Challenges of Improving Intensive Care Medicine in Eritrea: Impact of an Italian Cooperative Project of Educational and Clinical Support

Valentina Anichini, Giovanni Zagli, Hagos Goitom, Giovanni Cianchi, Andrea Cecchi, Lucia Perretta, Emanuele Bigazzi, Barbara Gazzini, Simone Proietti, Alessandro Di Filippo, Simone Toccafondi, Gianfranco Gensini, Giancarlo Berni, Adriano Peris

Anesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Florence, Italy;.
Anesthesia and Intensive Care, Faculty of Medicine, University of Florence, Florence, Italy;.
Department Intensive Care Unit, Orotta National Referral Hospital, Asmara, Eritrea;.
Department of Critical Care Medicine and Surgery, Careggi Teaching Hospital, Florence, Italy;.
First Aid of Emergency Department, Careggi Teaching Hospital, Florence, Italy;.
Tuscany Region Sanitary System, Florence, Italy..

DOI: 10.4236/ojanes.2013.37069                

Abstract

Intensive care in Africa is available only in teaching or referral hospitals. Here we report the experience of a multidisciplinary collaboration between physicians and nurses of the Emergency Department (First Aid and Intensive Care Unit) of a tertiary referral hospital (Careggi Teaching Hospital, Florence, IT) and physicians and nurses of Orotta National referral Hospital in Asmara, Eritrea. The project was aimed at performing clinical assistance and training on the job to the local staff to improve the standard of care in the local Emergency Department. The duration of the project was initially planned to be 30 months, but unfortunately it was interrupted after 18 months because of lack of funds. The Italian staff was composed of two physicians and two nurses per period. To monitor local ICU activity, a retrospective survey of 36 months was performed. During the 36 months of data collection, 1169 patients were admitted to the ICU. Intra-ICU mortality rate resulted comparable before, during, and after Italian presence. On the contrary, the 28-day mortality resulted significantly lower bo th during and after the Italian stay. After project interruption, the Italian staff maintained contact with the Eritrean ICU personnel, who were invited to attend the Italian ICU for one month per year, and collected information about Orotta ICU activities.

Keywords

Intensive Care Unit; Developing Countries; MEWS

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. Usman, G. Mebrahtu, J. Mufunda, P. Nyarango, H. Goitom, A. Kosia, Y. Ghebrat, A. Mosazghi, S. J. Atanga and M. M. Equbamichael, “Prevalence of Non-Communicable Disease Risk Factors in Eritrea,” Ethnicity & Disease, Vol. 16, No. 2, 2006, pp. 542-546.
[2]	E. D. Riviello, S. Letchford, L. Achieng and M. W. Newton, “Critical Care in Resource-Poor Settings: Lessons Learned and Future Directions,” Critical Care Medicine, Vol. 39, No. 4, 2011, pp. 860-867. doi:10.1097/CCM.0b013e318206d6d5
[3]	C. P. Subbe, M. Kruger, P. Rutherford and L. Gemmel, “Validation of a Modified Early Warning Score in Medical Admissions,” QJM: An International Journal of Medicine, Vol. 94, No. 10, 2001, pp. 521-526.
[4]	C. P. Subbe, R. G. Davies, E. Williams, P. Rutherford and L. Gemmell, “Effect of Introducing the Modified Early Warning Score on Clinical Outcomes, Cardio-Pulmonary Arrests and Intensive Care Utilisation in Acute Medical Admissions,” Anaesthesia, Vol. 58, No. 8, 2003, pp. 797-802. doi:10.1046/j.1365-2044.2003.03258.x
[5]	R. M. Towey and S. Ojara, “Intensive Care in the Developing World,” Anaesthesia, Vol. 62, No. Suppl 1, 2007, pp. 32-37. doi:10.1111/j.1365-2044.2007.05295.x
[6]	H. Goitom and S. Dania, “Case Report Percutaneous Dilatational Tracheostomy: A Bedside Procedure in the Intensive Care Unit,” Journal of Eritrean Medical Association, Vol. 3, No. 1, 2008, pp. 45-46.
[7]	H. Goitom, “Lower Extremity Deep Vein Thrombosis among Intensive Care Patients in Orotta National Referral Hospital, Asmara, Eritrea,” Journal of Eritrean Medical Association, Vol. 4, No. 1, 2009, pp. 1-4.