COVID-19 and the Need for Global Critical Care Training. Why Ventilators Alone Are Not the Answer

Abstract

The current coronavirus disease (COVID-19) pandemic has unearthed many weaknesses in healthcare systems worldwide. In doing so, it has caused high-income countries to deal with the uncomfortable situation of resource allocation that has long been a daily occurrence in low-and middle-income countries. The shortage of equipment continues to be a major problem in low-and middle-income countries, but there is an even greater shortage of human resources in the form of trained individuals capable of caring for critically ill patients. With physicians being in short supply in many areas throughout Africa, the question becomes where do these human resources come from? In Kenya, clinical officers are the frontline workers and backbone of care in many healthcare settings and outnumber physicians four to one. AIC Kijabe Hospital, located in rural Kenya, recognized this need and identified this cohort of clinicians as a means of ramping up local emergency and critical care. In doing so, the Emergency and Critical Care Clinical Officer training program was created in 2015. Since its inception, the Emergency and Critical Care Clinical Officer program has been training nonphysician clinicians to care for critically ill patients with physician support. In this perspective piece, we outline our attempt at capitalizing on this pool of human resources to advance the care of critically ill patients, describe lessons learned along the way, and try to highlight the utility of their unique skill set in the setting of a pandemic.

Informing healthcare operations with integrated pathology, clinical, and epidemiology data: Lessons from a single institution in Kenya during COVID-19 waves

“…Closely related to therapeutics was the unmet need for in-patient care. This includes not just intensive care unit (ICU) beds but also increased demand for intensivists, nursing care, and personal protective equipment ( 7 , 18 , 19 ). And, all this in a background of other communicable and NCDs, medical and surgical healthcare needs, that now had to be conducted with heightened infection control protocols.…”

Association of clinical prediction scores with hospital mortality in an adult medical and surgical intensive care unit in Kenya

“…At the time of this study, as is common in many resource constrained settings, there was no formally trained critical care physician on site ( 15 ). However, KH is a training site for a nationally recognized diploma program for clinical officers in emergency and critical care medicine ( 16 , 17 ). KH has 5 adult ICU beds and 10 adult high dependency unit (HDU) beds.…”

Boosting ICU capacity during the COVID-19 pandemic in the western Balkan region, The Republic of Srpska experience

“…[20][21][22][23] Procurement of equipment and reconstruction of hospital walls were done relatively fast, whereupon health care authorities recognized a much bigger and more significant problem-the lack of trained staff. 24 At the very beginning of the pandemic crisis WHO identified education as a major priority especially in LRS, but distance and resources remained significant barriers to rapid education dissemination. 25 In the pre-pandemic period treatment of critically ill patients was conducted by intensivist (subspecialists) only in the MICU UCC RS.…”