Burn Care in Tanzania Striving for excellence with limited resources Fiona Coia - The Mid Yorkshire Hospital NHS Trust/ (Northumbria Healthcare Foundation NHS Trust) United Kingdom
Introduction
Actions:
Future Plans:
In September 2011 a Multi-disciplinary Team (MDT) from Northumbria Healthcare Foundation NHS Trust visited Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania, East Africa. KCMC is situated at the base of Mount Kilimanjaro and is a tertiary referral hospital serving a population of over 11 million people in Northern Tanzania. KCMC has recently completed the building of a dedicated Burns Unit which will serve Tanzania and East Africa.
Burns teaching - Included Adult and Paediatric burns, estimation of size and depth, causes of burns, fluid resuscitation, sepsis, analgesia, play therapy and distraction, dressings and their efficacy, scarring and contractures , and psychological aspects of burn care for staff and patients and their families. • Teaching methods included: Didactic teaching, Lectures, Bedside teaching, Small group teaching, Interactive sessions: scenarios, Workshops, Plenary sessions: reflection
• Staff Exchange- Matron of KCMC visiting UK 2012. KCMC staff visiting UK in 2013 • KCMC open Burns Unit. • Tumaini University – Burn Care Course • Tri-annual visits to KCMC
• Utilising existing resources encouraged staff how to make the best of available resourcesdemonstrating how to make a “many tails” overlapping bandage from cloth we bought to secure large dressings to the abdomen - utilised throughout the hospital as a result.
• Aid to Learning - a series
Surgical Ward - KCMC
Purpose of visit
of small flip cards, attached to a clip detailing how to estimate burn size and depth (with photographs) and treat burns were developed. The cards were translated into Swahili by Doctor Mark Swai at KCMC and have been utilised by the Burns MDT and outlying hospitals who may receive patients who are unable to travel.
Staff at KCMC
Teaching at KCMC
Our role as a team was to: • Deliver evidence –based educational input for the Multi-disciplinary team, medical, nursing, physiotherapy and occupational therapy students and other disciplines from surrounding areas. • Work with the MDT to support better patient outcomes. • Prepare for move into dedicated Burns Unit at KCMC. • Utilise donated non-adherent dressings and assess the efficacy and ease of use for patients and staff. • Work with nursing staff, assisting with dressing changes and patient care.
Northumbria Burn Team 2012
Charles 2011
Dressing Procedures
Outcomes of interventions:
KCMC Burns Unit 2011
Distraction and Play therapy - Blowing bubbles was useful in encouraging physiotherapy and movement as children would reach out for them. Making toys out of available resources. •Trial of non-adherent dressings - firm has kindly donated silver dressings for 2012 visit. •Mother and carers observed and copied these actions for their children and other children undergoing a dressing change. •Engagement with staff - excellent exchange of knowledge, opinions and ideas. Mentoring staff -e-mail contact.
Masai mother and child
References: Jamison. D, Feachem. R, Malegapuru . W (2006) Disease and Mortality in Sub-Saharan Africa The World Bank. Washington D.C Delgado .J, Ramirez-Cardich. M E, Giliman. R H (2002) Risk Factors for burns in children: crowding, poverty and poor maternal education Injury Prevention 2002 , 8 . 38-41 Mbembati. N.A , Maseru. L.M, and Leshabari. M.T, ( 2002) Childhood burn injuries in Dar es Salaam: Patterns and perceptions of prevention. African Safety Promotion (1 ) 42-45
KCMC Burns Unit 2012
Identified Issues The nursing staff and MDT have excellent skills, are motivated and dedicated but were limited somewhat by the resources available. • Educational issues - established prior knowledge and delivered a series of sessions to meet staff requirements • Team work- learning to work as a Multi-disciplinary team to effect a successful patient outcome • Analgesia - efficacy of available medication • Bandages/Dressings - trialling non-adherent dressings • Burn prevention and First Aid in the Community
Acknowledgements; Mrs Brenda Longstaff, Ms Helen Boon, Northumbria Healthcare Foundation NHS Trust, Urgo Medical TM, KCMC Board of Directors, staff and patients, Dr Mark Swai, Matron Mamseri
Contact details:
Distraction therapy
Fiona Coia , fiona.coia@midyorks.nhs.uk, Clinical Teacher, Trust HQ/Education Centre, Pinderfields Hospital , The Mid Yorkshire Hospital NHS Trust, Aberford Road, Wakefield, West Yorkshire, WF1 4DG