By Alex Gahima
Kisoro District Hospital’s new Intensive Care Unit (ICU) has been praised for its potential to save the lives of critically ill patients from the clutches of death, without having to first transfer them to a regional referral or National hospital.
The new Critical Care Facility at Kisoro Hospital is the first of its Kind to be operationalized in Uganda and possibly in East and Central Africa.
An ICU facility is a separate, self-contained area within a hospital, with specialized equipment designed for close continuous monitoring, rapid intervention and often protracted treatment of critically ill patients with acute organ dysfunction.
Critical illness or injuries that often result in acute impairment of one or more vital organs, causing imminent or life-threatening deterioration in a patient’s condition qualify them for ICU services.
Specialized Medical Staff attached to any given ICU treat patients in order to prevent further physiological deterioration and morbidity.
The health workers do everything medically possible to prevent loss of human life for a patient during that state.
Anesthesiologist and Intensive Care Specialist at Mulago National Referral Hospital, Dr. Arthur Kwizera is the vision bearer that formed the original thought to establish an ICU at Kisoro District Hospital, the first of its kind in Uganda.
According to Dr. Kwizera, Deaths that could easily be avoided continue to be registered in health facilities across the country because critical care medicine has not been given the recognition it deserves under the Ugandan health care system.
“Being able to provide high quality ICU services at lower costs to the population, especially at the district level will help inform minimum ICU standards for optimal patient outcomes at a national level”, Kwizera said.
According to the Ministry of Health, Uganda has five National Referral Hospitals, five Specialized Hospitals, 16 Regional referral hospitals and 46 functional general hospitals.
A 2019 study conducted by Makerere University College of Health Sciences titled ‘Assessment of the Current Capacity of Intensive Care Units in Uganda’ found that only 12 ICUs across the Country were functional.
The Association of Anesthesiologists of Uganda (AAU) describes a functional ICU, as one that admits critically ill patients and has the ability to provide mechanical ventilation.
The assessment further revealed that, only 35 beds out the 55 beds found at the 12 functional ICUs had ventilatory capacity while 20 beds could not meet the required standard.
Uganda recorded its first Coronavirus case on March 21st, 2020. The events that unfolded in the days and months that followed, can only be described as pandemonium.
The country registered over 3,632 deaths out of 171,983 cases. All major health facilities, including Mulago Referral Hospital, Uganda’s biggest and Oldest Hospital grappled with medical oxygen deficiencies.
Criteria for Choosing Kisoro District
Kisoro District Hospital, located in the Southwestern part of Uganda borders with two countries: Democratic Republic of Congo to the west and Rwanda to the south catering to the medical needs of a large catchment area, thanks to the Government policy of free medical services at all Government Health facilities in the Country.
The Historical problem of refugees from the Democratic Republic of Congo places Kisoro Hospital as the major health facility in the area to handle any medical complications that tend arise whenever there is an influx of refugees caused by Political instability in the neighboring DR. Congo.
Dr. Kwizera, a native of Busanza Sub County in Kisoro District says he was driven, in part to set up the ICU in Kisoro after a devastating loss, his own father died while at Kisoro Hospital due to lack of ICU services.
Dr. Kwizera says many families that do not have access to ICU services and need to make a decisive decision often fail to make one in time because of the logistical costs involved.
“Traveling from Kisoro to Kabale is no easy feat because of the nature of the hilly terrain, the long winding and sharp corners can be nightmarish when trying to get your loved one to Kabale regional referral hospital for ICU services”, Kwizera said.
Kabale Regional Referral Speaks Out
Director of Kabale Regional Referral Hospital Dr. John Filbert Nyeko says, Kigezi Sub region did not have any ICU services before 2020 and only had to improvise after Government realized the severity of Corona virus disease which was quickly spreading throughout the country.
Dr. Nyeko says the new ICU in Kisoro District will serve as a model, not only for Kigezi Sub region but for the entire country under the General hospital setup.
According to Dr. Nyeko, medical students from Kabale University will now have the opportunity to train and gain more practical skills from new ICU in Kisoro which was previously not possible.
New ICU In-charge explains.
Mbonye Martha Ann (MBChB), the team leader at the new ICU in Kisoro says, the unit operates an 8-bed capacity however only two beds are currently being used to handle patients in Critical condition.
12 patients who were admitted to the ICU with cases including respiratory failure caused by Pulmonary Tuberculosis, Heart failure, shock and diabetes were all successfully discharged upon recovery.
The former Isolation ward now turned ICU at Kisoro Hospital was renovated and fitted with three negative pressure rooms and one Dialysis room.
“The plan is to have a peritoneal Dialysis in the future however the service is not available currently”, Mbonye explained.
The Medical Officer who proudly graduated from Makerere University says her team comprises of an Anesthesia Critical Care Officer and a Critical Care Head Nurse along with five volunteer nurses who are committed and dedicated to saving lives.
According to Mbonye, ICU services in Uganda’s central business district can cost between 600,000 to 1,000,000 Million Ugandan Shillings per day.
“Patients who transferred from the emergency ward to the ICU in critical condition and later recovered from their illness, often pose this question with great fear, how much is it going to cost me? only to learn the service is no cost to the patient”, Mbonye said.
Kisoro Hospital Medical Superintendent Dr. Emmanuel Bahane said the new ICU is a prayer that has been answered by God because many suffering patients have been opting to stay home and wait for death rather than burden their families with the logistical and financial challenges involved in a medical transfer.
Dr. Bahane admits that the hospital needs to come up with a good sustainable plan after six months because that is when the good will of Dr. Kwizera and friends, under their project will come to an end and the project will be handed over to Kisoro District Local Government for full management.
“The current workers in the ICU are not being paid by Government because they do not exist in the Government structure since Government has never had an ICU at district level. With the support of the District Council, patients might be required to pay a small fee under cost sharing to meet the needs of the ICU”, Bahane explained.
Secretary for Community Based Services and District Councilor for Muramba Sub County, Martin Hakizimana said the quality of health care has significantly improved across the entire district thanks to a government that is willing to listen and meet the people’s needs.
Hakizimana says the idea to introduce a small fee to access ICU services will be present before the district council however other well-wishers can choose to shift that burden from the people of Kisoro by supporting the operations of the ICU to ensure its sustainability and success.
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