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The Nigeria Pediatric ICU (PICU) Project

By Odiraa Nwankwor, MD

I am a pediatric intensivist, and I am from Nigeria. As an intensivist in the US, I offer multi-disciplinary care to children who are critically ill, in an ICU environment. Our team offers various forms of support for any organ-system failure ranging from tracheal intubation/mechanical ventilation to extracorporeal membrane oxygenation (ECMO). However, in Nigeria and most other low and middle income (LMIC) countries, children who are critically ill are not cared for in an ICU environment. Most of the hospitals in these resource-limited settings lack the capacity and resources to intubate and mechanically ventilate children who are in respiratory failure from varied causes. As you read this blog, if a child goes to any of the major tertiary pediatric institutions in these regions, in respiratory failure or has any major organ-systems dysfunction, the fate of that child is grim. There are millions of such children, even at this moment.

It is on this premise that we at Health Place for Children Initiative (www.healthplaceforchildren.org) decided to embark on this journey to build and maintain resilient health systems and structures, which will support training in the delivery of adequate care for children who are critically ill, in resource-limited settings. The Nigerian PICU Project is a prototype. In this project, we have selected the University of Nigeria Teaching Hospital (UNTH) in Ituku-Ozalla, Enugu as a pilot. This will be the first organized pediatric intensive care unit (PICU) in Nigeria. In the past 2-3 years, we have assembled donated medical supplies, equipment and devices valued at over $250,000 and shipped same to UNTH Enugu. These supplies were donated by Nemours/A.I. DuPont Hospital for Children in Wilmington, Delaware, Cooper University Hospital in Camden, New Jersey and PromptCare Companies, New Jersey. In September 2019, my 10-member team made up of 4 doctors (3 pediatric intensivists and 1 pediatric surgeon), 4 pediatric ICU nurses, and 2 respiratory therapists traveled to UNTH Enugu to establish a 5-bed pediatric ICU, and started the initial phase of training for the local doctors, nurses and physiotherapists (who function as respiratory therapists).

In 2020, we have scheduled two trips to UNTH Enugu to continue with capacity building and manpower development. We have identified clinical champions (younger pediatric consultants and nurses) for this project. We plan to send one consultant pediatrician to South Africa for a one-year training in pediatric critical care, and two nurses to either South Africa or Kenya for 6 months of additional training in pediatric nursing critical care. We will add a clinical engineer to our team for our trips in 2020. The clinical engineer will focus on training the local biomedical personnel on how to troubleshoot and repair malfunctioning equipment in the ICU. We project that the ICU will be fully functional by the last quarter of 2020. We hope to showcase the UNTH Enugu PICU model as a proof of concept, and upscale this project. Our vision is to establish one pediatric ICU at a major teaching hospital in each of the six geo-political regions in Nigeria by the end of 2025.

5-Bed Pediatric ICU at UNTH Enugu, Before
5-Bed Pediatric ICU at UNTH Enugu, After

I went to medical school at the University of Nigeria, College of Medicine Enugu. I trained in Emergency Medicine in Dublin, Ireland before relocating to the US in 2005 to start residency in pediatrics at Woodhull Medical and Mental Health Center in Brooklyn, New York on the J-1 visa. It was a huge cultural and social shock to move from a mellow and easy-going Dublin to the hustling and bustling life of New York. But we quickly adapted. Today, almost 15-years later, I work as a pediatric intensivist both at Nemours/A.I. DuPont Hospital for Children in Wilmington, Delaware and Cooper University Hospital in Camden, NJ.

My journey in medicine stretches across three continents and multiple cities. In all these, my family and I have experienced different cultures and we have been greatly enriched by those. I have also been enmeshed in different health systems and structures. Through these and my trainings, I have been molded into a global health personality, with special interest in the care of critically ill children in resource constrained environments. It is my privilege now to contribute to the improvement of health outcomes for children in my home country, Nigeria.