“Children don't just die, not in this hospital and certainly not in this country” was her response when enquired about when Mortality Meetings are held in a hospital in UK. And why did that shock me? I have been so used to the monthly Morbidity and Mortality meetings in my hospital, a kind of mini inquest where stock is taken of disease entities that brought children to the hospital and sadly those that killed them. The column for “avoidable deaths”- death that could have been prevented if we had certain gadgets to monitor them or certain interventions to help them breathe better – is always full.
“Children just don’t die” I chuckled to myself. A typical day in my hospital begins with the sight of a child who is hanging onto his life by the finest of threads, yanked out of a taxi which has barely screeched to a halt and rushed to the Children's Emergency Room (CHER). Usually, no call has come through so absolutely no preparation has been made to receive such a sick child. Every attempt is made to revive such a child under the circumstances, sometimes after displacing a relatively stable child from his bed onto the mother's laps. Frantic calls are made to the various intensive care units in the capital, Korle Bu adult ICU, Ridge Hospital, 37 Military Hospital or Police Hospital for a space. Only a few fortunate ones get to find a space to be saved as these centres are usually full to capacity.
The Children's Emergency Room of the Department of Child Health, Korle Bu Teaching Hospital, has been crying for renovation for years. Constructed in 1964, at a time that the population of Accra was nowhere close to a fraction of what it is now, that small room designated the CHER has seen no expansion and is always full. The sight of sick children with different conditions sharing beds, vomiting and defecating onto one another is the norm. And that was all the emergency room had. No monitors, no HDU and no intensive care unit.
As a medical student, I swore never to work in that crowded claustrophobic room. As a house officer, witnessing firsthand the miracles that happened even without the gadgets in that small crowded space, I decided to specialize in paediatrics at Korle Bu. It was also around that time that efforts were intensified to get a one-stop shop for a new emergency room, a paediatric intensive care unit and a high dependency unit.
Attempts to have a new place constructed to help the teeming children referred to the department produced disappointing results. Because of the vulnerability of children, the care of children is hugely subsidized so an internally generated fund for the project was a big no. What would be the justification to withhold treatment for a child because parents cannot afford? Different methods were employed to put across our problem. Moving real-life documentaries were made and televised on various television stations to showcase our plight and help raise funds for the project. Corporate bodies were approached for help but the huge cost scared them away. Various funds – raising institutions and charities – were approached but the situation persisted. Perhaps, the most disappointing of them all was the exploitation of the situation by politicians. As expected, three sod cuttings for the construction of a new unit by various governments were witnessed. It did not help that these sod cuttings happened during election years. The promise was quickly forgotten once the election ended.
And so, news of the intention of the First Lady of Ghana, Her Excellency Mrs. Rebecca Akufo-Addo and the Rebecca Foundation to construct a new Paediatric Intensive Care Unit (PICU) was greeted with well-founded skepticism. Not even the alacrity with which the Mothers and Babies Unit of Komfo Anokye Teaching Hospital was constructed and handed over could completely erase our lingering doubts. Gladly though, a little over eight months after the old building that housed the CHER was demolished, a newly constructed and furnished PICU stands in its place. Although it is called PICU, it actually houses a neonatal intensive care unit (NICU) as well.
The new first class PICU houses 6 paediatric intensive care beds with ventilators including one isolation unit for infectious diseases. There are 16 High Dependency Unit (HDU) beds for seriously ill children who do not have to be on a ventilator making a total of 22 beds at the toddler's end. The unit also houses 5 ventilator slots for neonates (newborns) who need ventilatory support, 4 incubator slots for newborns with infectious diseases and 12 HDU cots for neonates who are sick but do not require ventilatory support at the neonatal end. This makes a total of 21 spaces for newborns. This adds up to a total bed capacity of 43 for the unit. As expected of a modern building, there is a counselling room to speak privately with parents of wards confidentially and a breastfeeding cubicle for mothers to either breastfeed or express their milk for their babies. There are also modern nursing stations, a see-through station to give an idea of happenings in the cubicles without entering them, a meeting room to discuss cases, a cashier and IT unit, a pharmacy and a laboratory. In addition, there are staff changing rooms for males and females, a staff lounge and restrooms. There are 4 visitors' toilets which are disabled-friendly, toilets and showers for staff as well as offices for doctors and nurses. The whole unit is highly energy efficient with low voltage solar panels installed to augment power supply. It also houses an oxygen room extension, compressor room, water tanks and air housing unit to improve ventilation. A backup generator is also installed to deal with power challenges. The unit is well fitted with monitors for the patients, modern beds and all required gadgets needed to run the facility to international standards.
It is absolutely mind-boggling to know that this huge edifice and furnishings were all done by the First Lady and the Rebecca Foundation. It was commissioned on 15th May, 2019.
The contribution the PICU would make to the welfare of children is beyond measure. The number of avoidable deaths recorded in our units because of lack of ventilatory support would be drastically reduced when fully operational. It is hoped that the all familiar sight of transporting seriously ill children to other facilities for ventilatory assistance would be a thing of the past.
Even though the new unit does not guarantee absence of mortality in children, it does guarantee a reduction to the barest minimum of avoidable deaths. So let us all join the Head of Department, Prof. Ebenezer V. Badoe and workers in the Department of Child Health, the numerous children who would patronize the facility, the numerous lives that would be saved by that facility and the entire citizenry to say 'ayekoo' to the First Lady and the Rebecca Foundation. The emotional roller-coaster that greets my inability to secure an ICU care for a child under my care is hopefully over. And even though time is said to erode gratitude, for me, my gratitude for the provision of the PICU will outlive time itself. We cultivate with prayer and deeds that her continuous support for the unit will continue for years to come.
Once again, the children of Ghana and their parents say thank you, Mrs. Rebecca Akufo-Addo and the Rebecca Foundation.
A member of Paediatric Society of Ghana
By Dr Frank Owusu-Sekyere
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