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ICUs in Uganda: An Interview with Dr. Mary Nabukenya

Sep 5, 2020

The Government of Uganda is undertaking an ambitious effort to increase critical care capacity by fully equipping ICUs at all regional referral hospitals across the nation. We’re proud the Gradian Comprehensive Care Ventilator (Gradian CCV) and our model of robust training and service can support this critical moment and the partners on the frontlines, such as the Association of Anesthesiologists of Uganda (AAU) and Joint Medical Store (JMS)—a leading medical device and pharmaceutical distributor—making this change a reality for the nation’s COVID-19 response and future health system strength.

The AAU and JMS recently produced a series of short video interviews with anesthesiologists and intensive care specialists about the current state and future vision of critical care in Uganda and what it’ll take to get there, from policy to equipment to education and tackling the biggest challenges to progress.

Dr. Mary Nabukenya is an anesthesiologist and a critical care specialist at Mulago National Referral Hospital and a lecturer at Makerere University and, in this video, discusses the current state of ICU bed distribution across Uganda, specific plans for ICU expansion, and the role the Gradian CCV is playing in supporting this increase in capacity.

Video Transcript:

“Hello, my name is Mary Nabukeya. I’m an anesthesiologist and critical care specialist at Makerera University and I work at Mulago National Referral Hospital.”

“An ICU bed is not just a bed. It comes with accessories that qualify it to be an ICU bed. So you need, at the very basic, you need the bed with special functions. It should be able to move up, move down. You need to have a monitor for the patient to check the patient’s vitals. And then for an ICU, it [is] best if it’s beyond your basic monitoring, beyond just basic blood pressure monitoring, beyond just pulse oximetry, and pulse reading. You need at least an ECG, you need invasive blood pressure monitoring, and a few other things that come with that. And then you need the ventilator to come with that.”

“And of course if you have ventilators…[you need] multiple power sources near the bed. You need to have suctioning, you need to have pumps which can be used to run drugs and fluids for the patient. So that is, at the very basic, what an ICU bed is.”

“About two years ago Dr. Atumanya et. al. did a study to look at the landscape of critical care in Uganda. And they found that we had about 55 ICU beds in the entire country. And this is for a population of about 42 million people. What that means is we had about 1.3 beds per one million of the population.”

“At the time, these ICU beds were found in 12 ICUs in the country. And of these ICUs, about 83 percent were in the capitol city. So you only had about 17 percent ICU beds spread out throughout the rest of the country. And the public hospitals at the time that have ICUs were Mulago National Referral Hospital, Lira, Jinja, Kawolo and Mbarara Hospital.”

“At the time, these ICU beds were found in 12 ICUs in the country. And of these ICUs, about 83 percent were in the capitol city.”

“ICUs in this country are predominantly run by anesthesiologists, and of course the critical care nurses. At the time, we had about 80 percent of anesthesiologists also within the capitol city. So you had only a few of them working elsewhere in the regional [referral] hospitals, and rural hospitals looking out for these patients.”

“And then, of course, when we look at the nurses, Atumanya et. al., in their study, found 171 critical care nurses in total working in these ICUs. But of these, only 13 had been formally trained to work as critical care nurses. So that was a really small fraction of nurses taking care of critically ill who had the appropriate training.”

“So what the ministry of health has done and is doing in the regional referral hospitals is going to set up 10 bed ICUs in all 14 region area of hospitals. What that means is [that] each ICU should have some ventilators. And to date, they have acquired 109 critical care ventilators from Gradian Health Systems.”

“So what the ministry of health has done and is doing in the regional referral hospitals is going to set up 10 bed ICUs in all 14 region area of hospitals.”

“These ventilators will need people to run them. So the Association of Anesthesiologists of Uganda is going to embark on training of medical officers in these hospitals. We’re going to train critical care nurses, or even just the nurses who will be located to these units to look after the patients.”

“And then there will be need for continuous support, supervision. And these are not ICUs that are just created for COVID, but we hope they will continue to work even after COVID has been managed.”

“The Ministry of Health has acquired a number – over 100 [Gradian] Comprehensive Care Ventilators. They are low-cost ventilators, and they’re really built for low-resource settings, where power supply is uncertain, where oxygen supply is uncertain. Today, you have oxygen cylinders, tomorrow you don’t. All this has been put into consideration.”

“Today, you have oxygen cylinders, tomorrow you don’t.”

“So it has multiple sources of power. It has multiple sources of oxygen. And then the other thing is the comprehensive care ventilators are quite simple and pretty easy to use after you’ve had some training on them.”

“The other thing is they can be used in many situations. You can also use them for an emergency department [ED]. You can use them during patient transport. They can be used for both adults and children.”

“The biggest challenge that remains is human resource. Once all these ICUs are put in [and] regional referral hospitals have a 10-bed ICUs, they’re going to need people to man them. You need nurses, you need the doctors to manage the units. So yes, the Association of Anesthesiologists of Uganda is going to train people on how to use the equipment. But then who’s going to run the units? As I said, out here, the majority of ICUs are predominantly run by anesthesiologists. And currently, about 77 percent of these people are in the city. So we don’t have enough to go out there.”

“And then, too, we need nursing. There’s only one critical care nursing program in the country at the moment, and that’s in Mbarara. They can only produce so many. So there’s going to be a huge stride forth for nurses that are specially trained in critical care.”