“We’re Losing Children We Could Save”: The Need for a Pediatric ICU at MTRH

Every morning and many evenings in Eldoret, Dr. Joram Nyandat faces a daunting caseload: children gasping from pneumonia, toddlers limp from dehydration, teens with head injuries after road crashes. He is western Kenya’s only pediatric intensivist—managing critically ill children across crowded wards, an overstretched emergency department, and, when space allows, a few beds in the adult surgical intensive care unit (ICU) at Moi Teaching and Referral Hospital (MTRH). 

Dr. Joram Nyandat (left) looks on during the Pediatric Fundamental Critical Care Support course. More than 100 residents, nurses, clinical officers and medical officers have completed the course at MTRH.

“On a typical day we receive three to four requests for a pediatric ICU bed,” he says. “Most of them don’t get one.” Experience shows that many will succumb to their illness or injuries. “That’s what keeps me up at night,” Nyandat says quietly. “We’re losing children we could save with the right support for two or three days.” 

MTRH’s Shoe4Africa Children’s Hospital was built with a dedicated wing for a pediatric intensive care unit (PICU). The space can host two 4-bed ICU pods plus a 4-bed step-down unit (12 beds total). Over the last two years, AMPATH partners have worked together to plan and provide the necessary training and procure the required equipment. Dr. Nyandat recently completed a pediatric critical care fellowship at British Columbia (Canada) Children’s Hospital.  

Dr. Adnan Bhutta, division chief of pediatric critical care medicine at Indiana University School of Medicine; his colleague Dr. Michael Lintner-Rivera, assistant professor of clinical pediatrics; and Dr. Mudit Mathur, director of pediatric critical care at Kaiser Permanente Fontana Medical Center in California, are committed to assisting Dr. Nyandat to open the much-needed facility.  

What a PICU would change 

The cases most likely to benefit are common—and imminently survivable with short bursts of organ support: respiratory failure from bronchiolitis or pneumonia; hypovolemic shock from gastroenteritis; sepsis; complicated malaria; poisonings from agricultural organophosphates; post-operative children who need a day or two of close monitoring. “Kids are remarkably resilient,” Dr. Nyandat says. “Get them over the hump and they turn around. Give them 48 hours of support—and a chance.” 

“In resource-limited settings, outcomes are better when children are cared for in a dedicated PICU,” added Dr. Mathur. During his visits to Eldoret, he provides advice and training and covers critical care needs to provide Dr. Nyandat with short breaks.  

“If we’re to make any dent in childhood mortality, effective pediatric emergency and critical care are essential,” said Dr. Bhutta who has also visited Eldoret and provided training to visiting clinicians at IU. “Through our AMPATH partnership, we can build these crucial services in western Kenya and reduce preventable childhood deaths. We value the AMPATH model. Thanks to everyone’s dedication, we’re optimistic about this project’s future—and eager for ideas that help us get there faster.” 

Critical Care Training is the Foundation 

Kaiser Permanente School of Medicine (KPSOM) supported Dr. Nyandat to attend the Pediatric Fundamental Critical Care Support (PFCCS) course in Southern California and Dr. Mathur then helped secure a Society of Critical Care Medicine (SCCM) grant to cover license fees and materials needed to start this training in Eldoret. Dr. Nyandat is now a certified PFCCS instructor and course director. Together with nurse educator Faith Sila, Dr. Nyandat and Dr. Mathur have held four PFCCS courses at the MTRH simulation lab training over 100 residents, nurses, clinical officers and medical officers. Dr. Nyandat also helped export PFCCS to Tanzania and assisted SCCM in Liberia, proof that local capacity can propagate across borders. 

Dr. Mathur has introduced point-of-care ultrasound (POCUS) for registrars and medical officers, teaching volume, cardiac, and pulmonary assessments and ultrasound-guided IV access. A handheld ultrasound donated by KPSOM now lives in Dr. Nyandat’s pocket and changed his practice overnight. “Finding an ultrasound used to take hours,” Nyandat says. “Now it takes seconds.” 

In parallel, Dr. Maria Srour, assistant professor of clinical medicine at IU, and Dr. Lintner-Rivera are collaborating with Dr. Nyandat to launch a POCUS course focused on critically ill children and to evaluate outcomes post-training. 

Putting all of the Building Blocks in Place 

Monthly Zoom meetings between the AMPATH team track bed requests, identify bottlenecks, and align support. To replace anecdotes with evidence, the IU Center for Global Health is supporting a PICU database to log admissions and outcomes—information that will drive clinical care, quality improvement, research and program launch decisions. 

Research is a key part of the plan. “I meet with Dr. Nyandat one to two times a month to work on grant applications,” Dr. Bhutta says. “We haven’t secured funding yet, but we’re committed to building a research program within the PICU.” In October, Dr. Bhutta will sponsor Dr. Nyandat’s visit to the U.S.—first to an international meeting, then to Indianapolis to connect with IU faculty. 

The team hopes to launch a fellowship in Emergency and Critical Care at Moi University within a year. “Building people is the only way to build services,” Nyandat says. “A fellowship would change the trajectory for western Kenya.” 

A window that saves lives 

Dr. Nyandat frames the final challenges to opening the PICU using the “4S” model described by Partners in Health founder Dr. Paul Farmer—space, staff, stuff, and systems.  

The physical space exists for a 12-bed PICU, though it is currently partly occupied by pediatric oncology overflow. Staffing is the biggest hurdle with fiscal constraints, policy changes, and nurse migration, limiting progress. Additional nurses are needed at MTRH in order to allow existing PICU-trained nurses working in other parts of the hospital to be assigned to the PICU. Some equipment is in place, but ventilator replacements will soon be critical as COVID-era contracts expire. Bedside monitors, infant scales, pulse oximeters, CO2 monitors and portable chest x-ray capacity are needed. System and protocol development are underway. Dr. Nyandat is eager to get started. 

Once the PICU is operational, Dr. Nyandat has developed a 3-phase plan to progressively scale up capacity. He projects that with $1 million USD in support the MTRH PICU can become a center of excellence for pediatric critical care in Kenya.  

“Children are suffering in silence,” he says. “We must advocate for them. Put them into policies. Build the unit we promised them.”