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ICU for children: Open wound in Greece’s health system

Intensive Care Unit for children are an “open wound” in Greece’s the National Health Service ESY as recent cases of children in need for an ICU bed had to travel hundreds of kilometers have shown.

In total, there are 55 ICU beds for children in public hospitals, of which 35 are in Athens and the rest in Thessaloniki, Patras in the mainland as well as on the island of Crete.

  • 35 in Athens
  • 10 in Thessaloniki serving the whole of northern Greece
  •  7  in Patras serving the Peloponnese and western Greece
  • 3 on Crete serving all the islands

Particularly affected are regions in northern Greece as no children’s ICUs exist  in the hospitals of Eastern Macedonia, Epirus, Thessaly, Central Greece, and the Islands (except Crete). All children who require special hospitalization are transferred to ICUs.

The whole of Northern Greece relies on the 8 pediatric intensive care beds in Ipporateio hospital: 4 ICU beds are for non-covid. 2 for Covid and another 2 for newborns.

Since the virus and respiratory infections started this year with intensity, the 8 beds of Hippocrates are almost always occupied.

According to the Panhellenic Federation of Public Hospital Employees (POEDIN), Rio hospital in Patras has 7 non-covid ICU beds and 2 for children with Covid.

The gaps and difficulties of the country’s health map have been highlighted in the most dramatic way recently by the continuous transfers of minor patients from regional hospitals to the Children’s Intensive Care Units (ICU) of the hospitals of Attica and the Rio University Hospital in Patras.

The inherent shortcomings of the ESY in this field, combined with the current outbreak of seasonal viruses in the child population, have pushed the health system to its limits in terms of the care and hospitalization of minors.

Children in need of ICU traveling through the country

After Christmas, at least five babies and children had to be transported intubated, from Epirus and Macedonia to the south due to shortage of ICU beds in the North.

The most dramatic was the case of 6-year-old Thomas from Grevena, N. Greece. The otherwise healthy boy suffered a cardiac arrest and had to be transported with an ambulance 300 km, an ambulance that broke down while on the road. Upon arrival at Rio hospital, doctors intubated the  young patient and did everything they could to save his life. Two days later, they declared Thomas was brain-dead.

On Epiphany day, an 11-year-old girl with serious underlying diseases and Covid-infection was transferred from the University Hospital of Ioannina, N. Epirus to a children hospital in Athens with a combination of air transport and land transport. As there was no free bed in the ICU of  the Rio hospital and “due to fog, air transport from Ioannina to Attica could not take place. So the intubated little girl, accompanied by a doctor and with all the safety measures, was transported by ambulance to Aktio, from there with an aircraft o Elefsina military airport and from there again with an ambulance to Athens,” president of POEDIN Michalis Giannakos told media.

On Monday, January 9, a 2-year-old baby in need of ICU was first transferred with an ambulance from Kavala to Thessaloniki from where it could be further transport with a helicopter to Athens.

Ambulance vehicles of Public Service EKAV traveled hundreds of kilometers to ensure the hospitalization of the minors in the Children’s ICU.

Safe transports through the country, says POEDIN

POEDIN president Giannakos stressed that “the transports are safe, but they do not cease to be an inconvenience for the intubated children and their parents, who follow them to hospitals that are located at long distances from their place of residence”.

In all cases, the mobilization of the health mechanism and the reflexes of the on-call doctors as well as the EKAB were immediate and fast, given the available solutions, media report.

However, because the health map, although it includes University and general hospitals in Epirus, Macedonia, Thrace and Thessaly, with pediatric clinics, does not include a Children’s ICU.

Lack of planning is a chronic problem

A correct planning would have to include in each region an adult ICU, a children’s ICU and why not a neonatal ICU. But this would mean also a set of necessary medical specialties, including pediatric intensivists and higher public expenses.

Speaking to local media best.gr, Gavriil Dimitriou, Professor of Pediatrics-Neonatology at the University of Patras, Director of the Pediatric Clinic in rio hospital listed the chronic problems in the country regarding children’s health care.

“In Greece there was never any health care planning. I have been dealing with newborns all my life, I am the director of pediatrics and the Children’s ICU. Until 2016, they ignored the newborns. I said then that ICUs for adults are clearly needed, but we also need to talk about newborns. To become an adult you must first be a healthy newborn and a healthy child,” Dimitriou stressed.

Neonatal ICUs have a big problem, mainly in terms of nursing and equipment, he added stressing that the ICU beds in Rio hospital are mostly all occupied..

“When a child enters the ICU for a day or two and is out of danger, they go to pediatrics, which is also full. A serious problem is that there are not many Pediatric Intensivists because there was never any motivation. Few go to this specialty because it only exists in hospitals,” he noted.

He pointed out that “in order to do something right, there must be a health plan that has never existed in Greece. For every 1,000 births you need 3 intensive care beds. This is the thought you start with to find out what you need to make.”

Noting that there cannot be ICUs for adults, children and neonatals in every region, he stressed that there must be a system that is safe and fast and this must include also the adequately equipped ambulances.,

Dimitriou recalled the “good old” practice In Greece. “We only talk about [solution] when something happens.”

He stressed that “health planning means people who know the subject discuss what we need, how much we need, what we can find. In addition to experienced staff, funds are also needed because an ICU bed is expensive.”

Health Ministry reacts to the problem, but not with own funds

The necessity of planning and operating additional Children’s ICU beds has been reportedly acknowledged by the Health Ministry “and this is clearly reflected in their decisions.” media noted.

In this context, the construction of a Pediatric hospital in Thessaloniki with 33 ICU-beds, among others, has been launched with a donation of 160 million euros from the Stavros Niarchos Foundation.

The donation for the large hospital was approved by the Parliament in February 2022 and is expected to start operating in 2025,

Also, the creation of a Children’s ICU is underway at the University General Hospital of Larissa, with a donation from the local business family of Xenophon Gandonias.

Professor of pediatric infectious diseased at the University of Thessaly director of the Pediatric Clinic of the University Hospital of Larissa, Giorgos Syrogiannopoulos, told daily kathimerini that the children’s intensive care unit is expected to start operating in summer of 2023.

He stressed that doctors in the hospital had been struggling for 20 years for this.,

Typical for the slow paces of the Greek state when it comes to Health is that a
in 2010, a donation was given by the Stavros Niarchos Foundation for the creation of this ICU for children in 2010.
But since the timetable for the acceptance of the donation and the design of the ICU was not respected, the donation was eventually  lost.
PS I hope the donations will be sufficiently use and do not have a similar fate like the ICU beds donations for Covid-patients that remained unused due to shortage of staff.

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One comment

  1. Out of interest: Do those numbers include beds in private clinics?