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.

Dr Towey writes:

The practice of intensive care is a very demanding speciality even in countries where the funding of healthcare is secure and the average income of the patients is high. The majority of the poorest countries in the world are in sub-Saharan Africa and most of the intensive care wards in this part of the world are in the large urban areas. However there is good evidence to show that the practice of a modified form of intensive care in the rural areas of sub-Saharan Africa in a low income country as Uganda is not only possible but effective even with limited funds. See link  September | 2020 | Once the nurse to patient ratio is reduced, good monitoring obtained and the interventions of trained anaesthetists available then remarkable results can be obtained.

Over the last 20 years the support of African Mission to the intensive care ward to St. Mary’s Hospital Lacor has been very rewarding. The crucial areas are in the purchasing of second line antibiotics for patients in severe sepsis, special oxygen masks enabling high percentages of oxygen to be administered and central lines for patients in which peripheral intravenous access has become limited. Sometimes there are items which can only be purchased in Europe such as intravenous 3 way taps and ventilator viral filters and with the support of African Mission these items can be supplied and the smooth working of the ward then maintained. The good morale of a smooth working intensive care ward with rewarding good outcomes contributes to life saving practice throughout the whole hospital.

More recently as the reputation of St. Mary’s Hospital Lacor’s intensive care ward becomes better known we have been able to advise and support other hospitals in northern Uganda and South Sudan in improving both their anaesthetic practice and intensive care practice with equipment and items difficult to purchase. We thank our donors for giving us the capability to provide this example and outreach.

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