Thread by @ahankari

This paper makes so much sense. Especially in the context of US with ECMO & other aggressive treatments raising costs in high CDH volume hospitals.

Medical and other costs.

#CDH #CongenitalDiaphragmaticHernia

pubmed.ncbi.nlm.nih.gov/35030432/

1 of the biggest costs is the loss of workdays. From the office which usually pays for the #MedicalInsurance So often the course of treatment changes mid course due to insurance conditionalities.

The other major cost for the family is being away from home, from other kids who might be at home and arranging some form of childcare for them. This impacts the working of the other partner/ spouse as well.

Although many of the larger tertiary care hospitals have attached #RonaldMcDonald houses for stay of caregivers of the babies, not all do.
Extended hospitalization means that they may have to check out of the RM houses before the treatment is completed.

Yet another extremely significant
& unfortunately common cost to the caregiver is breakdown of the family unit due to the combined medical, economic & emotional stresses of dealing with #CongenitalDiaphragmaticHernia

Are things similar in India?
No.
Not that there are not similar prohibitive costs. They are there. Even the regular Blood gases tests, x-rays and post-op care take a terrible toll.

Yet, there are some mitigating factors.
1st the skill of the Indian pediatric surgeons who are far more exposed to #CDH & its repair protocols.
2nd the extreme devotion of the nursing staff who play the most important role in the critical post-op stage.

3rdly, the crude, but *at times*, effective jugaadu substitutes to the expensive tertiary care.
Visits to NICUs across the country abound with stories of how babies are saved. With practically no high cost equipment.

4thly, there's that much maligned Indian institution of the joint family which rallies around when push comes to shove.

Drs. still ask the parents IF they want to save the baby, at HIGH costs.

Most often parents agree, with the assurance of the family.

Yes, it is very skewed in favor of those who have the financial, emotional and family wherewithal.

But, finally it is Divine blessing which determines the outcome.

Sri Krishnaarpanamastu!

I am blessed to be the mother of a #CongenitalDiaphragmaticHernia survivor.
My #Cherub was born with the advantages of being a big baby & a privileged family.
But the odds were REALLY BAD. LCDH, PH, Malrotation, the works.
No ECMO, but here we are.

Thanks to the excellent pediatric surgeon, pediatric docs, intensivists and the NURSES!

And deva Krupa.🙏