Nerve wrecking

Improper care after neurosurgery can cause brain damage leading to death or disability," says Dr. Sunil Perera, Consultant Neurosurgeon at the National Hospital of Sri Lanka. Having been at the hospital since 1996, Dr. Perera has been deeply concerned about the inadequate post-operative care due to insufficient facilities and support systems such as an Intensive Care Unit (ICU).

Even after successful surgery - complex brain and spinal cord operations- there have been a large number of deaths reported each year, due to inadequate facilities. An additional ICU to provide comprehensive care to all neurosurgery patients with head injuries, brain tumours and haemorrhages, would go a long way towards bringing down the mortality rate and the Neurosurgery Unit 2 is now seeking private sector support to remedy this situation (See box). 

The National Hospital of Sri Lanka, Colombo has two Neurosurgical Units, for both emergency cases and casualties, catering to all varieties of neurosurgical diseases/conditions. In the case of Neurosurgery Unit 2, it has access to 47 beds in Ward 64 for both male and female patients. But this number falls short of requirements. On an average, there are 88 patients needing beds every day and six operations are performed daily.

Ward 64 has been divided into four, the first section for patients who although they need medical care are well on their way to recovery. Patients still requiring considerable amount of care are in sections 2 and 3 (male and female). Those awaiting surgery or Magnetic Resonance Image scanning are also kept in this area. The fourth section with eight beds is for patients who have just had surgery, who need more care than others. This is known as a high dependency unit.

Entering the High Dependency Unit, one cannot help notice that the patients here are in a critical condition. But this unit is a far cry from an ICU and leaves much to be desired in terms of facilities. Although the nurses are busy attending to the patients, the beds placed so close together cannot provide the atmosphere of a proper ICU. The Unit also lacks a ventilator, one of the most important facilities required at this stage, to assist those with lung injuries and breathing difficulties. 

Needless to say, the facilities available are grossly inadequate to deal with the large number of patients. As a result, many ward patients are discharged earlier than the stipulated date and ICU patients are treated in the ward to make room for new patients, which lead to unnecessary complications.

Only the most traumatic/critical of post-operative cases requiring ventilator facilities are sent to the ICU of Unit I of the Neurosurgery Department. This is in an entirely different block, almost 200 metres away. This means that patients from Ward 64 which is on the third floor have to be brought down and taken to the ICU of Unit I. "Unnecessary time is wasted in shifting patients either by ambulance or on trolleys during which time we sometimes have to do a cardiac massage on the way," says Dr. Nilukshi, the Medical Officer of Ward 64. 

The present High Dependency Unit, within Ward 64 of the National Hospital premises can be upgraded and utilised as an ICU for Ward 64 patients. 

This new ICU or 'High Dependency Unit' with all required facilities would take care of the critically ill and also reduce considerably the burden on the nurses of Ward 64. As patients in a critical state need ICU facilities, which means one nurse per patient, the extra care for the most needed would save patients from serious complications. 

The patients' recovery will depend on the monitoring in an ICU where optimal care can be given. Withholding this can lead to brain damage which may not be reversible. An interesting fact that needs mention is that in 1980 there were four neuros-urgeons at the National Hospital and six neurosurgeons in the whole country. Today there are two neurosu-rgeons at the National Hospital and four in the whole country.
 

Appeal for aid Owing to financial constraints, the Ministry of Health has been unable to finance an ICU for Neurosurgery Unit 2. Dr. Sunil Perera has now appealed to the private sector - individuals and organisations for support. The cost for the new unit which includes six ICU beds, piped gas and vacuum system, ventilator facilities, monitoring facilities (Intracranial pressure monitor, ECG and Pulse Oxymetry) is estimated at Rs. 6 million. The Health Ministry would take responsibility for supervision. With such an ICU, head injury management and the morbidity/mortality rate will improve dramatically. The on-going Neurotrauma Project costing Rs.1300 million that is funded by the Government of Saudi Arabia, will only be completed in 2006. With two CT scanners at the National Hospital, more cases are being diagnosed every day and improved facilities are urgently needed.