Improving the lives of burns victims in Nepal

8th March 2013

 

Immersed in the beauty and adventure of the Himalayan Mountains seventeen years ago, I did not foresee that I would return to Nepal so often in the future; but since 2008, I have visited Kathmandu nine times. My initial visit to see if help was needed in the burns unit in Kanti Children’s Hospital, has spiralled into a multi-agency partnership aiming to support and improve burn care in Nepal.

The human cost of burns seems inexplicably overlooked when you consider the distribution of global aid and those causes which excite public sympathy. Did you know for instance, that in low income countries, nearly 4 million women each year are severely burnt – a similar number to those diagnosed with HIV and AIDS ; that more school-age children in low income countries die of burns each year than TB or malaria?  For every death, many, many more suffer life-altering contractures and disability from even minor burns and scalds. 

The 22-bedded burn unit of Kanti, typical of most in low income countries, is a distressing place to be.  Managed by three overworked paediatric surgeons, the ward is basic; the single hand-washing sink is sealed over (to prevent flies); there are only two nurses per shift; poverty-stricken relatives sit by bandaged children. Frequent screams and cries emanate from the dressing-room. 

However, this is not a hopeless situation. Much immediate and long-term suffering can be ameliorated by relatively simple interventions: effective painkillers, early skin grafting, additional food and the use of splints, (which can be made of locally-available and cheap materials, such as plastic tubing and cardboard).  But staff need support to make these changes. Our Health Link with Kanti has involved nurses, surgeons and therapists. We have worked together on the wards and in theatres and we have partnered with the visionary charity Interburns to teach the specifically-tailored Essential Burn Care course to healthcare staff.  With a focus on team-working and effecting change, this collaboration has driven real improvement in the care offered to burn patients. 

We have together taught seven Essential Burn Care courses to over 250 participants and trained 23 Nepalis, who themselves have gone on to teach Essential Burn Care. Those attending courses have often not had any burn training before; they report that the knowledge was helpful and follow-up telephone questionnaire has shown that they have used this knowledge in their work. An Interburns Training Retreat in 2011 stimulated those in Kathmandu to form the active Nepalese Burn Society. Kanti staff have also visited us in Alder Hey Hospital.  

The results of an evaluation into the effectiveness of our programme have been encouragingly positive. The Link is widely known about and considered beneficial. Painkillers have been changed and all staff report improved pain-control for patients. New guidelines on nutrition and dressings are being followed by most of the nurses. The surgeons perform earlier surgery and more patients have splints and physiotherapy. Not all feedback is positive and there is still work to be done: some feel that the Link should be widened and there have been challenges around budgeting, communication and working with the hospital administration.

Indeed, working overseas in this manner is like climbing the Himalayan peaks; it takes a lot of preparation and hard work and often, you are despondent that you will not make the summit. But working as a team, you do eventually reach the top and joyously celebrate this achievement, before realising that there is another, greater summit ahead and you must carry on up the next slope. But though progress feels slow, these two comments from the evaluation are cheering:

“[Since the project] a drastic change has been seen day by day for nursing care as well as for burn patient.  Their quality of life is improving, we have seen that” (Nepali nurse). 

“I used to think burns management was very challenging, almost impossible, too hard.  Now my attitude has changed.  With teamwork we can definitely do good care and provide better service to burn patients” (Nepali surgeon).

Additionally, all the UK team felt that this work was beneficial for them personally and also brought benefits to the NHS. From my own perspective, it is an incredibly rewarding experience. More than just the opportunity to revisit a beautiful and hospitable country, it is a chance to meet remarkable people, form deep friendships, learn about equality and trust in partnership working and see sick children get better.  It is a privilege to be part of a team, which after four years, has now laid the foundations in Nepal towards the goal of achieving safe and effective care for those unfortunate enough to be burned, no matter where they are born in the world.

Sian Falder
BAPRAS Member

 

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