Category Archives: News

Dr Ray Towey’s work with St Mary’s Hospital, Lacor, Uganda

Dr Towey has volunteered at St Mary’s Hospital Lacor, Gulu, Uganda since 2002 (part time since 2008). He had previously been in Tanzania for 8 years.

St Mary’s is a not for profit, church supported, general hospital of 476 beds in northern Uganda. For many years it has had a small four-bed Intensive Care Unit near the operating theatre, which was upgraded to an eight-bed unit in 2005. It is a teaching hospital for anaesthetists, medical students, nurses and laboratory technicians and it is attached to Gulu University Medical School. The majority of the patients are the rural poor and can come from remote areas up to 100 miles away from Gulu.

Since 2002 Dr Towey has been involved in the training of anaesthetic officers, nurses, and medical students. He is now a part time volunteer and is focusing on the development of the intensive care ward. As the reputation of the Intensive Care Unit in St.Mary’s Hospital Lacor has spread in Uganda Dr.Towey advises other hospitals in the area of how best to develop their own units to build capacity and improve surgical care for the most vulnerable patients.

How African Mission can support St Mary’s Hospital and surrounding hospitals in northern Uganda in 2024

Dr Towey writes:

Thank God the Covid pandemic is over. The work in the ICU continues with as always its high demands and as I write in January 2024 the routine work of the ICU remains the postoperative stabilisation of surgical patients, the care of snakebite patients, and the management of head injured patients. I anticipate that we will need funds to upgrade at least one very good ICU nurse who has shown a particular skill. Very often the critically ill patients do not respond well to our first line antibiotic drugs and the second line more effective antibiotics can be  too expensive to our very poor patients. With donations we can offer a course of second line antibiotics which may be lifesaving. In 2024 we will continue to support the ICU with good quality tracheostomy tubes with inner cannula to facilitate safe nursing care. Education as always is an ongoing need and we plan to print or buy several books to maintain the ICU and the Anaesthetic School as places for good ongoing education for all the staff and students.

The cost of the transportation of central intravenous neck lines will also be an important item which must continue. One of the outcomes of the Covid pandemic is that many hospitals in northern Uganda have realised the vital importance of oxygen therapy and high dependency wards and intensive care wards. The reputation of St.Mary’s Hospital Lacor has spread nationally and we hope to be able to give advice and on some occasions practical support to acquire essential equipment for these remote hospitals. We thank all our donors that enable the staff to be effective health care professionals and show that hospitals in this post conflict remote region of sub-Saharan Africa are a sign of compassion and hope.

Attending to the crops in Fatima Mission

The video shows the special needs young people attending to the crops in Fatima Mission. African Mission paid for the irrigation system and thanks to this and to the hard work of the young people there has been an excellent crop of onions, tomatoes, garlic, chomolia, cabbage and sugar beans. Farming skills are an important asset in such a rural setting and the vegetables grown help provide the young people with a healthy diet.

Fatima Mission young people playing a Marimba – Nov 20

The following video shows six of the young people staying at Fatima Mission playing an instrument called a Marimba. Three things to note: (1) most of these young people are blind,  (2) this video was filmed after the young people had been given ONE DAY’S instruction on how to play this instrument and (3) the building in which they are playing was paid for by African Mission donors.

To see the video please click HERE

Dr Towey speaks of his work

Dr Towey was interviewed about his work in Africa by Dr.Mike Dobson for his podcast series ‘Anaesthesia Compass’.

The resultant three podcasts can be found on Spotify, or wherever you get your podcasts:

International research that Dr Towey has contributed to:

Essential Emergency and Critical Care – a consensus among global clinical experts (March 2021)

Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients can be overlooked in health systems. Essential and Emergency Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.

Read the full findings of the study (pdf)

Intensive care management of snake bites (July 2020)

Read the abstract

Intensive care medicine in rural sub-Saharan Africa (Jan 2017)

Read the abstract

Intensive care management of snakebite victims

Intensive care management of snakebite victims in rural sub-Saharan Africa: An experience from Uganda

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H-J Lang, J Amito, M Duenser, Raymond Towey

Background. Antivenom is rarely available for the management of snakebites in rural sub-Saharan Africa(sSA).

Objective. To report clinical management and outcomes of 174 snakebite victims treated with basic intensive-care interventions in a rural sSA hospital.

Methods. This cohort study was designed as a retrospective analysis of a database of patients admitted to the intensive care unit (ICU) of St. Mary’s Hospital Lacor in Gulu, Uganda (January 2006 – November 2017). No exclusion criteria were applied. Results. Of the 174 patients admitted to the ICU for snakebite envenomation, 60 (36.5%) developed respiratory failure requiring mechanical ventilation (16.7% mortality).

Results. suggest that neurotoxic envenomation was likely the most common cause of respiratory failure among patients requiring mechanical ventilation. Antivenom (at probably inadequate doses) was administered to 22 of the 174 patients (12.6%). The median (and associated interquartile range) length of ICU stay was 3 (2 – 5) days, with an overall mortality rate of 8%. Of the total number of patients, 67 (38.5%) were younger than 18 years.

Conclusion. Results suggest that basic intensive care, including mechanical ventilation, is a feasible management option for snakebite victims presenting with respiratory failure in a rural SA hospital, resulting in a low mortality rate, even without adequate antivenom being available. International strategies which include preventive measures as well as the strengthening of context-adapted treatment of critically ill patients at different levels of referral pathways, in order to reduce deaths and disability associated with snakebites in sSA are needed. Provision of efficient antivenoms should be integrated in clinical care of snakebite victims in peripheral healthcare facilities. Snakebite management protocols and preventive measures need to consider specific requirements of children.

Authors’ affiliations

H-J Lang, St. Mary’s Hospital Lacor, Gulu, Uganda

J Amito, St. Mary’s Hospital Lacor, Gulu, Uganda

M Duenser, Department of Anaesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, Linz, Austria

Raymond Towey, St. Mary’s Hospital Lacor, Gulu, Uganda

Full Text available by clicking HERE

Cite this article

Southern African Journal of Critical Care 2020;36(1):39-45. DOI:10.7196/SAJCC.2020.v36i1.404

Article History

Date submitted: 2020-07-30
Date published: 2020-07-30

COVID 19 APPEAL

Dear African Mission supporter,

first of all I would like to thank you for all of the the support you have given to our work to date. 

We are all living with the impact of Covid 19 and the huge upheaval it is causing to our lives. As I write the death rate caused by the virus stands at 18,500 (ONS figures in the week up to the 10th April) here in the UK. The pandemic has yet to fully impact on Africa but when it does the numbers of death are expected to be very high. We have a short window of opportunity where we can provide some vital equipment to St Mary’s Hospital in Uganda that will help in the fight against this deadly disease.

Please click HERE to see an appeal from Dr Ray Towey, who has worked in St Mary’s Hospital since 2002. Any help that you can give at this time would be very much appreciated and could well be literally life saving.

The quickest way to give is online at https://cafdonate.cafonline.org/12578#!/DonationDetails or youcan also send a cheque made payable to ‘African Mission’ to our usual address (African Mission, 12 Melior Street, London SE1 3QP).

Thank you for considering this request.

Paddy Boyle,

African Mission Administrator

Having a party at Fatima, September 2018

The young people in the video below are those who are receiving an education at Fatima Mission. Of the 21 young people residing at Fatima, 10 are deaf & unable to speak, 7 are totally blind, 3 are partially sighted (one of whom who is also partially deaf) and 1 is physically handicapped.

Before coming to Fatima many of these young people led very isolated lives and were faced with a bleak future. Thanks to the education they are receiving and the fact that they are living in community with others, their confidence and ability to relate with others is growing as you are about to see …

Research Audit in St Mary’s Hospital, Lacor Gulu, Uganda, 2017

Original article published in the journal Anaesthesia, 2017

Intensive care medicine in rural sub-Saharan Africa

M. W. Deunser1,2 R. M. Towey3 J. Amito4 and M. Mer2,5
1 Senior Consultant in Intensive Care, Department of Anesthesiology, Peri-operative Medicine and General Intensive Care Medicine, Salzburg University Hospital and Paracelsus Private Medical University, Salzburg, Austria
2 Global Intensive Care Working Group, European Society of Intensive Care Medicine, Brussels, Belgium
3 Consultant, 4 Anaesthetic Officer, Department of Anaesthetics and Intensive Care, St. Mary’s Hospital Lacor, Gulu, Uganda
5 Consultant in Intensive Care, Intensive Care Unit, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa

Summary

We undertook an audit in a rural Ugandan hospital that describes the epidemiology and mortality of 5147 patients admitted to the intensive care unit. The most frequent admission diagnoses were postoperative state (including following trauma) (2014/5147; 39.1%), medical conditions (709; 13.8%) and traumatic brain injury (629; 12.2%). Intensive care unit mortality was 27.8%, differing between age groups (p < 0.001). Intensive care unit mortality was
highest for neonatal tetanus (29/37; 78.4%) and lowest for foreign body aspiration (4/204; 2.0%). Intensive care unit admission following surgery (333/1431; 23.3%), medical conditions (327/1431; 22.9%) and traumatic brain injury (233/1431; 16.3%) caused the highest number of deaths. Of all deaths in the hospital, (1431/11,357; 12.6%) occurred in the intensive care unit. Although the proportion of hospitalised patients admitted to the intensive care unit increased over time, from 0.7% in 2005/6 to 2.8% in 2013/4 (p < 0.001), overall hospital mortality decreased (2005/6, 4.8%; 2013/14, 4.0%; p < 0.001). The proportion of intensive care patients whose lungs were mechanically ventilated was 18.7% (961/5147). This subgroup of patients did not change over time (2006, 16%; 2015, 18.4%; p = 0.12), but their mortality decreased (2006, 59.5%; 2015, 44.3%; p < 0.001).

Discussion

This study is the first to offer a comprehensive insight into the epidemiology and outcome of critical illness in a rural sub-Saharan African setting. As the ICU is the only facility in the study hospital where critically ill patients are cared for, and because the study hospital is the only inpatient facility in the region, our study population is likely to represent the true spectrum of critical illness for a large rural sub-Saharan African region. Furthermore, the virtual absence of financial barriers preventing patients from entering the ICU, which may be the case in other ICUs in low-income countries [1, 2], eliminates an important selection bias from this study.

In conclusion, our study gives a comprehensive overview of the epidemiology and outcome of critical illness in a large sub-Saharan African ICU population. It represents the first and largest study from a rural ICU in sub-Saharan Africa, and serves as an important reference for a region where there is an paucity of data, offering a greater understanding of the practice of intensive care in such areas. Although only hypothesis-generating, these results support the role of intensive care medicine as a life-saving medical specialty, even under difficult conditions and with limited resources, as well as the need to foster and grow such services in these regions.