Burn care in Nepal, an update August 2016

Update April 27, 2019

Here is a report in The Kathmandu Post that discusses burn care. The 21-year-old woman was a victim of “bride burning.”

The piece includes a description of the incident, as well as a graphic photo ( not re-published here). It also gives an update on the prevalence of burn injuries in Nepal, including some statistics, such as the fact that in 2018 there were 56,000 burn injuries in the country. On Facebook, somebody posted this commentary:

ना बेटी को पढ़ाई जाती है, ना बेटी को बचाई जाति है , बेटियाँ तो सिर्फ जैसे तैसे पैदा हो जाति है। पहले गर्भ मे हत्या की प्रयास होती, बच गइ तो बचपन मे लापरवाही करके मारने प्रयास होती है, फीर भी बचाई तो कोई पापीलोग रेप करके उनकी हत्या कर देता, अगर ईस से भी बच गई तो भिखारी लोग दहेज के लालच मे उसे मार देते। और इन सब से बच गइ तो भी कुछ पापी पति और कुछ क्रुर औरत (सासु) ही उनकी हत्या कर देती। फीर प्रदेश सरकार कहती है बेटी पढावो, बेटी बचावों।
अरे बहुत होगया सरकारी नाटक, कुछ कर सकते हो, तो कड़ी कानुन बनावो और ऐसे जानवरों का सफ़ाया करो! प्रदेश की राजधानी, धनुषा जिल्ला और उसके आसपास ५ औरतें मारे गइ है और वो भी पिछले १२ महिना नही, पिछले १२ हफ़्ते भी नही, पिछले १२ दिनों मे।
पिछले साल बहुत स्कुल भर्ना की नाटक किया सरकार ने, कहा गये आज तुमलोग? बेटी को तुम पढ़ा तो सक्ते नही, कम से कम यिनहे पापीयो से बचावों।

Translation of above:

Neither the daughter is taught, nor the daughter save the caste, the daughters are just like the one who is born. In the first pregnancy, there was an attempt to murder, if you survived, then there is an attempt to kill in the childhood, even if the fear is saved, some sinners would have raped and killed them, if they were saved from this, then the beggars would have killed him in the greed of dowry. Even if i escaped from all of these, some sinner husband and some cruel woman (Mother-in-law) would have killed them. Fior State government says daughter teach, daughter save.
Hey, a lot of government drama, if you can do something, then make a strong law and destroy such animals! The Capital of the state, DHANUSHA DISTRICT AND 5 women around it have been killed and they are not even the last 12 months, not even the last 12 weeks, in the last 12 days.
The government has played a lot of school admission in the last year, where are you today? You can not read the daughter, but at least you can save the sinner from this.

Don’t tell me that this never happens.

April 2018 Update: six-minute CNN video about the Burn Center in Kirtipur

https://edition.cnn.com/videos/world/2018/01/03/vital-signs-nepals-largest-burn-center-c.cnn

March 12 2018 update: Today’s Nepal news is a plane that veered off the runway while landing and burst into flames. Two dozen victims survived and were brought to hospitals in Kathmandu. I am sending the victims good karma and also praying for God to guide the hands of the doctors and nurses. In the meantime, in such an accident there is a high proportion of burn injuries. And so, I am re-posting this blog entry for people who wish to learn more about the health care system of Nepal.

Oct 2017 update – thrilled to report that “Burn Care in Nepal” is the “untold Global Health Story of the Year” for 2017 – go to: https://www.globalhealthnow.org/2017-10/reconstructing-hope-surgeons-mission-help-nepals-burn-patients to read the first of a three-part series.

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.