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Tanzania 2013 Blog

The day of the Burns Symposium had arrived

The day of the Burns Symposium had arrived. The team assembled in the lecture room ready to begin. However a data projector and laptop had to be found at the last minute so that the presentations could begin. Electricity was still hit and miss with at one point the lights going out and air conditioning coming on. However, everyone was glad to be able to charge mobile phones after two days without electricity. More than 40 people attended the symposium including representatives from local and national television and radio so that the messages from the symposium could be widely spread. Surgeon Jeremy Rawlins took a short break from theatre to deliver an inspirational lecture about the importance of early surgical intervention for acute burns, to prevent the development of disabling scarring and contractures which he had seen at KCMC throughout the week.

Katie Piper gave her final talk to an engrossed audience just before dashing back to pack for the airport after a busy four-day schedule visiting local schools and hospitals. After the event the feedback forms were collected and many of the participants wrote about Katie’s inspirational talk. One commented “life can change anytime, but the most important is I should not lose hope”.

The heavens opened once again overnight with heavy rainfall

The heavens opened once again overnight with heavy rainfall. Ripe avocados thudded onto the roof of our accommodation during the night accompanied by the chattering of the monkeys in the trees gorging on the ripe fruit. It was a cloudy and cold start to the day as we piled into the jeep once again to head up the mountain to Kibosho Village to visit the primary schools and district hospital. The children were delighted to see us and really enjoyed the play acting as Jerome Marshall, the clinical psychologist, showed the children how easy it was to be distracted and allow accidents to happen in the home. Katie Piper talked to the children about the importance of being a good friend to those who have suffered burns injuries and that the support of the community for burns survivors was needed to give them the best chance of living a fulfilling life after their injury. As Katie led a final question and answer session to find out how much the children had learnt from the lesson, hands were thrust into the air and everyone wanted to be the first to answer!

The theatre team had a long and challenging day with three cases taking more than 12 hours to complete. A nine-year-old boy had a very severe skin contracture of the neck causing his bottom lip to join his chest. A number of skin grafts were successfully performed to free up the neck and remove hardened scar tissue. Meanwhile on the wards sister Fiona Coia and sister Claire Swales provided post operative care for the patients working with experienced KCMC nurses as a team to provide the best possible outcome for the patients. Both intensive care and the burns ward were beginning to fill up with patients who had been operated on and still people kept arriving hoping to be one of the lucky ones to receive life-changing surgery. The procedures were more complex than anticipated and extra theatre staff had to be brought in so that the team could continue to operate into the evening. Specialist nurse Peter Smith was drafted in to bring the complement of staff up to the required level. The team finally trudged home in the dark just before 10pm, exhausted but satisfied that they had achieved such a good outcome from what had been a particularly challenging day.

Heavy rain came down throughout the night leaving the roads slippery with mud

Heavy rain came down throughout the night leaving the roads slippery with mud. The team piled into a jeep for the short trip up the mountain to Mdawi Primary School where pastor Allen Lekay was waiting to greet us complete with a troop of boy scouts! After an impressive display of singing and marching, desks were brought back into the impromptu parade ground so that the rest of the school could come together for the fire safety lesson.

Community matron, Lorraine Jackson worked with translator Amina Temu to interact with the children and ensure that they understood the fire hazards within the home. By the end of the session they had prepared a safety leaflet to take back home to discuss with their family. In the afternoon, Katie Piper delivered an inspirational presentation to the medical students, encouraging them to look at the whole person and to work together with all professionals to ensure the best support and outcome for burns patients. The students were moved by Katie’s story and inspired to take forward her uplifting message as they moved into practice.

Meanwhile back at KCMC theatres the surgical team battled with failing electricity with frequent power cuts causing lights to go out and equipment to stop and require re-setting once generator power was restored. Despite the difficulties, the team managed to complete three more complex cases, including a man who had been assaulted and required some facial rebuilding. The lack of constant electricity supply also meant that phone and internet networks were affected and it became impossible to keep in contact with the outside world. Even local phone calls between the team became an issue.

Back on the surgical ward the team found that 10 more patients had arrived overnight

Back on the surgical ward the team found that 10 more patients had arrived overnight, with more continuing to arrive throughout the day. It was becoming very difficult to select patients for surgery as there were so many cases. Finally, four patients were scheduled for surgery. The cases were very complex due to the severity of the burn injury, many of which had happened some time ago so the burn scar tissue had become well established, making it even more difficult to release the scars and apply skin grafts. In the end three patients received their operations, a baby girl with burns to the hand, a nine-year-old girl whose arm was straightened, and a seven-year-old boy who had movement and function restored to his arm, wrist and hand. Sister Fiona Coia and sister Claire Swales worked with the burns nurses on the wards to assess patients and provide teaching and training at the hospital bedside. The surgical ward was very busy with beds up and down the corridors and anxious parents and relatives by each bed. A small seminar room within theatres was used for the first series of lectures as part of the burns seminar. Helen Morris from the North East Ambulance Service explained about the importance of correct first aid for burns patients. Sadly it is quite common for the wound to be treated with items which, not only do not help to treat the burn, but which can even lead to infection. Matron Lorraine Jackson had a meeting with the dean of nursing to discuss the possibility of developing a leadership course for the undergraduate nurses. The dean was hugely enthusiastic and asked Lorraine to prepare a lecture on quality assurance to deliver to the third year B.Sc Nursing students the following Monday. Lorraine was also asked to deliver a lecture on the UK community nursing model and the role of specialist nurses.

On Monday the team travelled up the slopes of Mount Kilimanjaro

On Monday the team travelled up the slopes of Mount Kilimanjaro to visit two schools to teach first aid for burns injuries. The headmaster of one school was so delighted he brought all 240 pupils onto the school playing field so that they could all take advantage of the lesson. All of the children were asked to draw pictures of their home and identify fire hazards. Plastic surgeon Jeremy Rawlins and nurse Tony Thompson, rewarded the best artists with a high visibility vest so that they would be safer walking home in the dark. The children were delighted and danced around the classroom with glee. Specialist nurses Sue Colley and Peter Smith spent the day at the hospital assessing patients in readiness for the plastic surgeon’s arrival. People had travelled from far afield, some as far away as Dar es Salaam, to seek the opportunity for life-changing treatment. The rest of the team arrived late at night from the airport, ready to present lectures the following morning. It was after 11pm when finally we had finished plans for the day ahead.

Arrived to the sight of Mount Kilimanjaro

Arrived to the sight of Mount Kilimanjaro shrouded in cloud as the rainy season is finishing. The hospital is as busy as ever. The team met up with Professor Alomi, the director of hospital services, before going onto the wards. We are preparing patients for the arrival of the plastic surgeon from Australia on Monday. During the ward round we met a young mother of a four-month-old baby who could not afford the medication to treat her epilepsy. During a seizure she had fallen onto the cooking fire. She had been lying there for more than an hour before her mother returned from the fields. The burns to both hands and arms were very severe. It is hoped that the surgeon will be able to save her hands but we will have to wait until Tuesday to find out whether or not she is a suitable patient for reconstructive surgery. We spent some time talking to Dr Kondo, the head of surgery, to discuss arrangements for the training sessions on burns management. Although we had thought perhaps 20 doctors and nurses would attend, the numbers had grown to more than 50, with doctors, surgeons and nurses due to travel to KCMC from hospitals across the Kilimanjaro region.  Our one day symposium had become a four day training course! The demand for specialist training is greater than we had thought!

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