Author Archives: Raymond Towey

A patient to remember

Very often working in the hospital as an anaesthetist we react in patient’s lives in short but intense ways and never see that patient again. Last week this mother brought her daughter back who in 2012 was critically ill as a newborn and is now growing as a healthy 4 year old. We celebrate a good outcome and how it taught us the value of high flow oxygen therapy. Thanks to all the donors who supplied CPAP machines since then.

 

Research Audit in St.Mary’s Hospital Lacor Gulu Uganda 2017

Original Article Published in the journal Anaesthesia 2017

Intensive care medicine in rural sub-Saharan Africa

M. W. Deunser,1,2 R. M. Towey,3 J. Amito4 and M. Mer2,5
1 Senior Consultant in Intensive Care, Department of Anesthesiology, Peri-operative Medicine and General Intensive
Care Medicine, Salzburg University Hospital and Paracelsus Private Medical University, Salzburg, Austria
2 Global Intensive Care Working Group, European Society of Intensive Care Medicine, Brussels, Belgium
3 Consultant, 4 Anaesthetic Officer, Department of Anaesthetics and Intensive Care, St. Mary’s Hospital Lacor, Gulu,
Uganda
5 Consultant in Intensive Care, Intensive Care Unit, Charlotte Maxeke Johannesburg Academic Hospital and
University of the Witwatersrand, Johannesburg, South Africa

Summary
We undertook an audit in a rural Ugandan hospital that describes the epidemiology and mortality of 5147 patients
admitted to the intensive care unit. The most frequent admission diagnoses were postoperative state (including
following trauma) (2014/5147; 39.1%), medical conditions (709; 13.8%) and traumatic brain injury (629; 12.2%).
Intensive care unit mortality was 27.8%, differing between age groups (p < 0.001). Intensive care unit mortality was
highest for neonatal tetanus (29/37; 78.4%) and lowest for foreign body aspiration (4/204; 2.0%). Intensive care unit
admission following surgery (333/1431; 23.3%), medical conditions (327/1431; 22.9%) and traumatic brain injury
(233/1431; 16.3%) caused the highest number of deaths. Of all deaths in the hospital, (1431/11,357; 12.6%) occurred
in the intensive care unit. Although the proportion of hospitalised patients admitted to the intensive care unit
increased over time, from 0.7% in 2005/6 to 2.8% in 2013/4 (p < 0.001), overall hospital mortality decreased (2005/
6, 4.8%; 2013/14, 4.0%; p < 0.001). The proportion of intensive care patients whose lungs were mechanically
ventilated was 18.7% (961/5147). This subgroup of patients did not change over time (2006, 16%; 2015, 18.4%;
p = 0.12), but their mortality decreased (2006, 59.5%; 2015, 44.3%; p < 0.001).
………………………………………………………………………………….

Discussion
This study is the first to offer a comprehensive
insight into the epidemiology and outcome of critical
illness in a rural sub-Saharan African setting. As the
ICU is the only facility in the study hospital where
critically ill patients are cared for, and because the
study hospital is the only inpatient facility in the
region, our study population is likely to represent
the true spectrum of critical illness for a large rural
sub-Saharan African region. Furthermore, the virtual
absence of financial barriers preventing patients from
entering the ICU, which may be the case in other
ICUs in low-income countries [1, 2], eliminates an
important selection bias from this study.
…………………
In conclusion, our study gives a comprehensive
overview of the epidemiology and outcome of critical
illness in a large sub-Saharan African ICU population.
It represents the first and largest study from a rural
ICU in sub-Saharan Africa, and serves as an important
reference for a region where there is an paucity of
data, offering a greater understanding of the practice
of intensive care in such areas. Although only hypothesis-
generating, these results support the role of
intensive care medicine as a life-saving medical specialty,
even under difficult conditions and with limited
resources, as well as the need to foster and grow such
services in these regions.

Tetanus Boy Goes Home after 3 months

Jeremiah,(not his real name) finally went home this week after nearly 3 months in the ICU. A major struggle for all the ICU staff against the dreadful tetanus disease which he contracted from chronic wounds in his feet. He is here with the volunteer nurse Agatha from Italy who is helping to nurse and rehabilitate him. He is 5 years old but looks very undernourished. Immunisations against tetanus in Uganda are still not universal. We thank God for the hard work and dedication of all the ICU staff.

Fr.Jeya’s students need a few beds and some heating in the hostel

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Zimbabwe is far south of the Equator so they have a winter season where in the night it can be very cold and water can freeze in unheated buildings. Fr.Jeya’s hostel for his students needs a few beds and some heating. Help us to get his students off the floor and warm in the winter so they can be undistracted in their studies. Help us to give them a future.

Tetanus patient goes home

tetanus pttetanus pt 3

Most men who develop tetanus at the age of over 50 rarely survive. They have little immunity as they do not get any maternity immunisations in early life. This man survived and is going home and came from the general ward to thank the ICU staff. A special moment for all for which we thank God.

CPAP machine in action

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Our CPAP machine is able to give a set percentage of oxygen in air at a set pressure. With the added pressure we are able to reduce the concentration of oxygen while still improving the baby’s oxygen blood content. In premature babies too much oxygen can be dangerous. We thank the donors who have given us a machine that can help the smallest and weakest babies in northern Uganda.

Help needed for the disabled in Fr.Jeya’s parish Zimbabwe

Fr.Jeya disabled

Fr.Jeya has a great concern for the disabled children. Some of these children are blind and others deaf. He is using his pastoral centre building to give them accommodation to attend school in the nearby Fatima school. The building is very  basic and he wants to upgrade it to give hot water and heating and indoor cooking facilities. In Zimbabwe the temperature can fall to 0 degrees in the winter. At the same time we would like to give hot water and heating to Fr.Jeya’s house. Please help us to help these disabled children and Fr.Jeya their best friend by donating now via http://www.charitychoice.co.uk/african-mission-57639  Many thanks for your support.