizations, such as Burma Children’s Medical Fund (BCMF).

Challenges

The majority of our patients have poor living conditions in terms of hygiene. They may not have good knowledge of the importance of cleanliness. For instance, even though we placed rubbish bins in the ward, some just throw the garbage on the floor. While patients are admitted, we raise awareness and provide parents with health education in hygiene, nutrition, and disease prevention.

Due to limited funding, we are able to refer less patients to the Thai government hospital. While we provide counseling to patients on their diagnosis and need of referral, we also explain them our funding situation and our challenges. We know some have come all the way to Mae Tao Clinic from Burma, how burdensome it must be for them even to pay transportation, how much frustrated they are when we have to tell that we cannot cover all the medical expenses in case of severe disease. Although this is the reality we have to ask them to contribute to referral costs, e.g. for X-ray, advanced laboratory testing or referral costs.

Meet Our Patients here: http://maetaoclinic.org/our-services/our-patients/

(Last update: 29 March 20218)

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.

 

 

History and Present

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. 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 69% from the Thai side and 31% from inside Burma.

The department focuses on curative care, growth monitoring, nutrition assessment and malnutrition, and is committed to treating the common illnesses it sees, such as dengue fever, anaemia (hematologic disorders), diarrhoea and acute respiratory infections.

Health education is the department’s 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.

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).

Challenges

During the rainy season, a number of seasonal disease patients’ visit surges. Due to the excessive caseloads, some patients have to go back home without receiving treatment. In addition, since we moved to the new clinic compound in 2016, some patients find it hard to visit the clinic for follow-up who are strongly encouraged to revisit, i.e., malnourished or chronic disease patients. To tackle this issue, we schedule for the follow-up date monthly from bi-weekly.

Staff
There are 5 health workers including in charge at Child Medical OPD, providing essential healthcare service and psycho-social support to children. Child Medical OPD consists of 4 examination rooms with 1 ultrasound.

Immunisation

All babies born at the Clinic, or those registered with the Clinic within two weeks of birth, are offered a free Hepatitis B and BCG vaccination. The vaccinations offered by Mae Tao Clinic are the same as those received by Thai children, and in 2017, 19,261 were administered.

History

Although the Child OPD officially opened in 1998, its vaccination programme began as early as 1995. As part of Maternal and Child Health services, 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 and BCG vaccination is provided.

The vaccinations offered by MTC are the same as those received by Thai children, and in 2010, 3,841 doses were administered, which became nearly five-times more in 2017 (19,261 doses). To gain immunity, each child must complete the three-dose course.

Immunisation programme

Immunisation programme is supported by the Thai Ministry of Health, as MTC follows the Thai EPI (Expanded Programme on Immunisation) 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. BCG and Hepatitis B vaccines, provided just after the birth were given to nearly 100 % of babies born in our reproductive health department. Access to immunisation inside Burma is difficult due to the cold chain limitations. 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.

(Last Update: 27 April 2018)