Steve Adaduns: Time to strengthen capacity to manage critical illnesses

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By Dr Steve Adudans

Twitter @SteveAdudans

The outbreak of the COVID19 exposed the gaps in the critical care sector in Kenya. At no time have we experienced a population-wide disease in the magnitude of the virus. Countries in West and Central Africa have over the years experienced Ebola outbreaks, which has pushed them to put in place proper case management structures and skills.

The outbreak of the virus caused a major panic because it had been predicted that our cases would overwhelm health facilities if examples of the magnitude of the infection in Europe and America were to be experienced locally. Thankfully, we have had far much lesser fewer cases of patients in need of ICU admissions.

During this period, our lack of oxygen in health facilities, ICU beds and skilled medical personnel has badly been exposed, underlining the fact that over the years, many people have been suffering away from the glare of the public eye. Critical care services have been hampered by economic reversals resulting in low wages, manpower flight overseas, poor funding of hospitals, and endemic corruption.

The outbreak of the COVID19 somehow pushed the government to  improve things. Since the detection of the first case early in the year, Kenya has increased the number of public hospital ICU beds from 153 to 319, and isolation beds to 11,426 in both health and non-health facilities.

The WHO states that every hospital performing surgery and anaesthesia must have an ICU. Critical care medicine is unique, challenging, and dynamic. It requires attentive, skilled nurses, respiratory therapists, and intensivists to adequately treat patients in the ICU.

In Kenya, the high level of critical illnesses is related to the increased burden of HIV and AIDS, malaria and trauma, and to manage these critically ill patients, resources are needed. This burden is expected to increase with increasing population and increased access to hospitals. To curb the demand and supply gap, changes concerning admission and referral practices and/or increased numbers of allocated ICU beds and skilled health care professionals are required. If the number of beds is not increased, not all deserving patients will be able to access ICU care. ICUs in tertiary and specialist hospitals are better equipped than those in rural public hospitals. Private hospitals’ ICUs are only accessible to persons with medical insurance.

Proper management of critically ill patients requires adequate material, human, infrastructure and financial resources. Worldwide, there is a problem in health care services regarding resource allocation. However, in intensive care units (ICUs), this problem is exacerbated by the fact that patients are critically ill and require expensive treatments, life support machines, skilled personnel and constant monitoring Monitoring of ICU patients has high financial implications, including equipment and consumable costs, training nurses and their salaries and the recruitment of specialist doctors.

Shortage of resources is sometimes related to increased demands for health care services, linked to population growth and changes in demographic profiles. An increased number of illnesses such as renal failure, diabetes mellitus and cardiac disease require critical care. As the population continues to grow, the shortage of critical care services for the given population becomes more . Every ICU has an inherent ‘capacity’ or ‘ability to provide high-quality care for everyone who is or could become a patient in that ICU on a given day’. However, there might be a need for resources that are not available and/or inadequate to provide the desired standard of care.

Our critical care capacity is weak and requires systematic changes to health strengthening to save the lives of hundreds of thousands more in the years to come.

Dr Steve Adudans is the Executive Director Center for Public Health and Development

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