Written Stories

First Caesarean Section Delivery in Salyan Hospital

13 Sep, 2016 By: Dr Sanij Singh

Salyan hospital was established in 2024 BS with efforts from then prime-minister Marich Man Singh Shrestha. It is located in Khalanga, Salyan about 3 kilometers from main bazaar area.  This is a 15 bedded hospital which has not provided any surgical services to patients since the establishment. After completing my MDGP from NAMS I was posted in Salyan hospital through NSI with goal for betterment of hospital and most importantly to start the surgical services in the hospital. I was fully aware of the challenges that I will be facing in the due course of time. After arriving in Salyan and getting to know the situation of the hospital. I came to know I had to start from a scratch. Realizing this huge task ahead I felt a little helpless, yet knowing the fact that my colleague Dr Krishna Raut will be joining me shortly gave me encouragement to start.

For the fact that there has been no operative service in the hospital all the staff had almost nil experience. I had to start sensitizing them as to basics of surgical services. I started to prepare a possible OT team. In the mean time prepared list of items we had available and items we needed, as NSI was keenly waiting for the list and to help us. Lack of adequate water supply posed a great challenge to us. In due course of time slowly we renovated the OT room, were able to get a new water source, though still inadequate. NSI sent us the adequate equipments that we had earlier requested. In the meantime Dr Krishna Raut joined us and now we had 2 people in OT team. One of the medical officers, Dr Bishal Shrestha went for anesthesia training in Tansen hospital supported by NSI, thus when he returned we had 3 in our OT team.  Later after about 4 months we were joined by staff nurse Pooja Oli for OT support. The equipments also arrived during that time. So we all geared up to set the OT room and by the end of 5th month we had an OT room. Yet the problem of sterilization was there, so again we had to import formalin for fumigation. After completing all these and after fumigation we had a functional OT room at our service .We felt really proud of it as we had worked really hard to achieve. Prior to start of operative services availability of Blood is also important, for that we developed a possible donor list from police, army and local youths as walking blood bank.

It was 27th of chaitra, 2068; an 18 years old Shanti Pariyar came to our hospital in ambulance that cost them Rs 3250. She is from a Siddeshwari VDC, which is in north-west of Salyan. She was accompanied by very young looking husband Ram Prakash Pariyar, 21 years old,  has passes SLC and helped his parents as tailoring. They were married for 3 years and lived in a stone walled house with grass roof. The husband has 5 other sibling included 2 younger brothers and 3 sisters. The breadwinner of the family was his parents earning from tailoring roughly about Rs 5000 per month.

This was first pregnancy for Shanti. She had her regular ANC check up at the local health post by MCH worker Meena DC.  The health post is about 40 minutes walking from her home.  On 25th of Chaitra around 7 pm Shanti went to the health post due to labor pain. However she was in latent phase of labor then. The next day around 5 pm she didn’t make much progress yet had labor pain. On examination her cervix was 4 cm dilated and was referred to higher center for further management as she was not progressing satisfactorily. They didn’t have enough money then thus they walked off home and stayed home for that day. It was then on 27th of chaitra after gathering some money, hired an ambulance and came to Khalanga, Salyan Hospital in evening. When we examined, her cervix was about 4 cm dilated. Fetal heart sound was good. We started her on Oxytocin. She progressed little during the night in morning she was about 6 cm then about 10 am on 28th of Chaitra she was about 7 cm. Around 2 pm her cervix was same, then we decided that we have to perform a caesarean section on her. We updated the patient party, told them about out treatment options. At first they were quite reluctant to consent for Operation. With no other options left they agreed and we proceed to the Operation. After that we successfully delivered her healthy baby boy weighing 2700grams. Post operatively she recovered well and was discharged home on the 7th day of operation after full removal of suture. This is how Salyan Hospital opened its doors to operative services for the first time.

The success was because of cooperation and support of all hospital staffs, so I would like to appreciate for their invaluable support to save mother and baby and hope for continue support in future.

Dr Sanij Singh
MDGP, Salyan Hospital

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