INTERVIEW: Upgrading Egypt’s ERs crucial to alleviate ICU pressure

Dina Ezzat , Monday 1 Apr 2024

Ramadan could generally be a slower month for elective medical procedures in Egypt. Most Muslim patients prefer to schedule medical appointments and interventions, if possible, before or after the holy month of fasting.

Adel Al-Ansari, head of the scientific committee of the Egyptian Society for Intensive care and Trau
Dr Adel Al-Ansari, head of the scientific committee of the Egyptian Society for Intensive care and Trauma

This is not the case for intensive care units (ICUs) that might get some increase with critical cases being admitted for intensive care following medical emergencies that could hit people with chronic diseases during their un-regulated fast.

According to Adel Al-Ansari, head of the scientific committee of the Egyptian Society for Intensive Care and Trauma, inadequate hydration, excessive intake of food after long hours of fast, smoking habits, failure to observe the prescribed medical routine and insufficient medical checkups for patients with diabetes and cardiological issues are common reasons for having people, especially in the middle age and older brackets, being admitted into ICUs, especially during Ramadan.

According to the World Health Organisation (WHO), noncommunicable diseases (NCDs) including cardiovascular diseases and diabetes are the lead causes for deaths in Egypt, including premature deaths. Smoking, high intake of salt, which is estimated by the WHO to be double the recommended allowance, and obesity are key factors in this case. Over the past few years, the Ministry of Health has launched a campaign to promote awareness over NCDs.

However, according to Al-Ansari, the turnover of NCD-related cases into ICUs in Egypt, both in the privileged and challenged socioeconomic zones, show that commitment to better health practices is still lacking. “Attentive healthcare could spare many people from hospitalization and certainly from ICUs,” he said.

Meanwhile, Al-Ansari added that the majority of cases who need ICU admission in Egypt relate to deep vein thrombosis, pulmonary embolism, cerebral hypoxia, Ischemic cardiomyopathy, heart disease, and cancer.

Early diagnosis and adequate medical follow-up of NCDs and early identification of malignant tumours are essentials for easier treatment, fewer rates of admission into the ICU, and higher recovery rates, he added.

Reducing demand on ICUs in Egypt starts with the correct medical management of cases at the very early stages. “This is why we argue that one of the best ways to reduce pressure on ICUs is to improve the quality of medical diagnosis and medical care at emergency rooms [ERs],” he said. Proper diagnosis and follow-up could spare patients from the complications that would inevitably leave the case in need of ICU admission, he noted.

Egypt has questionable ICU availability. It is not unusual for ER doctors to have problems finding ICU beds for patients rushed in with diabetic coma, heart attacks, or strokes. Ministry of Health recent figures indicate that on average there is one ICU bed for every 7,000 people. Last year, the ministry launched a campaign to increase ICU availability and improve the efficiency of a network designed to help hospitals and medical doctors transfer cases in need of ICU or to help families find ICU space through the “137” hotline.

“I think serious work is put in place to increase the availability of ICU spaces in public and private hospitals nationwide. However, resolving the problem is also about reducing demand for admission – or long admission --when possible,” he said.

Towards this end it is imperative to work on improving the training of ER doctors and to better equip them with necessary laboratorial and radiological facilities to best diagnose the cases at the onset. To reduce ICU admission period, he added, there is a need for continued training of ICU doctors and better equipment of ICUs.

Al-Ansari agreed that the lack of necessary financial resources for equipment acquisition is certainly a handicap in many cases. However, he added that equally problematic, “more now than ever before”, is the human resources drain with many of the best ICU doctors finding it better for their careers and personal interests to pursue opportunities in developed countries that have opened up for recruitment of medical staff since the COVID-19 pandemic.

The lack of adequate chances of affordable advanced medical training and financial compensation and doctors’ long working hours, at times in poorly equipped medical units and hospitals, have for long been prompting many of the smartest of physicians, and for that matter of nurses, to opt for opportunities overseas. Government officials have repeatedly admitted that there is a growing shortage in the number of physicians per citizen in Egypt.

Al-Ansari argued that the brain-drain is particularly clear with ICU medical staff. This, he said, is adding to the complexity of resolving the ICU problem in Egypt. “Obviously, ICU availability and adequate equipment are not going to resolve the problem of ICUs if we don’t have enough well-trained doctors,” he said.

There are several schemes to help provide advanced training for fresh and mid-career ICU doctors, he pointed out. One scheme proving to be efficient is providing easily accessible online courses and training. There is also, he added, a scheme for fellowships and workshops held on regular basis under the auspices of the Egyptian Society for Intensive Care and Trauma.

“This is not an easy issue to resolve, but I think we are on the right track. There are some good indicators, including declining mortality rates [of ICU patients] and decreasing number of complaints about lack of ICU availability. However, there is big room for improvement,” Al-Ansari said.

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