The NED Intensive Care Project began in August 2016, with the help of Dr. Pablo Extremera as coordinator, who carries out important work with great impact on the population of Zanzibar, since he has managed to develop, optimize and relaunch the ICU of the Mnazi Mmoja Hospital, serving patients from both said hospital and the NED Institute.

For NED, the creation of the ICU has meant one more step in the quality of care for the population and an increase in the life expectancy of people in more complex and critical health situations, a state of high incidence in the region


The basis of the Project is the solidarity of all the volunteers who altruistically decide to go to Zanzibar and contribute with their experience, decision making and work.

From its start in August 2016 to March 2020, the NED UCI Project has organized more than 40 missions and a total of 88 volunteers (intensivists, anesthetists and nurses), some even repeatedly, have collaborated with the project maintaining a consistency to what throughout the entire period. This sustained presence of volunteers has allowed the same line of work to be followed and, above all, to create a work routine for local staff on what day-to-day life should be like in an ICU. We plan to maintain this dynamic in the coming years.


NED Intensive Care Project: Missions & Volunteers


On the other hand, and thanks to donations from all the volunteers and the NED Foundation, during this period we have managed to build and equip a Pharmacy for the UCI as well as two warehouses that at the beginning of the project were non-existent.

The Pharmacy is supplied by various means; from the donations of the volunteers, as we have already mentioned, from the patients and their families who, depending on their economic level, collaborate with the purchase of material and medication and finally through the Mnazi Mmoja Hospital itself, which since the end of 2018 has begun to provide medication and own UCI material.

There is still a long way to go to be a ICU pharmacy in a developed country, but the construction of the ICU pharmacy itself has allowed us to work in an environment capable of responding to urgent daily needs.


Material before and after the construction of the pharmacy.


As an essential part for the operation of an ICU, admission criteria and action protocols have been established adapted to the context of the Mnazi Mmoja Hospital in Zanzibar.

The ICU admission criteria was one of the first measures implemented to correctly select the patients who were admitted taking into account the limitations of a unit with limited resources. Initially not well accepted by the rest of the departments of the Hospital due to its restrictive nature, however, they have been the basis with which to start working seeing results in the short term. With the passage of time and the improvement of the unit and the hospital, these criteria are progressively changing to adapt to the new needs and reality of the hospital. In addition, ICU protocols have been created to standardize treatments and actions.

A database has been established in order to analyze the work carried out.

Finally, a class program has been established to be taught by volunteers to the UCI staff with the aim of completing it every two years and repeating it cyclically in a more updated way.

Perhaps most important of all, beyond the statistics, is the change in perception that has been achieved in the Hospital around the ICU. Currently, the ICU is considered an example to be followed by the majority of the Hospital staff (from nursing to Medical Management staff).

Change of perception of the ICU in the Hospital.


The local staff is being trained for free in Intensive Care thanks to the professionals who come altruistically on a regular basis.

La unidad está creciendo gracias a, inicialmente el empuje de la Fundación NED, pero recientemente también debido a la inversión del propio Hospital respondiendo a las necesidades creadas por el Proyecto UCI. La Unidad ofrece apoyo y confianza al resto de departamentos del Hospital en situaciones críticas, incitando a la realización de cirugías y técnicas más complicadas y a ingresar pacientes más complejos.

The unit is growing thanks, initially, to the push of the NED Foundation, but recently also due to the investment of the Hospital itself, responding to the needs created by the UCI Project. The Unit offers support and trust to the rest of the Hospital’s departments in critical situations, encouraging the performance of more complicated surgeries and techniques and the admission of more complex patients.

Thinking about the future, given the good feelings that the project maintains in terms of significant improvements in the UCI, satisfaction of the local staff and good impressions from the volunteers, we think that we should continue with the UCI project for two more years and then return to evaluate it once again.

Therefore, we continue to look for volunteers who want to collaborate with the project in the coming years. Our top priority remains ICU-experienced nurses and medical intensivists / anesthetists. We must not forget that the basis of the Project is to train local staff in an ICU in a developing country. One of our great hopes for the future is to be able to send local personnel abroad so that they can stay for a time in a first-class ICU and learn another way of working with all available means.

Thanks to the compilation of cases in the database by the volunteers, results are being generated that we plan to publish soon in congresses and scientific journals.

We plan to maintain this dynamic as there have been many new and old volunteers who have confirmed their desire to collaborate again .

We really want to thank all of you for using your time, experience and money in solidarity in a project like this. There are two keys to making this project work; having found young local staff eager to learn and the generosity of good people with high specialized health training who are aware of the luck of being born in the right place and want to give something in exchange for it.

Coordinator Report


The coordinator of this great project is:


  Dr Pablo Extremera Navas

Neurointensive Coordinator


In August 2016, from the NED Foundation (Neurosurgery, Education and Development), we have signed a collaboration agreement with the management of the Mnazi Mmoja Hospital for the organization of the ICU and the specific training of staff (doctors and nurses).

Admission criteria have been established, a morning visit pass, organization of essential materials and medication, training in usual procedures in the ICU, and weekly daily classes and theoretical-practical courses are also being held with great acceptance by local staff. Initially, the classes were only going to be for ICU staff but given the interest of other doctors and nurses from other services (Anesthesia, Gynecology and Obstetrics, Emergencies …) we are also collaborating with them. In the same way, we are not only organizing the new ICU but we are also doing the same with the old ICU and probably in the coming months, after the inauguration of the new Pediatrics and Maternity building, we can also do it in the different critical units of these services.

At the clinical level, in just a few months, an improvement in the quality of care has been achieved, which has meant that there are more patients admitted of greater complexity and severity and with better results in terms of mortality and morbidity.

This project is being carried out continuously throughout the year thanks to the rotation of different intensive care doctors and ICU nurses from all over Spain to ensure continuity in the measures adopted.

Overlooking the future, we have started conversations and procedures to continue with a second part of the UCI project, which will consist of sending local Zanzibar staff for a few months to certain Hospitals in Spain for their training in Intensive Care.

Despite the exciting project underway, this has only just begun and there is much to improve and consolidate. That is why at NED, we encourage intensive care doctors and anesthesiologists as well as ICU and Resuscitation nurses to be part of the project. For any information or query do not hesitate to contact us at the following email: or through the foundation’s website

The coordinators of this project are:

  Dr Pablo Extremera Navas

Neurointensive Coordinator

    Dr Gisela Alamán y Laguarda

Neurointensive Coordinator



One of the projects we have undertaken with great enthusiasm is the implementation of an Intensive Care Unit at the Mnazi Mmoja Hospital on Zanzibar Island (Tanzania) where pediatric and adult patients in the Zanzibar area are accommodated. While it is preferably for neurocritical patients, it can be expanded to other medical and surgical patients according to the needs of the moment.

The start up of the unit is to be progressive; we do not intend to work at full capacity from the start since we must:

Provide the Hospital and the unit with the minimum equipment required for the adequate attention to this type of patients

Train both the medical and nursing staff in neurosurgical patient management and in other basic pathologies. At a later stage, we plan to carry out an education and nutrition program for the pediatric population.

Establish a close, ongoing, relationship between the two hospitals, Hospital de la Ribera (Alzira-Valencia) and Mnazi Mmoja and therefore the two Intensive Care Unit, which would enable us to improve results and perform “online” in cases that we consider appropriate

NED Foundation missions, which started in 2008, have been carried out so far at Mnazi Mmoja Hospital to collaborate on intraoperative management of neurosurgical patients in a close relationship with hospital anesthetists. By implementing assisted ventilation systems (until then intraoperative ventilation had been performed manually), it has been possible to control postoperative patients in intensive care where they have installed a continuous monitoring system and mechanical ventilation device that, in the absence of the air conduction and oxygen system, will work with oxygen bottles. Nurses and aids have been instructed in the control and monitoring of neurosurgical patients and this has helped them, as far as possible, in the control and treatment of other pathologies of their environment.


The coordinator of this great project is:



Dr. Gisela Alamán y Laguarda

Neurointensive Care Coordinator.