Out of Africa--a mother's journey.
OBJECTIVE
To outline the journey of a mother of a critically ill child in her quest for care for her infant. This article outlines the barriers faced, disappointments, and the indignity of poverty. Questions and commentary relating to the care of the critically ill in resource-limited environments underline the issues she faces. Critical illness is very common in the developing world with most childhood deaths occurring in Asia and sub-Saharan Africa. These areas are handicapped by limited access to critical care and intensive care facilities. This paper is not intended to review preventive strategies and simple inexpensive treatments that may prevent diseases and diminish critical illnesses.


METHODS
Experience obtained from a sabbatical in Africa.


METHODS
A literature search with the following terms was conducted: intensive care, critical care, emergency care, children, developing countries, severe pneumonia, ventilator-associated pneumonia, nosocomial infections.


METHODS
Abstracts that seemed to relate to the care of critically ill or injured children from the developing world were then reviewed and relevant aspects were discussed.


CONCLUSIONS
Critical illness is common in areas of the world plagued with minimal resources to deal with its ravages. Parents try to do what is best for their critically ill children, but navigation of systems and lack of resources are daunting propositions. On any given day, this story or versions of it occurs in many parts of Africa and in low income countries in general. I saw similar scenes several times daily in Uganda and Kenya and, although the issues are slightly different in South Africa, failures of healthcare processes resulted in similar adverse outcomes in all areas. This is a mother's story.
Kissoon
Niranjan
N
Acute and Critical Care Medicine, British Columbia's Children's Hospital, University of British Columbia, Vancouver, BC, Canada. nkissoon@cw.bc.ca
D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D002675:Child, Preschool; D003422:Critical Care; D016638:Critical Illness; D003906:Developing Countries; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D008288:Malaria / Q000188:drug therapy; D044342:Malnutrition / Q000150:complications; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D011014:Pneumonia / Q000188:drug therapy; D011203:Poverty; D019035:Rural Health Services / Q000458:organization & administration; D013019:South Africa; D014218:Triage; D014454:Uganda