Management of paediatric head injury in remote Nepal

Soo Jung Hospital in Doti, Far-Western Nepal is a small district hospital founded in 1994 and run as a private hospital with support from charity donations. It is staffed by two doctors, and two health assistants, supported by a team of nurses and nursing students. Approximately 50 people are seen as outpatients each day. There is a four bed emergency department and two inpatient wards which are able to accommodate 16 patients between them. Basic x-ray facilities are available, but for further imagining studies and surgical interventions patients must be referred to a tertiary centre, the nearest being 7-9 h away by road. Cases of major trauma must be managed with these limited facilities for prolonged periods of time. In addition to this, once a decision has been made to attempt an interhospital transfer, this is undertaken in a vehicle ill-equipped, or staffed, to perform medical interventions en route.