The future of cleft
and craniomaxillofacial care

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Newsletter 2022

Building Faces Building Futures

Professor Tony Markus and Mr Sunil Sah

The Craniofacial Centre Nepal was established in August 2017. It was the vision of Sunil Sah, Consultant Maxillofacial Surgeon at Pinderfields Hospital in Wakefield, originally from Janakpur 25 years ago and who did his medical and surgical training in the UK. Seeing the devastation after the earthquake in 2015, he decided to return to Kathmandu with a group of UK maxillofacial surgeons to help manage the craniomaxillofacial trauma. However, as time went on, he realised there was a great need to help in and around Janakpur, identified as one of the two poorest parts of the country.

Janakpur TempleJanakpur is the capital of Province 2, in the plains of Nepal, roughly south east of Kathmandu, bordering the Indian states of Bihar and West Bengal with the local Madheshi people straddling the border. It is the birthplace of Sita, one of the central figures of the Hindu epic, the Ramayana. She married Lord Rama. In her honour, there is a massive and hugely impressive temple, one of many in Janakpur, decorated with many paintings in the local Maithili tradition.

The Craniofacial Centre was built in the summer of 2017 by Sunil Sah and a group of local doctors and dentists, who like so many from Janakpur, had left to build their lives elsewhere in Nepal due to the very poor economic conditions in the region. Our Craniofacial Center not only focusses on the patients suffering from the various craniofacial deformities but also on training the local surgeons and allied professionals so that they are competent enough to deliver high quality of treatment the patients deserve.

The Craniofacial Centre Janakpur

We have continued to achieve our aims and develop them further. Our focus remains on establishing previously unavailable healthcare opportunities for patients in Province 2 as well as training and support of cleft and craniomaxillofacial professionals. In order to achieve these aims, despite Covid, training has continued in the form of zoom conferences with experts from the India, UK and Europe.

However, our main focus this year has been towards completion a major new facility in Janakpur. Great progress has and continues to be made.

Despite the difficult times due to COVID-19, we have managed to establish the new permanent home for the Craniofacial Center, Nepal. We would like to thank our colleagues and friends at the Janakpur Trauma and Orthopaedics Foundation, especially and foremost Professor Ram Kewal Shah, who enabled and facilitated the establishment of the Craniofacial Centre, providing his hospital and support for over the last four years.

CFC Hospital

The new CFC hospital has been established not far from previous hospital and provides us with a dedicated 25-bedded hospital. All our equipment in the old hospital, largely funded by generous donations from Intouch Global Foundation and many others, has been transferred to the new facility.

 

The ground floor consists of an eight-bed ward as well as out-patient facilities. We have kept our four dental chairs so as to provide oral and dental surgery support to our local communities, all provided by local dental surgeons. Additionally, there are consulting rooms and administration offices.
The entire first floor contains the very well-equipped large operating theatre and 8 bedded level II supportive care (post-op recovery). The oxygen pipeline is connected to 20 beds and 6 oxygen concentrators provide extra support in addition to our bottled gases. Emergency electricity backup is maintained 24 hours with support of a generator.

Craniofacial center

The second floor contains further beds and changing facilities for the staff.

On the third, there is a kitchen and small dining area and the re-instated medical library, all books provided by Book Aid International from the UK. The fourth floor provides accommodation for the resident medical officer and visitors. On the very top is housed washing machines and other domestic equipment.

Craniofacial Center came into existence with an aim of providing high-quality patient care at low or no cost, providing free treatment to the large number of very poor people of this region. The population of Province 2 is around 6 million. It shares its border with India, the northern part of Bihar, which has a population of around 66 million. As there are no other designated craniofacial hospitals in Province 2 or the north of Bihar, our Centre has major potential and scope to cater to the needs of this large population.

The new facilities have got good access to the main connecting road in Province 2.

New appointments at CFC Hospital

Dr Rajesh

Dr Rajesh We have recruited Dr Rajesh as a trainee maxillofacial surgeon at Craniofacial Centre.

He had done BDS and MS in Oral and Maxillofacial surgery from University of Dhaka as well as postgraduate training and MPH.

We would like to welcome Rajesh at CFC hospital.

 


Mr Balkeshwor Thakur (Saurav)

Mr Balkeshwor ThakurWe have appointed a full time hospital manager, Mr Balkeshwor Thakur (Saurav).

He has vast experience in management. He has worked in Qatar for Qatar Airways as well as Hotel Annapurna, a five star hotel in Kathmandu. Before joining us, he was working at the Janakpur Orthopaedics and Trauma Hospital. CFC hospital will benefit from his past experience with the airline and hotel industry as well as hospital.

 


Miss Kajal Mishra

Miss Kajal MishraWe have also appointed a new staff nurse, Miss Kajal Mishra.

She has qualified in BSc Nursing from Janakpur and she has huge experience in day to day nursing as well as well in the operating theatre.

 


 

Craniofacial Library

Thanks to the magnificent donation from Book Aid International, we have continued to build a major resource not only for the Craniofacial Centre but also for the medical community in Janakpur.

We have received over 30 boxes of new edition books related to Maxillofacial surgery, plastic surgery, Orthopaedics and trauma surgery, acute medicine care and many more books related to dentistry. Local surgeons and trainees have regularly used this library.

Craniofacial Library

Lockdown due to Covid-19

Lockdown due to Covid-19The Craniofacial Centre is involved in various other activities too, to contribute in the welfare of society as a whole. During the first wave of COVID-19 in the year 2020, the Center distributed food to people who lost their jobs due to pandemic. Besides that, masks and sanitisers were distributed and a programme was organised to help people understand the importance of hand hygiene, social distancing and use of face masks to battle COVID-19 at an individual level. During the same time, the Centre also provided free dental treatment to needy people who could not afford the procedures, following the proper COVID-19 protocols.

Janakpurdham is a sacred city that is very rich culturally and people here celebrate festivals with great zeal and enthusiasm. During Dussehra, a camp was organized where the crowd were briefed about the importance of social distancing and use of masks/shields. Thereafter face shields, branded with the craniofacial centre logo, were also distributed among the people so that they could protect themselves during the festive time.

CFC turned into designated Covid-19 Isolation Centre

Covid-19-Isolation CentreAs construction of the centre was nearing completion, India and Nepal were badly affected with the deadly second wave of COVID-19. Sadly, the Provincial government in this part of the world, as elsewhere in Nepal, was not prepared for the calamity and many lost their loved ones. People were even struggling to get a bed in hospital, desperate to access basic essentials for survival such as oxygen and medicines.

From the start, the Craniofacial Center itself has worked towards the betterment of the people and tried to help society in every way possible. Therefore, the Craniofacial Center converted its newly constructed building into a temporary 20 bed COVID-19 ISOLATED CENTER in collaboration with the PROVINCIAL HOSPITAL, JANAKPURDHAM & NRNA (Nepali Residents of North America) NCC OF USA in this need of an hour. In the isolation centre, the COVID patients were given free food, free medicines, continuous oxygen supply, with doctors, nursing staff and paramedics present around the clock. The staff within the isolation centre were also given support from expert COVID-19 Consultants around the world via video conferencing. The Craniofacial Center also provided free accommodation and free food to the staff on duty, in the residential part of the building. The main aim of this idea was to make sure that we were able to reach as many people as possible infected with the COVID-19 who needed care and also to make sure that no one should die on the roadside or due to lack of proper infrastructure.

Weekly Camps in Province 2

The camps are now on a regular and firm footing, covering the entire province. On each, a surgeon, a dentist, a nurse and our liaison officer /social worker spend a day, or if they are at a greater distance from Janakpur, two days, working. We have developed a simple database, which collects demographic data, records activities carried out and identifies people who need more specialised treatment at the centre. We ideally need a mobile dental clinic to simplify the travels and travails.

 

School Screening Programme

In addition to camps, we also conduct school screening programmes twice a week in the nearby schools in Jankapurdham. Through this we aim to screen children with any craniofacial anomalies at a very young age so that they get the much needed attention at soon as possible.

School Screening Programme

Surgical weeks October -December 2021…. And 2022

Surgical weeksWhat a great way to finish 2021! We were, at last, able to start operating in the new centre. In the last six weeks, we have managed to perform surgery on 18 cleft cases.

I would like to thank the team from Kathmandu what has provided great support as well as our colleagues from India, Mr Jayanth Kesave and Zaid Khan, for operating on them and helping our local surgeons at the centre get trained as well.

We have lined up some other problems for surgery this year including parotid tumours, temporomandibular joint ankylosis and post traumatic deformity correction

In order to provide not only a top quality service for our patients but also to provide first class training for our surgeons, we have established a rota of surgeons from India who very kindly have agreed to give up their time and create an almost continuous presence.

They will be supplemented by surgeons form the UK and Spain, and possibly even New Zealand (Covid regulations permitting).


Ongoing training and support activity

Keeping up with the Zoom culture of lockdown, we have had monthly webinars on diverse subjects ranging from head and neck oncology, temporomandibular joint problems and orthognathic surgery. So far, we have been very fortunate to have had distinguished speakers from the UK, Spain, Germany, New Zealand and India and audiences from almost every corner of the world as well as our trainees in Janakpur

We have been fortunate to secure funding from the European Association of Craniomaxillofacial Surgeons for trainees from Nepal to spend time in Europe, at three centres – Madrid, East Grinstead and Wakefield. Surgeons from the European centres will continue to visit Janakpur to train local staff

Whilst our main efforts have been concentrated this year in Nepal, we have continued to make grants to international trainees in support of further specialist craniomaxillofacial training.

Special thanks to our visiting surgeons

Our special thanks to Mr Jayanth Kesave, who has a supported from beginning of craniofacial centre by regularly visiting, an advising for day-to-day activities as well helping in teaching and training to the junior trainees in Nepal.

Visiting Surgeons

We would also like to thank and mention the names of the people who visited our centre in Janakpurdham, who supported us and helped us improve and prosper with each passing day. Here are their names:

Our Supporters of the Craniofacial Center

We are indebted to large organisations for great generosity. Their vision supporting our work in the long term makes it possible to develop our services, our training programmes and capital developments

And to very many generous individuals who donate significant amounts

Thank you