Meet the Pediatric Intensivist and Emergency specialist at KNH

By Verah Mugambi

As the largest referral hospital in the country, we pride ourselves as a world-class patient-centered specialized care hospital. True to it, we have specialized doctors and nurses who are always committed to their duties.

It can be tense when kids are in the hospital and even more so in the Pediatric Intensive Care Unit (PICU). However, understanding the people and equipment in the PICU can help you feel better prepared to help your child.

In Kenya, we have only two pediatric intensivists & emergency specialists, and one works here at Kenyatta National Hospital. Meet Dr. Mukokinya Kailemia, a Pediatric Intensivist and an emergency specialist at KNH Pediatric Intensive Care Unit (PICU). She joined KNH three years ago as a Pediatrician before specializing in Pediatric Intensivist and Emergency.

According to Kenya Paediatric Association (KPA), a Pediatric Intensivist is a doctor with special training in diagnosing and treating children who are seriously ill or injured children. Pediatric intensivists use special procedures, treatments, and medicines to care for children in a pediatric intensive care unit of a hospital.

“Paediatric Intensive Care Unit (PICU) is an area in the hospital where very sick kids aged between two months to 13 years require intensive care or the highest level of medical care,” Dr. Kailemia stated in the interview with the Newsline team.

It differs from other parts of the hospital, like the general medical floors. In the PICU, kids get intensive nursing care and close monitoring of heart rate, breathing, and blood pressure. These can include ventilators (breathing machines) and medicines used only under close medical supervision.

What types of patients are in PICU?

Diagnosis of patients admitted to the PICU includes trauma, sepsis, pneumonia, solid organ/bone marrow transplants, post-neurosurgery, post-airway reconstruction, organ failure (kidney, liver, lung heart), patients with neurologic deterioration, and any other children with a rapid progressive critical illness. “In PICU, we always use a multi-disciplinary approach with the patients. You can’t work alone. We have several pediatric subspecialists, e.g., Neurologists, Cardiologists, Paediatric surgeons, etc. In addition, the PICU team may include residents (doctors who have completed medical school and are training to be Pediatricians) and PICU fellows (pediatricians training to be attending intensivists),” Dr. Kailemia explained.

Why pediatric Intensive & emergency specialists?

Dr. Kailemia: From med school, I felt pediatrics was one of the neglected areas. Most of the efforts are put toward adult medicine rather than pediatrics. Children are tomorrow’s future; remember, some are too young to speak for themselves, so mainly as a doctor, you have to think through what the patient is feeling… for me, that’s interesting.

Also, there is a need for an intensivist & emergency specialist combined in our hospital and the country. Another colleague and I were the first group in the country to do it blend; that pediatric intensivist & emergency medicine. Most people do it as separate courses.

Challenges

Dr. Kailemia: First, we see very sick patients, and outcomes vary. Some go home, others are left with severe neuro issues, and unfortunately, others don’t make it. It takes a toll on you because the aim is to save all patients, but losing them is painful. Being unable to keep them all is the worst part of the day.

The worst part is that most of the conditions we deal with are not congenital… it is not something someone is born with. Some of these diseases are preventable and also manageable. This is a bit discouraging because sometimes you feel that you could have saved the patient if you had gotten the patient earlier.

“Of late, we have been getting several positive outcomes, from the year 2022, we have had a reduction in our mortality, and that’s a big thing, especially for a public pediatric ICU. It’s a result of teamwork. We have an excellent team of nurses, consultants, and registrar all have been helpful,” she said with a smile.

What does it take to be a Paediatric intensivist and emergency specialist?

Pediatric intensivists have specialized training. After completing medical school as a pediatrician, one must complete a three-year pediatric residency and then a three-year fellowship in pediatric critical care; you can do it separately or combined; pediatric urgent care or (&) emergency specialist. After that you work for one year then you get your recognition. Board certification examinations in pediatric critical care are offered every other year, and one must also maintain board certification in general pediatrics.

Dr. Kaleima and a colleague attend to a patient

PHOTO | COURTESY

Dr. Mukokinya Kaileima being celebrated by Kenya Paediatric Association after a successful milestone

PHOTO| FB

How do you deal with overwhelm?

As a team, we debrief each other or talk to colleagues outside the hospital because sometimes, if things go south, you wonder what did I miss? Where did I go wrong? I normalize spending time with family and friends, listening to music, exercising, etc.

According to Dr. Kailemia, there’s a need for more human resources among pediatric intensivists & emergency specialists. “These children are the future so I hope more doctors in medical schools focus on PICU,” she concluded.