Critical care capacity in Haiti: A nationwide cross-sectional survey

Abstract

Objective Critical illness affects health systems globally, but low- and middle-income countries (LMICs) bear a disproportionate burden. Due to a paucity of data, the capacity to care for critically ill patients in LMICs is largely unknown. Haiti has the lowest health indices in the Western Hemisphere. In this study, we report results of the first known nationwide survey of critical care capacity in Haiti. Design Nationwide, cross-sectional survey of Haitian hospitals in 2017–2018. Setting Haiti. Subjects All Haitian health facilities with at least six hospital beds. Interventions Electronic- and paper-based survey. Results Of 51 health facilities identified, 39 (76.5%) from all ten Haitian administrative departments completed the survey, reporting 124 reported ICU beds nationally. Of facilities without an ICU, 20 (83.3%) care for critically ill patients in the emergency department. There is capacity to ventilate 62 patients nationally within ICUs and six patients outside of the ICU. One-third of facilities with ICUs report formal critical care training for their physicians. Only five facilities met criteria for a Level 1 ICU as defined by the World Federation of Societies of Intensive and Critical Care Medicine. Self-identified barriers to providing more effective critical care services include lack of physical space for critically ill patients, lack of equipment, and few formally trained physicians and nurses. Conclusions Despite a high demand for critical care services in Haiti, current capacity remains insufficient to meet need. A significant amount of critical care in Haiti is provided outside of the ICU, highlighting the important overlap between emergency and critical care medicine in LMICs. Many ICUs in Haiti lack basic components for critical care delivery. Streamlining critical care services through protocol development, education, and training may improve important clinical outcomes.

COVID-19 reveals weak health systems by design: Why we must re-make global health in this historic moment

“…Despite discourses of collaboration, capacity-building, and horizontal partnership between the Global North and Global South (and well-intentioned state and civil society actors), such unequal power structures keep the global health research and implementation agendas from substantively improving health systems to deliver comprehensive, high-quality care globally (Gautier et al, 2018;Okeke, 2016). Furthermore, global health efforts in the wake of capitalist structural adjustment policies often seek to circumvent national governmentsallured by the promise of 'efficient', decentralised, market-based, private actors (Keshavjee, 2014) and result in uncoordinated, unequal, and ineffective systems.…”

“…The African CDC, established in 2016, has made efforts to assist technical teams in Africa to respond to COVID-19 (Africa CDC, 2020), but major gaps remain in terms of lab and workforce capacity, essential medications and equipment such as ventilators in order to have a fighting chance against this pandemic. For example, despite millions of dollars poured into Haiti in the name of development, the country, which has a population of 11 million people, has the capacity to ventilate 62 people (Losonczy et al, 2019). Sierra Leone has one ventilator (Naveed, n.d.) despite calls by the WHO for health systems strengthening after the 2014 Ebola crisis (WHO, n.d.).…”

“…Yet, because tuberculosis is not of epidemic proportions in centres of economic and political power, it is not considered a major threat to global health security, and so it is deprioritized. In the case of TB, we see that the tried and classic approach of a) searching for the sick using a high sensitivity test; b) treating those with TB disease rapidly with antibiotics as well as nutritional, material and accompaniment support; and c) preventing disease with prophylactic treatment and infection control including contact tracing were never advocated for poorer countries in the Global South (Losonczy et al, 2019). And if we reflect on the 2014-2016 West African Ebola outbreak that claimed 11,310 lives in the three affected countries, many people criticised the delayed response by the WHO and the global community (O'Carroll, 2018).…”

“…We are living in a historic moment, a crisis brought on partially by a virus, SARS-CoV-2, and partially by the de-funding of basic public health systems in the context of longstanding global power differentials. These differentials-borne largely from racialized and nationalist ideologies associated with the extractive processes of colonialism and neoliberal privatisation (Keshavjee, 2014)-shape the ways we think about and respond to disease, risk, health, well being, and survival on a number of important levels. Health systems already facing enormous challenges, underfunded and understaffed, are the norm rather than the exception at this time of the emergence of COVID-19especially in the Global South.…”

Capacity of intensive care units in Ghana

“…There is however increasing concern that the number of COVID-19 patients that need critical care could outstrip available capacity, particularly in the light of the progression of the pandemic in other parts of the world. Globally, critical care capacity in unevenly distributed and elaborated in detail in existing literature [ [1] , [2] , [3] , [4] ]. The existing critical care capacity of many African countries is unknown because it is a relatively new and underdeveloped specialty.…”