Malawi Liverpool Wellcome (MLW) Research Programme has designed and opened a High Dependency Unit (HDU) at Queen Elizabeth Central Hospital, Blantyre, Malawi, to care for critically ill adults. Opening of this unit was accelerated to care for patients suffering from severe COVID-19 infection. This work compliments MLW provision of a new oxygen concentration plant at the hospital, which opened in June.
Adults admitted to hospital with critical illness are vulnerable and at high risk of morbidity and mortality, especially in sub-Saharan African settings where resources are severely limited. As life expectancy increases, patient demographics and healthcare needs are increasingly complex and require integrated approaches. Patient outcomes could be improved by increased critical care provision that standardises healthcare delivery, provides specialist staff and enhanced patient monitoring and facilitates additional treatment modalities for organ support.
LSTM’s Dr Ben Morton is a senior clinical lecturer in critical care medicine at MLW. He explained: “In Malawi, we established a new high-dependency unit within Queen Elizabeth Central Hospital, a tertiary referral centre serving the country’s Southern region. This unit was designed in partnership with managers, clinicians, nurses and patients to address local needs. The work we undertook included alignment with existing services, refurbishment of a dedicated physical space, recruitment and training of specialist nurses and provision of continuous monitoring and oxygen delivery equipment. As the global COVID-19 pandemic unfolded, we accelerated unit opening to meet the anticipated increased clinical demand of patients with respiratory complications.”
In an article published in the British Medical Journal of Global Health, Dr Morton and his colleagues describe the process of establishing the high dependency unit, how it was used to care for patients with severe COVID-19 infection and plans for future research and quality improvement. The nursing staff work in hybrid roles with both clinical and research responsibilities to drive improved clinical care. Dr Morton continued: “We plan to use this unique resource to conduct translational research to better inform care for patients with severe illness. This clinical/research model will be used to secure sustainable funding to maintain and advance HDU care capabilities for patient benefit.”
MLW is a partnership between LSTM, the University of Malawi’s College of Medicine, University of Liverpool (UoL) and Wellcome and in the 25 years since its formation has changed health in the country, with particular impact on malaria, pneumonia, childhood diarrhoea, typhoid, HIV and TB.