The LMIC Critical Care Patient – A Rwandan Experience

Nana Sefa

PGY 3

Emergency Medicine Critical Care Fellow

The LMIC Critical Care Patient – A Rwandan Experience 

I spent a couple of weeks in the Intensive Care Unit (ICU) of the University Teaching Hospital in Kigali. This was a very informative time during which I encountered a completely different patient population. Two aspects in particular stood out. First, the oldest patient I saw in the unit during the entire two-week period was a 60-year-old female. This patient was actually an outlier when is comes to age. On most days, the 7-bed ICU had patients aged between 18 and 39 years. This is contrary to the ICU population at the BWH MICU, where a 50-year old on most days could be the youngest patient. Additionally, about 50% of patients in the ICU in Kigali were patients with obstetric complications. During my multiple months in the BWH ICUs, I have known of only a handful of obstetric admissions to the ICU.

Without conducting a formal study, I also noticed that the mortality rate of patients was fairly high. The relative young age and the high mortality of patients in this ICU is very concerning. The quality-adjusted-life-years lost would be significant if calculated. It stands to reason that the socioeconomic value of the loss of these patients would be substantial. Additionally, given that these patients are dying during their most productive years, the country is also losing a significant amount of its manpower.  

My observations highlight the need for an investigation that would determine the underlying causes of the admission of a relatively young patient population to the ICU in Kigali, Rwanda and the issues leading to the relatively high mortality rate. Until the causes of these phenomena are elucidated, designing interventions that would meaningfully change these outcomes would be impossible.

My time in Kigali was not only educational on a professional level, but also on a personal level, inspiring me to focus part of my work on shedding more light on the uniqueness of this ICU population and improving mortality and patient outcomes in similar contexts.