Tough choices and challenges in paediatric intensive care

Prof Arthur Argent was surrounded by family at his inaugural lecture (from left, back) his son Jonathan, wife Sally, son Brendan, daughter Lucienne, and his mother, Helen, who turned 97 on 25 November.

An intensive care unit (ICU) is sacred ground for Professor Andrew Argent of UCT's Department of Child and Adolescent Health.

In his inaugural lecture on 24 November, Argent explained that the paediatric intensive care unit is sacred in the sense that it is a place of profound experience for many people, is not readily accessible to all who need it, and its raison d'être is often dealing with life and death issues.

Titled Paediatric Critical Care - Working on sacred ground, Argent's lecture took his audience into the heart of his work at the Red Cross War Memorial Children's Hospital (RCWMCH), and the challenges he and his team face on a daily basis.

Argent notes that providing care to children with life-threatening illness or injury can be prohibitively expensive in poverty-stricken areas. However, several workers in poorer countries, using available resources, have found innovative and cost-effective methods for providing such care. An example of this is training professional drivers in first aid, as they are often first on the scene at traffic accidents.

"There are several methods that can save thousands of lives cheaply," said Argent. "Often, simple reorganisation may save lives at minimal expense."

But Argent points out that although South Africa is in an income range that can afford intensive care, the infant-mortality rate is too high. This, he argues, means that we have to focus on ensuring the most cost-effective and efficient ways of caring for children who are critically ill.

"We have to ensure that these children have rapid access to effective early treatment, at the appropriate level in the health care system.

"The RCWMCH is a place of tough choices," added Argent. "We have to decide who gets the resources, such as beds. And in decision-making we have to work out why we do it, how we do it, and do it openly and transparently."

Despite these difficulties, the hospital's ICU maintains an extremely low mortality rate.

Argent says that an ICU's "dark side" is a challenge for the people who work there.

"It's an environment that can have a strong impact on one personally. People struggle with death, with the emotional impact of severely ill children. They are often stressed, and many feel underappreciated. This can result in depression and burn-out, which is a huge problem - not only for the staff, but also because it may affect the quality of care received by the patients."

He added: "We owe it to our children to maintain these services. Our country can afford it, and we need to do everything we can to meet that commitment."