Dr Praveen Khilnani, a pediatric intensivist and clinical director, Rainbow hospital, Delhi, a multispecialty hospital for children, talks about the idea behind setting up a children’s hospital in the capital and the challenges the doctors face while treating children. 

Why do we need a children's hospital?

I have worked at various children’s hospitals in the US for more than 20 years and always wanted to set up a hospital similar to Boston Children hospital. The idea was to bring all medical and surgical subspecialties--from major complex surgeries, to neurology, cardiology, pulmonolgy, oncology, etc--for children under one roof to help treat many challenging diseases. Many of these specialties are not given enough priority in a general hospital.

A child with Down syndrome, for example, may require many specialists to treat multiple health problems associated with it. We should be able to treat all aspects of a complicated disease at one hospital. We would also want to provide cutting-edge technology to diagnose rarest of the diseases.

Why are there not many such hospitals in India? 

The biggest concern in setting up such institutes is how to make them self-sustainable.

Rainbow, a chain of hospitals for children in Hyderabad and other states is already a success. We are going to replicate the same model in Delhi.

How much emphasis will you put on research? 

Research would be an important part. We would not be doing basic science research but clinical research. We are also going to have educational programme for doctors such as DNB, fellowships in pediatric intensive care, etc during which doctors will publish their research. We have a tie-up with some US institutes (including American academy of Pediatrics) and we would collaborate with them for clinical research targeted towards improvement of child health at large.

What are the major challenges in India as far as healthcare for children is concerned?

The biggest challenge is to get people to seek treatment for their girl child. You will be surprised but even today there is a lot of disparity and a significant gender gap as far as hospital admissions of children is concerned.

Secondly, most people come late for treatment. They try quacks in their neighbourhood, home remedies, alternative medicines before coming to a hospital. When a patient is in a critical stage, the cost of the treatment increases and so do the chances of mortality.

Most people try quacks in their neighbourhood, home remedies, alternative medicines before coming to a hospital. When a patient is in a critical stage, the cost of the treatment increases and so do the chances of mortality.

Antibiotic resistance is another challenge doctors have been fighting across the world...

Hospital-acquired infections are the most difficult to treat. We have already adopted the international protocols and guidelines that require you to maintain sterile conditions in the hospital as well as restrict use of high-end antibiotics for every routine infection.

We want to build an antibiotic stewardship programme.

Pediatricians and microbiologists work together and take appropriate steps to keep the level of bacteria under control in our hospital.

Antibiotic resistance is also a big concern. Judicious use of antibiotics is the only way to address it. We don’t allow medical representatives to introduce newer antibiotics directly to general pediatric OPD except to specialists regulated by hospital infection control commitee.

How do you ensure the judicious use of antibiotics among pre-term babies who have to stay in NICU for a long time?

We insist that babies are closely observed and infection markers are monitored including bacterial and fungal cultures. This allows us to avoid the unnecessary use of antibiotics.

Deteriorating air quality in Delhi and in neighbouring  areas  is also a big problem. How does it affect children?

Pollution affects both adults as well as children in the same way. But in kids, lung capacity is lesser and the airways are narrower. Even a slight irritation in the lungs can stimulate secretions which lead to further narrowing of the airways in a child.

When there is difficulty in breathing, lungs send signals to the brain to concentrate on breathing and nothing else. So, a child stops eating food and becomes irritable while breathing fast .As a word of caution, after a period of struggle the child may get tired and turn blue, so one must get medical help if any child is breathing fast and irritable before it’s too late.

Children with any residual lung disease are more prone to respiratory problems.

The government should take some stringent measures to control the vehicular pollution in cities. It is a big challenge.

There is a growing mistrust between doctor and patients these days, especially when you are dealing with children. 

I believe that if there is a continuous and truthful communication between the relatives or guardian of a patient and the treating doctor, chances of conflict are less.

 But there are instances when we fail to save a patient even after patients have spent a lot of money on the treatment. What people don’t understand is that a doctor would keep trying till the last moment and there is no other motive.

Here frequent counselling is very important. Also, we are soon going to have a video- counseling facility.

Don’t you think the result of this mistrust is that healthcare providers are moving towards defensive medicine?

When consumers of healthcare are turning offensive, we need to turn defensive to protect our community. However,every doctor continues to treat with ethics and full compassion. Video- counselling as well as written documentation is only important to prove our side of the story in case of refute.