Kenyan critical care doctor and UK-Med member Serah Kaara tells us of her experiences setting up a life-saving intensive care unit (ICU) for pregnant women in Malawi as part of the UK Emergency Medical Team’s response to Covid-19. UK-Med Media manager ALI MEE Writes:
One of the saddest experiences for Serah was losing a 15-year-old mum in the main ICU.
“She was the seventh mother to die at Kamuzu Central Hospital (KCH) in the first few weeks we were here,” she says.
Despite improved maternal health indicators, Malawi still has one of Africa’s highest maternal mortality rates and neonatal mortality. Women in the country face a one-in-60 risk of death related to a pregnancy or birth, according to the World Health Organisation.
In September 2020, the Ministry of Health requested for support for Covid-19 response as the nation battled a surge caused by the Delta variant. As part of the emergency medical team, UK-Med sent a team of 10 international doctors and nurses to Lilongwe, in October 2021, to support and train health staff to deal with the virus and care for severely and critically ill Covid-19 patients.
The ministry had also asked our team to include pregnant women with Covid-19 in their support. While working in the main ICU, it became clear that there was still a tragically high number of mothers dying, even when they did not have Covid-19.
“Mothers were dying with abdominal sepsis and severe anaemia,” Serah explained. “Poor nutrition is a big issue here in Malawi. Poverty and a lack of access to education mean girls don’t get off to a good start.”
Whereas the median age for new mothers in Kenya is 28, where Serah lives and works as a critical care doctor, Malawi’s is lower—at just 19.
Giving birth at ages 14 or 15 has its own unique challenges and risks, such as eclampsia or babies with low birth weight.
Spurred on by the situation, Serah carried out a rapid needs assessment to identify how the team could best help.
Although KCH already had a four-bed high dependency unit (HDU), she discovered that critically sick women were not always being transferred to the main ICU in time.
“The main issue we observed was that doctors and nurses needed support identifying the difference between serious and critically ill patients, so they could escalate a pregnant women’s care in time to prevent a condition worsening,” continued Serah. “A limited number of beds in the main ICU also meant women had to wait for critical care.”
Serah and the team started running a training programme between 7am and 9am, followed by ward rounds to the ante-natal, post-natal, theatre, HDU and labour wards. They provided hands-on critical care coaching and mentoring.
Working with the heads of anaesthesiology as well as obstetrics and gynaecology, Serah identified equipment to set up an additional two-bed ICU specifically for pregnant women.
“They realised there was a need and they actually had the equipment in the store. They just needed the technical support from us to set up the equipment and feel comfortable using it,” she explained.
After just three weeks, the hospital staff had treated six mothers in the new unit.
Serah explains: “The big success story is that right now we don’t have any mothers being admitted to the main ICU and we’ve been able to save two mothers’ lives here in the maternity ICU.
“We’ve been encouraging staff to stop nursing mothers with conditions like hypertension, which can complicate in the general ward and bring them into the HDU so they can monitor them closely and give better care.
“The women have been able to deliver their babies safely and be in a position to continue with their life. That’s a good outcome.”
Safely back home
One mother was admitted for shortness of breath, but tested negative for Covid-19. While in the maternity ICU, the staff performed an ultrasound where they discovered that her heart’s valves had been permanently damaged.
Knowing an increased flow of blood puts additional pressure on the heart’s valves of pregnant women, posing a risk to both the mother and unborn, the obstetricians helped the woman deliver safely.
“We’re delighted to say that mum and baby are now safe and were able to go home,” Serah stated.
Another young woman was admitted with pre-eclampsia. She was suffering from hypertension and developed shortness of breath, respiratory failure and a condition that causes excess fluid on the lungs.
The team gave her antibiotics to clear the fluid on the lungs, intubate her and deliver her baby boy of 2.9 kilogrammes by a Caesarean section. After being on a ventilator for 24 hours, she was able to recover in the post-natal ward and go home with her baby.
The ICU now helps obstetricians manage critical patients without having to wait for a bed to become available in the five-bed ICU. “The staff has been able to recognise the critically ill and the severely ill mothers and we have been able to save more lives,” she said.