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Donor Progress Report

Paediatric Intensive Care Unit (ICU) Upgrade & Extension

Red Cross War Memorial Children’s Hospital

January 2016Prepared by The Children’s Hospital Trust

The Children’s Hospital TrustAdvancing Child Healthcare through the

Red Cross War Memorial Children’s Hospital

ICU Phase 1 Construction

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Luke van Staden, is from Hanover Park in Cape Town. He first arrived at the Red Cross Children’s Hospital after doctors at Groote Schuur Hospital discovered that he had a hole in his heart. He was diagnosed with atrioventricular septal defect (AVSD), a birth defect that caused two holes in his heart.

Luke was only 4 months old when his 46 day stay in the Paediatric Intensive Care Unit (ICU) at the Red Cross Children’s Hospital started. Luke spent some time at the temporary ICU F Floor while construction on the C floor was taking place. He was on a ventilator until he received open heart surgery on 20 November 2015. During his time in the ICU, Luke suffered multiple complications and infections such as pneumonia that posed a risk to his health. Luke did not improve after surgery and doctors informed his mother, Renicia that there was little hope of survival.

Two days after his heart surgery, Renicia received a call late one night. The call was from an ICU doctor informing her that her little boy had gone into cardiac arrest. Luke proved to be a fighter and the doctors refused to give up. Following 22 minutes of CPR, Luke’s little heart started beating again. “Treatment at this ICU for a child is a hundred times better than anywhere else” said Renicia, “It was a miracle that he made it.”

After spending time in ICU, Luke spent two weeks in the general ward at the Hospital, where his condition was monitored and the doctors taught Renicia how to change the dressing of his pacemaker – a task that needs to be done once every two days.

Luke’s doctors and parents were overjoyed when he was discharged on 14 January, as it was a true miracle that he survived such a traumatic, complicated journey in the ICU. “The doctors all took pictures of him when he was discharged – not one of them gave up on him,” explained Renicia. According to Renicia, Luke has been adapting well at home and his four older siblings are ecstatic to have their baby brother back at home.

Baby Luke, 4 Month old spends 46 days in ICU

The 22-bed Paediatric Intensive Care Unit (PICU) at the Red Cross War Memorial Children’s Hospital is the largest in Africa and provides emergency care for hundreds of critically ill or injured children. Most patients are infants and toddlers from within the Western and Eastern Cape, but some travel from the rest of the country and in some cases from Sub-Saharan Africa.

The PICU teams deal with complex cases including cardiac (250-300 cases per year), neonatal surgery (on the smallest of children, weighing only 700grams), neurosurgery, trauma and burns (50 – 60 per annum), tracheostomy children, respiratory and neurological conditions.

With over 1.7 million children in the Western Cape, this number has increased by nearly 200 000 in the last decade and so has the corresponding number and complexity of paediatric intensive care cases. Currently, there are only 35 paediatric intensive care beds within the Province. The current PICU at the Hospital has 22 of those beds with close to 100% occupancy.

Introduction to the Paediatric Intensive Care Unit (PICU)

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Why the Need for an Upgrade and ExpansionHaving a child in ICU is an overwhelmingly frightening experience for any family. Creating the most conducive environment, to the highest possible global standards, is therefore of paramount importance. In addition to the evident shortage of beds, the restricted space in the current PICU has caused a number of vital concerns for the clinical team.

The current space between the beds is at 16m² which is well below the accepted norm. The close proximity of patients makes it extremely difficult for the clinical team to manage hospital-acquired infections or cross-infections between patients. The current PICU does not include isolation wards. Clinicians therefore cannot make any provision for patients who have a compromised immune systems or who are contagious and carrying new germs, which can endanger medical staff and other patients.

There is also very little space for the storage of equipment while the patient is using very specialised machines. Vigilant families find a small space in between the machines to be at the bedside 24/7. On their two ward rounds, the multi-disciplinary clinical teams are forced to stand at the edge of the bed while discussing individual patients.

Having a child in the PICU with their life hanging in the balance is terrifying for parents, making the role of the social worker exceptionally important. They are able to explain the medical processes in a lay person’s terms and provide the emotional support needed throughout the ordeal. The families receive this support in a tiny office and which often cannot accommodate all concerned family members.Concerns have been raised in that there are no specialised facilities for neonates. These are babies who are younger than one month and older babies who have low birth weights. These babies are extremely vulnerable and need a high care facility with trained staff who will be able to care for them.

Phase 1 : Old C1 ICU wing before demolishing and reconstruction

Interim ICU Patient Facility - F Floor During the Construction ProcessDuring the first phase of construction, a temporary ICU Unit was set up on the F Floor of the Hospital. The C1 Unit patients were moved to the F Floor during this period. When the C1 Wing is completed, the ICU patients who are currently in the C3 Wing will move into the new C1 Ward.

Phase 1 : Temporary ICU space on F Floor

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ICU Phase 1 Under Construction photo’s

The professional team consist of:

The Children’s Hospital Trust has appointed KMH as the Architects and Principal Agent who will issue instructions to the following partners:

• Meyer Summersgill - Quantity Surveyor• Triocon Consulting Engineers - Mechanical Consultants• BFBA - Electrical Consultants• Kantey & Templer - Structural Engineers• Gossow & Harding - Building Contractor

The construction site was officially handed over on 01 September 2015. As of January 2016 the progress for Phase 1 completion was at 38% with the opening of the first phase is expected to be in June 2016.

Building Work Implications The construction workers are acutely aware that the building is taking place in a working hospital treating critically ill children. In February, a section of the Day Surgery Department in Outpatients will be shut down for a week whilst the roof is moved. This will enable fire proofing work for the ICU extension to be completed before the roof is put back on. This requires close liaison between the hospital staff and the building team. The building contractor keeps any noisy building work to the morning before the patients’ nap time between noon and 2pm.

The construction process is all on track with no problems experienced.

Progress of Building

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“Time is flying by so fast and we are so excited that the 1st Phase of the redevelopment is opening in June 2016. The builders have made an enormous effort in allowing ICU to

function while construction is happening

Dr Shamiel Salie - Paediatric ICU Consultant

“The move out of ICU C1 was a bit taxing but looking at the construction now, excitement is growing daily. We can see there’ll be plenty of space, creating a much better workflow

for nurses which will ultimately enhance patient care.

Nurse Johnathan Stuurman - Paediatric ICU Mentor (Clinical Education)

ICU Medical Staff Share Their Thoughts on the Construction

The Paediatric Intensive Care Unit Upgrade and Extension Project is progressing according to plan despite the difficulties of undertaking such a large complex project within a working hospital without disrupting hospital operations.

Our heartfelt and sincere appreciation extends to each and every one of our loyal donors for supporting this special project. It would not have been possible without your support. We look forward to showing you the completed project.

Conclusion

Financial Overview

Intensive Care Unit (ICU)

Building Equipment Total

Project Budget 74 375 570 25 624 430 100 000 000

Funding Received 41 797 702 9 092 963 50 890 665

Balance to Raise 32 577 868 16 531 467 49 109 335

The financial overview table below reflects the current funding position of the ICU Upgrade & Extension Project. The total project budget is R100 000 000 of which R50 890 665 has been raised. The total shortfall for the project currently amounts to R49 109 335.