The Intensive Care Unit of the Zaporizhzhia General Hospital for Children #5
Doctors working at this ICU each perform two duties. One duty is that of attending physicians to children who need intensive care. In addition, these doctors are the anesthesiologists during surgeries
Head of the Unit, Vyacheslav Kapusta
Zaporizhzhia is a Regional Administrative Center and is the sixth largest city in Ukraine. This General Hospital for Children has the only Intensive Care Unit for children in the city of 176,000 people. The ICU has 15 beds and is badly under equipped.
Doctors working at this ICU each perform two duties. One duty is that of attending physicians to children who need intensive care. In addition, these doctors are the anesthesiologists during surgeries. One set of equipment must serve both the ICU beds and the operating rooms.
Through the non-sterile doors and hallways to the ICU there is a constant flow of hurting children. They come with numerous inflictions and situations from premature birth to accidental poisoning to serious illness, allergic reactions, over doses of drugs and alcohol, post surgical care, neurological and cardiologic diseases, etc. - all the many reasons children from newborns to late teens need ICU attention.
Vyacheslav Kapusta is examining a patient
The Intensive Care Unit of ZGHC #5 is united with the Anesthesiology Unit. It means that the same doctors working at the ICU provide anesthesia to patients during surgeries. Those two units have not only the same doctors, but also the same equipment. And here is where the bad things start.
The fact is that the scarce resources are to be divided between the surgical patients and children staying at the ICU. E.g., both units have to share only four syringe pumps. The minimum they need (one pump per bed and one for each operating room) is 20 pieces.
There are only four working aspirators for both units with a minimum need of 20. In such a situation doctors have to make a difficult choice every day – which of the children will be left without the important equipment. It sounds wrong, doesn’t it?
One of the monitors in operation
This problem has one more aspect. Theoretically the surgery unit should be a restricted zone with high cleanliness requirements. In Western hospitals one can get to surgery units only through special doors. No items or people from the ‘outside’ apart from patients can get through those doors. As for staff and equipment, they can get to the ‘sterile’ zone only after having passed special manipulations.
The fact is that any individuals or items have infectious agents on them, which may cause serious complications if they get to a surgery room. And here the anesthesiologist has to carry aspirators, monitors, and syringe pumps between the ICU the surgery block and from one surgery room to another. Leaving it in the surgery block is not possible as the ICU patients also need it!
It is clear that we do not leave in a Western country, and surgery units with special doors are not soon to appear. But minimizing the number of items carried here and there is quite real. Only this will allow reducing the risk of surgical infections and will make the life of local staff much easier and the patients safer!
Apart from that the equipment available in the unit is often outdated and not appropriate for “crisis” little patients. There are some new machines, such as new artificial respirators, but there are very few of them. Other, older respirators may be used only short-term and only for children whose conditions are not critical. It would be really great to change them, if not for up-market respirators produced abroad but, at least for newer ones produced in Ukraine. But… this is only a dream for the ICU.
Artificial lung ventilator RO-6. Such ventilators were developed and launched into production in the beginning of seventies of the last century…
Another problem of the ICU is consumable materials. For the monitors to be able to define the level of oxygen in blood (which is a vital indicator!!!), special sensors are needed. Those sensors come in the form of cables, which means that sooner or later they break or fail. The cost of one sensor varies from 80 to 335 US dollars (depending on the manufacturer of the monitor). So… Vyacheslav Kapusta sadly shows me the monitors and oxygen saturation devices which can't be used as there are no sensors… The same thing is with the tubes which have served their term. The tubes are used for the monitor to pump the air up to measure pressure.
The breathing circuits of artificial lung ventilators (ALV) also wait to be changed. Besides, the unit has a permanent need in ALV filters (they are used to protect the child and the ALVs from infections), aspiration catheters (sterile tubes used to remove sputum from the lungs of difficult patients with special aspirators), special sets for port-a-cath installation, tracheostomy tubes… and this list is to continue.
“So how do you manage to cope?”, I ask Vyacheslav Kapusta. “Well, we have to ask parents to buy all the necessities, - he sighs, - we write long lists, and people are outraged as the amounts of money they have to spend are rather big… I fully understand them but… what can we do? And when there is nobody we can ask to buy those things (abandoned children, children from dysfunctional families, etc.), we are at a loss”.
All over the world intensive care units are the most “costly”. Their support takes up to fifty percent of the total budget of hospitals. These units require the most sophisticated equipment, the biggest amount of consumables and expensive medications. And the price one has to pay for lack of the necessary equipment, medications and consumables is extremely high. Here, in the ICU, every piece of equipment saves children’s lives.
Currently the Intensive Care Unit of ZGHC #5 needs:
- sensors for oxygen saturation monitors, production of UTAS & MASIMO (without them the expensive and very useful machines are staying in the warehouse) – 5 pieces
- one-syringe syringe pumps (devices used for pre-dozed administration of medications) – 10 pieces
- two-syringe syringe pumps – 4 pieces
- oxygen saturation monitors (to control oxygen level in blood) – 4 pieces
- intensive care and anesthesiology monitors (devices allowing to control pulse, pressure, oxygen level in blood, body temperature, etc.) – 5 pieces
- capnograph (device defining carbon dioxide level in the expired air, which is an important parameter for some serious diseases) – 1 piece
- surgical aspirators (used to extract sputum from the lungs of children under narcosis or using artificial respirator) – 6 pieces
- surgical aspirator with an accumulator (used in mobile clinics and when transporting crisis patients) – 1 piece
- UV lamps with a re-circulator (UV lamps are usually used to counter infections in the air and on surfaces. But their light burns eyes and skin of the individuals present in the premises. The little patients of the ICU unit cannot be taken out of their rooms for the period of UV disinfection, so nurses have to cover children with their heads also hidden under cover. Small children get scared during this procedure… Lamps with a re-circulator may operate with people present in the premises without doing any harm to them) – 5 pieces
Yes, there are a lot of needs. And the total cost of all the things required is significant. But nobody expects to solve all the problems at once. The ice can be broken with doing little things… If the ICU gets sensors for oxygen saturation monitors (320 US dollars), it will allow effectively monitoring the health state of four children daily. If the ICU is provided with aspirators (around 738 US dollars), it will reduce the risk of complications among six children daily. And then, with luck, there will be 1-2 monitors, 1-2 syringe pumps… and the doctors will no longer have to carry the equipment to the surgery room and back and will no longer have to select which of the children will be left without life-supporting equipment… The task seems really tough now, but the situation can be improved! The only thing is that one should not be scared of big expenses and should start doing at least something!
Address: 28A Novgorodskaya Str., Zaporizhzhia, 69076 Ukraine (Khortitsa district, Novgorodskaya bus stop)
Telephones: Chief Doctor: +3 8 (061) 224 94 19
Reception: +3 8 (061) 224 93 86
Information Desk: +3 8 (061) 224 93 89
Intensive Care Unit: +38 061 224 94 01
Head of the Intensive Care Unit: Vyacheslav Kapusta
For further information please contact the volunteers of “The Happy Child” Foundation