Conference abstract

Approach to delivering critical pediatric care in Zahle, Lebanon: training, surveillance and ethical considerations

Pan African Medical Journal - Conference Proceedings. 2018:9(50).22 Sep 2018.
doi: 10.11604/pamj-cp.2018.9.50.778
Archived on: 22 Sep 2018
Contact the corresponding author
Keywords: Pediatric intensive care unit, Zahle, Syria, Lebanon, critical care
Oral presentation

Approach to delivering critical pediatric care in Zahle, Lebanon: training, surveillance and ethical considerations

Ryan W. Carroll1,&, Amro Al Maiss1, Rebecca Anderson1, Marco Olla1, Zeina Ghanous1, Nikola Morton2, Hiam Al Zein1

1Médecins sans Frontières, Operational Centre Paris (OCP), France, 2Médecins sans Frontières, Operational Centre Paris (OCP), Medical Unit, Sydney, Australia

&Corresponding author
Ryan W. Carroll, Médecins sans Frontières, Operational Centre Paris (OCP), France

Abstract

Introduction: since the beginning of the Syrian conflict in 2011, there has been a massive increase in internally-displaced and refugee populations, with over 1.5 million in neighboring Lebanon: 33% are unregistered and cannot access UNHCR services; 70% live below the poverty line; and a majority (42%) live in camps in the Bekaa Valley, Lebanon, half of whom are children under 14 years of age. The ‘Lancet Commission’1 states that communicable and non-communicable diseases cannot be fully addressed without surgical intervention. We hypothesize the inverse is also true: surgical intervention will be incompletely effective without also addressing comorbidities, including those common to refugee populations. Competent post-operative ICU level care is tantamount to the operative intervention itself.

Methods: in an effort to provide access to comprehensive pediatric care, including general pediatric surgery, MSF (OCP) and a partner hospital in Zahle, Bekaa, are opening a 2-bed pediatric ICU (PICU) and 4-bed pediatric intermediate unit (PIMU), alongside an 18-bed general pediatric ward. We are addressing unique challenges that stem from delivering ICU level care, including: new approaches to recruitment; developing training methods and protocols new to MSF; establishing a high nurse-to-patient ratio; ensuring competent use of ventilators; and considering ethical dilemmas stemming from reanimating children in the specific socio-economic and cultural context.

Results: we have recruited a local pediatric intensivist and nurses, established relationships with nearby referral and teaching PICUs and opened the general pediatric ward. Beginning with table top simulations, we are utilizing clinical scenarios specific to ICUs (e.g. respiratory failure leading to intubation and mechanical ventilation) to identify critical gaps. As the launch date approaches, higher resolution rehearsals and simulations will be completed to fully emulate critical care delivery. Lastly, ethical dilemmas will be thoroughly discussed to better prepare the team.

Conclusion: opening a PICU and supportive services requires a unique multifaceted approach to recruitment, training and maintenance of care.