Burn care in Nepal, an update August 2016

In January 2016, I  wrote a piece about burn care on my other blog, titled “Bride Burning” in Nepal and Burn Injuries  http://wp.me/p3b3md-e1

My first book told the story of my first trip to Nepal. I worked with burn victims in 2007. Half the book is devoted to that experience. Burn injury is a big problem in Low Income Countries.

https://sacramentofthegoddess.wordpress.com/2016/01/17/bride-burning-in-nepal-and-burn-injuries/

The blog focused on the prevalence of burn injuries and the gender imbalance among victims. I wanted western readers to learn about the issue.

(oh, and you can buy my book at https://www.amazon.com/Hospital-at-End-World/dp/1935514288 )

This summer in Nepal I had the serendipitous chance to teach my course at Kirtipur Hospital, home of the Nepal Burn Center.

The hospital building is relatively new and still under construction. It serves a dual purpose, both as burn center and community hospital for the town.

Kirtipur is an ancient town in the Kathmandu valley, home of a large campus of T.U., and southwest of the center of the city, outside the ring road.

And below the photo is a video from a few years back that features Dr Shankar Rai, a reconstructive surgeon.

The fabric of Kathmandu’s bus system shows a wrinkle near Kirtipur since it takes two changes to get up the hill. This is one of the ad hoc bus parks.

The hospital is presently administered by Kathmandu Model Hospital. They freed up thirty staff to attend the CCNEPal three-day course.

the participants were a cross-section of hospital departments. Here, we’re about to do a demo of one of the scenarios of the course.

There is a wonderful nurse from Australia who is working through PHECT, named Tina Bryce McKay.

Tina Bryce McKay is a nurse from Australia who works at Kirtipur via PHECT. Earlier in the summer she came to Pokhara to help me.

I did not think i would teach in Kathmandu Valley, but when the schedule changed and I got some time, Tina got me the invite to train staff at Kirtipur.

Tina ( blue bandana) works to elevate the standards of staff training. Here she is, guiding a nurse through ecg analysis. Quite a bit of the class is devoted to elementary ecg and how to incorporate it into overall assessment. Any person who says ecg is not a cornerstone of critical care, does not know what they are talking about.

They gave me a tour of the place.

panoramic view of post-surgery ward during morning rounds. the layout is a large open space with low walls. The screen is used when dressings are change during rounds.

close-up of dressing cart

minor wounds will be examined at bedside and major ones go to “Theatre”

and another view:

Family involvement

Here is the waiting area outside the HDU, where patients are admitted when they have the most extensive burns. In Nepal, the family is expected to be nearby. In many cases, they donate skin to the victim.

just outside HDU. the gowns are used when visiting their loved one.

In the area where the HDU is, the Operating Theatre has a room designated specifically for grafting and debridement.

preparing for a debridement procedure. this would be done under light anesthesia to decrease the pain involved.

The HDU is a highly specialized Intensive Care Unit. When extensive burns occur, the victim inhales hot gas and can burn the upper airway. Inhalation burns are extremely serious.

panoramic view of HDU at Kirtipur. There were six burn victims that day. All required ventilatory support. All had suffered burns of greater than 60%

The percent of burns is an important point. For years it has been an axiom in Nepal that >60% burns is not survivable.

The “HDU” at Kirtipur is the most active critical care unit for burn victims in Nepal.

The physical plant of the hospital is only part of the story. In this case, Dr Rai – the main doctor behind the establishment of the hospital – is also a faculty member of NAMS, the National Academy for Medical Science, the oldest site for Post-Graduate Medical Education in Nepal. Along with other surgeons from NAMS, they have built a nationwide network to educate for best practices in burn care. Course have been held in many regions of Nepal, and local educators have been trained. They work with Nepal Burn Society; with Interplast; and with ReSurge International.

Here is a video from only two years ago that updates Dr Rai since the earlier one above. It was made just as Nepal Burn Center was being built.

Another piece of the medical system needed for effective burn treatment is to have a skin donor bank. – http://setopati.net/society/1073/

The website for Kirtipur is http://www.nepalcleftandburncenter.org/

Training Courses

Comments

The hospital at Kirtipur serves a critical need in Nepal to upgrade the level of burn care. Their efforts go beyond the construction of a physical building – they are also creating a nationwide network for burn education and care. They partner with international NGOs to advance the practice. Burn  care is intense, and it’s inevitable that they will have staff turnover. They need to continue to train their staff, and I think they could benefit from partnering with NGOs that will send future nursing specialists in Burn ICU.

My own efforts to educate nurses and doctors in advanced life support have paralleled the approach adopted by the Nepal Burn Society,  I am  impressed by their success.

 

 

 

 

 

 

 

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