A call to care

Click to see a slideshow gallery of more photos from Dr. Mitchell's work in Tanzania

As a general surgery resident on my research sabbatical in East Africa, I observed the high burden of surgical disease children suffered there, particularly in trauma and burn injuries. Although international aid was being directed to infectious diseases, few governmental or nongovernmental funding agencies seemed to be addressing the issue of trauma and burn injuries in the pediatric population.

Katrina B Mitchell, MDIn my effort to understand this discrepancy, I came to realize that there simply was a lack of awareness in the medical and lay communities alike about pediatric trauma and burns. Hoping to change this, I began educating myself about the burden of pediatric burn injuries in the developing world, and then sharing what I had learned with my surgical, medical, and pediatric colleagues.

What I’ve learned

Trauma and burn injuries kill more children aged older than 5 years than HIV, malaria, and tuberculosis combined.¹ Overall, burn injuries are the third leading cause of pediatric death in the developing world, behind road traffic injuries and drowning.² Despite this, few international public health efforts historically have been directed at improving burn care from a systematic and institutional perspective. Furthermore, the United Nations Millennium Development Goal to reduce childhood mortality by two-thirds by 2020 cannot be achieved by tackling infectious diseases alone. The World Health Organization 2008 plan for the prevention of burn injuries clearly delineates the need for increased global attention to burns.³

Africa has one of the world’s highest rates of burn injuries and deaths from burns, the largest at-risk pediatric population, and the fewest burn care facilities. Burn injuries in low- and middle-income countries is a leading cause of disability-adjusted life years.⁴ Untreated childhood burns-even small ones-can result in severe deformity, loss of function, and social isolation.

Burn-injured children suffer social disability from disfiguring scars, and the trauma they experience is lifelong. Even with extensive plastic and reconstructive surgery, they never return to their preinjury appearance. Without proper treatment, even minor injuries can result in very poor functional and cosmetic outcomes. Worse, patients may develop invasive and aggressive cancers as a result of their burns. Preventing burns and treating acute injury to avoid scars and lifelong disability is a major goal of burn surgeons working in the developing world.

How can we help?

Based on my experiences, I elected to take an extra year of research sabbatical to work with East African governmental and nongovernmental partners and my medical school/hospital affiliation in the United States to establish the first pediatric burn unit in northwestern Tanzania. We currently are in our 18-month pilot project phase that will enable local providers to improve existing infrastructure, establish burn care protocols, and lay the foundation for future development. Once providers have acquired additional education and training, they will be able to generate income from the burn unit project through patient care and fundraising. Overall, we hope to demonstrate improved outcomes for the unique needs of burn-injured patients and promote community education and outreach to improve burn injury prevention.

A mother cares for her small child who had an operation to close the scalp wound he sustained from a hut fire.

Given that our world is increasingly global, pediatricians can speak out on the issue of burn injuries affecting children not just within the United States, but also throughout the world. Pediatricians can also offer guidance to surgeons caring for burn-injured children about pediatric nutrition, intravenous fluid resuscitation, and pain medication. Burn surgery equipment, wound care supplies, and rehabilitation equipment are inexpensive and can be sourced locally. Burn care treatment is simple and can be learned by medical and lay providers alike.

If you would like to become involved with the pediatric burn unit in Mwanza, Tanzania, please contact project director Jim Gallagher, MD, of the William Randolph Hearst Burn Center at New York-Presbyterian Hospital (burndrjim@gmail.com).

Pediatricians may also want to help orphanages in the northwestern Tanzania Lake Zone region, particularly the Forever Angels Baby Home (foreverangels.org). Founded by Amy and Ben Hathaway, this orphanage cares for children with medical needs such as nutritional supplementation, ostomies, and wounds.

Consider membership in the American Burn Association (ABA; ameriburn.org). The ABA provides a multitude of resources relevant to the pediatrician’s role in burn care, including burn center referral criteria, basic wound care, and prevention initiatives.

Finally, the MetroHealth Medical Center (http://www.metrohealth.org/traumaburnsandcriticalcare) is an ABA-certified burn center in Cleveland, Ohio, that may provide local resources for pediatricians interested in contributing to the care of burn-injured children.

I hope that through this Dispatches piece I will continue to spread awareness of pediatric burn injuries and what can be done to improve care in Africa and other parts of the developing world.

REFERENCES

1. Ozgediz D, Riviello R. The “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa. PLoS Med. 2008;5(6):e121.

2. World Health Organization. Child injury prevention WHA64.27. http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_R27-en.pdf?ua=1. Published May 24, 2011. Accessed February 24, 2014.

3. Mock C, Peck M, Peden M, Krug E, eds. A WHO plan for burn prevention and care. Geneva: World Health Organization; 2008.

4. Peden M, McGee K, Sharma G. The injury chart book: a graphical overview of the global burden of injuries. Geneva: World Health Organization; 2002.

Dr Mitchell is a general surgery resident at New York-Presbyterian Hospital/Weill Cornell Medical Center, New York.