Critical care in Africa: a new chapter begins

INTRODUCTION

“In developed countries, care of the critically ill comprises a large proportion of health care spending; however, in developing countries, with a greater burden of both illness and critical illness, there is little infrastructure to provide care for these patients. There is sparse research to inform the needs of critically ill patients, but often basic requirements such as trained personnel, medications, oxygen, diagnostic and therapeutic equipment, reliable power supply, and safe transportation are unavailable. Why should this be a focus of intensivists of the developed world? Nearly all of those dying in developing countries would be our patients without the accident of latitude.” (Fowler et al., 2008).

Africa, a continent accounting for approximately 20% of the world’s land surface, comprises around 55 countries and has a population of 1.2 billion (16% of the world’s population) with a median age of 19.7 years old (median age of world’s population = 30.4 years) (United Nations Economic Commission for Africa, 2012).

Poverty, illiteracy, malnutrition, and inadequate water supply and sanitation, as well as poor health, affect a large proportion of the people who reside in the African continent. It has been reported that 80.5% of the sub-Saharan Africa population was living on less than $2.50 (GDP per capital) per day in 2005 (Global Forum for Health Research, 2004).

In the US, the health care expenditure is approximately US $7,000 annually per capita. In contrast, total annual expenditure on health in the vast majority of sub- Saharan African countries is under US $25 per capita and often less than 3% of the total GDP of each country (Global Forum for Health Research, 2004). These figures indicate the disparities of a global ‘10/90 gap’ which means that 10% of worldwide expenditure on health research and development is devoted to the problems that primarily affect the poorest 90% of the world’s population (Global Forum for Health Research, 2004).

Critical care in many parts of Africa does not exists at all. In some major capital cities with better economic states, ICUs do exist, and critical care practice, research and professional activity is comparable to that in some other western economies (Williams et al., 2015). However, these examples are relatively rare in Africa, and the challenges for critical care development require the support from the rest of the world (Bhagwanjee, 2006; United Nations, 2012).

This paper tells the story associated with the development of a Multinational Critical Care Nursing Organisation in the African region which is now known as African Federation of Critical Care Nurses (AFCCN). The learning lessons from this paper can inspire others to follow a similar journey despite difficult odds and challenges. We hope that one day critical care practice in Africa will be on a par with the rest of the world. The rest of the world now has a responsibility to assist in this noble goal!

JOURNEY OF CRITICAL CARE NURSING IN AFRICA

The history of the establishment of a critical care nursing leaders and associations network in Africa is exciting. It was, and remains, very difficult to communicate, travel and make our way to conferences in remote regions of Africa due to the limited resources. A chronological history of some of the significant early meetings that connected many of the current critical care nursing leaders is provided below.

LAUNCHING THE AFRICAN FEDERATION OF CRITICAL CARE NURSES

The first official African Federation of Critical Care Nurses Congress was held in Kampala, Uganda on 18-20 October 2017. The conference platform was shared with the African Sepsis Alliance. A meeting facilitated by Ged Williams, Founding President of WFCCN, and witnessed by current President Paul Fulbrook with members of the African Warriors, elected the founding board of AFCCN (Figure 4):

The operational plan developed in April 2017 was used to guide the team to successful completion of key tasks leading up to and beyond the launch of the AFCCN (Table 1). The launch of conference in Kampala also incorporated many members of the African Sepsis Alliance, and a strong and positive relationship had been formed between the two organisations. Members agreed to hold the 2018 AFCCN Conference in Mombasa, Kenya will be a cosponsored conference with the African Sepsis Alliance 3-5 October 2018.

A number of the Board members of AFCCN and ASA are shared between both organisations, further cementing the bonds and communication between two organisations.

Since the launch of the AFCCN, the African worries continue to communicate daily via WhatsApp and through the Facebook and website.

Figure 1. First meeting of WFCCN Board and African critical care nursing leaders, South Africa, 2007

MOVING FORWARD

Building on the partnership with ASA and WFCCN, AFCCN participated in developing, signing and disseminating the declaration of Kampala, a document designed to bring attention to the scourge of sepsis on African communities and the need to mobilise attention and resources globally to help tackle the problem of sepsis in Africa (African Sepsis Alliance, 2018). AFCCN leadership members also participated in the ASA conference and meetings in Khartoum, Sudan, and helped to formulate the Khartoum document that pledged to encourage the African Union to support a sepsis conference for African Ministers of Health with the support of the Sudanese, African, and Global Sepsis Alliances and the WHO (African Sepsis Alliance, 2018).

The AFCCN/ASA conference and meetings in Mombasa in October 2018 will bring many more critical care nursing leaders from across Africa under this joint forum to strengthen the membership and possible actions through a shared mission and governance to improve healthcare and life in Africa.

The AFCCN member organizations have embarked on a series of activities and initiatives to spread new agenda to strengthen critical care in Africa. The CCNAU is strengthening the capacity of nurses to assess and screen patients for sepsis which is a common illness contributing to large portion of death in Uganda. The Critical Care Nursing Association of Ghana plans to induct new members into the group in March, followed by a workshop in May and a symposium in September 13th to outreach and visit the country to increase awareness of the importance on sepsis management. The National Association of Nurse Intensivist of Nigeria (NANIN) has been one which is most actively involved in organizing national conference in partnership with many organization including AstraZeneca and WFCCN.

Figure 2. Ged Williams and the African Warriors establish a plan, Ghana. November 2016

Figure 3. The African Warriors and Ged Williams draft the AFCCN constitution at ECCC, Dubai, UAE, April 2017

CONCLUSION

The difference in latitude, culture, colour, and birthplace have been excuses to allow people to ignore the plight of communities in resource limited countries. African and other resource-constrained critical care nursing organisations need to be triage as one category if they are going to be a sustainable resource to lead and drive healthcare improvement and reform in their regions. Creation of regional critical care nursing federations in Europe, Latin America, Asia and now Africa has enlightened and inspired many critical care nurses to share their unique culture, support linkages among nurses across countries and continents to make a significant contribution to critical care practice globally. We are hopeful that critical care nursing in Africa under the leadership and guidance of AFCCN will grow from strength to strength and ensure a professional environment to inspire many new leaders to follow.

Figure 4. The newly elected AFCCN executives (sitting from L to R): Halima S.K, Faustina A.E, Aliga C.A, Daniel N and Michael M; standing extreme left, Paul Fulbrook (President WFCCN), extreme right, Gerald William (Founding President WFCCN) during the 3rd Regional Conference (held in Kampala, Uganda) together with country representatives from Cameroon, Ghana, Nigeria, Kenya, Liberia, Uganda and Sierra Leon. Photo by Rose Nakame

REFERENCES