How Covid-19 cases led Murang’a to building its first modern ICU

A medical expert managing ICU equipment at Murang'a County ICU Centre.[Boniface Gikandi,Standard]

Pauline Njogu beams with joy. Her mother has just been moved from the Intensive Care Unit (ICU) to the general ward, and for the first time in several weeks, the two can have a conversation.

Three weeks prior, her mother was wheeled into the ICU.

She had breathing difficulties and could not talk. Pauline and her family were scared of losing her.

“We had left her in the hands of God and prayed for a miracle. We thank God and these doctors for bringing my mother back to her feet,” she says.

A year ago, Pauline would have had to rush her mother to Kiambu or Nairobi for critical care because there was no ICU in Murang’a Level 5 Hospital or any other public health facility in the county.

 Escalating numbers

But, this changed after Covid-19 struck. With escalating numbers being reported, Murang’a County government built a 35-bed ICU in a record 21 days, in April 2020.

“This ICU is a godsend and it has helped so many people since it was built last year. We particularly thank our governor,” says Joseph Kang’ethe, a fruit vendor, who operates outside the hospital.

“Looking at what was happening in China and other places, we realised there would come a time when we needed an ICU for critically-ill patients. So, as the Covid-19 wave surged, we needed to be prepared for the sake of Murang’a residents ,” says Murang’a County Health Executive Joseph Mbai.

Mbai says that because space was already available at the hospital, the county used its own engineers and architects to design the building and construction started immediately.

This means the only tender that was floated for the project was for the supply of materials used in the construction, and this significantly reduced the cost of the project.

“We used labour contracts, which is allowed by law, because we wanted to build it in record time. We shared the work and gave the fundis the deadline.

“The person, who was doing the brick work, was different from the one doing the roofing, electrical and plumbing works,” says Mbai.

He says the construction was done day and night, supervised by Governor Mwangi wa Iria.

“By the 21st day, we had completed all the building works, then we started installing the machines. We got the first five ventilators from our local suppliers.

“We also liaised with other local companies that had excess stock and bought another six. We started with 11 ventilators,” says Mbai.

Other well-wishers donated another 17 ventilators.

The ICU has its own laboratory, nursing station and pharmacy. It has five doctors working on a rotational basis and a total of about 30 medics.

According to a 2020 survey by Edwine W Barasa, Paul O Ouma and Emelda A Okiro titled, Assessing the hospital surge capacity of the Kenyan health system in the face of the Covid-19 pandemic, there are 537 ICU beds and 256 ventilators in Kenya, and only 22 out of the 47 counties have at least one ICU unit.

Blessing in disguise

While it was conceptualised and built as a response to the Covid-19 pandemic, the Murang’a hospital ICU now serves more non-Covid-19 patients, not only from the county but also from neighbouring counties, including Nairobi.

According to Murang’a Level 5 Hospital Medical Superintendent, Leonard Gikera, the ICU serves and average of 10 patients a day and has admitted up to 27 patients at a time.

Dr Gikera says for the hospital and its patients, Covid-19 was a blessing in disguise.

Murang'a governor Mwangi wa Iria and county executive for public works Amos Njoroge inspect one of the ventilators installed at the 35 bed capacity Intensive Care Unit at Murang'a Level 4 hospital.[Mose Sammy,Standard]

“Apart from improving access to critical care services for our patients, the tedious journey to Nairobi in search of such services has been cut to zero,” he says. 

“For critical care patients, time is of the essence. If you are in an ambulance and have to take the one-and-a-half-hour journey from here to Nairobi, a lot of things can change.”

He says being a public hospital, the cost of their services is way lower than that of private facilities.

The doctor says the hospital spends at least Sh120,000 per day on a patient in the ICU, but the county government has subsidised the cost to Sh70,000 for patients.

“We gave free services for the first months after the ICU was opened, including to Covid-19 patients – an initiative of the county government,” says the doctor.

Mbai says Governor Iria’s administration spent Sh25 million of the county health budget on construction of the ICU.

He added that money given by the national government for Covid-19 mitigation was directed to equip the facility and pay the staff. 

Available resources

“We rearranged our priorities in the health budget and built the ICU using available resources. Together with equipment, we spent about Sh150 million. If we went the tender way, it would have cost more than Sh300 million,” he says.

“This is a clear indicator that government projects can actually be completed within a record time and spend less money if people remove personal interests and bureaucratic processes that hinder development.”

Governor Mwangi wa Iria says the pandemic has challenged authorities to think outside the box.

“It was a matter of saving lives or wait for external help. We made a decision to construct this ICU and treat Covid-19 patients here. This has averted a possible catastrophe.

Before the ICU was built, Murang’a County had to refer about 10 patients every month to other facilities, according to information on the county’s website.

Other than the ICU, the county government has also put in place several other measures to mitigate the spread of Covid-19.

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