The management of burns in a developing country: an experience from the republic of Yemen
Introduction
The management of burns has improved dramatically even in developing countries including some Arab states where well equipped burn units have been established in many newly built hospitals. In Saudi Arabia, 25 years back, burn patients were managed in general wards, and case fatality was high but no exact figures have been published. When decreased overall mortality rate is used as a crude measure of improved burn care, reports from the Arab world show that, indeed, much improvement has occurred. Thus, the overall burn mortality rates in Saudi Arabia range from 2.9%, [1] through 4.4%, [2] 5.9% [3] and 6.9% [4] to as high as 16% [5]. In Kuwait, the figure is 6.7% [6].
By contrast, in neighboring countries such as the Republic of Yemen, burn care remains unsatisfactory, and, the rates of morbidity and mortality are unacceptably high. Thus, whereas in most countries, post-burn hypovolemic shock as a cause of early mortality is rarely seen nowadays due to better understanding of its pathophysiology, yet, in Yemen, it remains a killer due to the lack of adequate fluid therapy.
This paper is an account of the author's personal experience with burn victims in the Republic of Yemen. The purpose is to draw readers’ attention to three issues. One is the victims’ plight. The other is the challenge posed to official bodies such as the International Society of Burn Injury, the WHO and its designated Collaborating Centers including the Mediterranean Club for Burns and Fire Disasters [7] and the World Assembly for Muslim Youth. Thirdly, the Yemen experience illustrates the opinion of Dr David Heimbach [8] that the resources needed for burn care in developing countries are not necessarily costly equipment and burn centers; they are knowledge, fundamental surgical skills and dedicated doctors, nurses and administrators.
Section snippets
Patients and methods
The Yemen experience described here is based on four visits to four main cities Mokalla, Sayown, Taiz and Aden–over a period of four years between 1996 and 1999. The author was a member of a surgical team sponsored by the World Assembly for Muslim Youth and Taiba Organization. The teams consisted of two Plastic surgeons and different surgical specialties, including ear nose and throat, general surgery, opthalmology, orthopedic surgery and urology.
The cases operated upon were patients already
Results
The duration of each visit and the number of operations performed are summarized in Table 1. The material is presented in two parts: the plastic surgery operations performed by the visiting team, and an over-view of burn care in Yemen which is based on personal communication with hospitals visited. The author could trace no literature on burn care in Yemen.
Structure and process of care
There were no burn units and burn care teams in Yemen. (We did not visit the capital city, Sanaa). Burn victims were admitted into general wards and treated by general medical practitioners and/or general surgeons, most of whom were not yet certified as specialists. Only one plastic surgeon was seen in the four cities visited.
The care given included administration of antibiotics and analgesia, along with iron and vitamin tablets. Dressing of superficial burns was continued until healing
Part 2: Plastic surgery operations performed by the visiting team
During these four visits, a total of 406 procedures were performed. Of these, 139 were for release of post-burn contractures, which is the focus of this communication. The distribution according to site is shown in Table 2. Thus, of 139 contractures treated, the hand (49; 35%) was the most common site.
The types of operation performed were as follows: release and split thickness skin graft, excision and full thickness skin graft, release and local flap, and, multiple Z-plasty.
This 12-year-old
Discussion
Burn care management in Yemen was found to be poor. This in part is a reflection of the inadequate health care facilities available for a developing country. From a literature search, the author could not trace a single paper on burns in Yemen, which in itself indicates an absence of serious interest in burn care. There were no epidemiological studies, and, the incidence of burn injury is not known. The information collected was based on personal experience of the local doctors managing burns.
Conclusion
Based on the experiences here described, and, in conclusion, it is suggested that, with initiative, effort and efficient organization of available facilities and resources, Yemen and other developing countries can achieve more in burn care management in line with the report of Heimbach. [8] Suggested steps to achieve better burn care should include (1) Communication with local health organizations in Yemen to find out their real needs. (2) Conferences/symposia to highlight the problem. (3)
Acknowledgements
The authur would like to express his sincere thanks to his colleague, Dr Jadkarim, for permission to publish their Yemen visits experiences, as well as the World Assembly for Muslim Youth and Taiba Organisation for their sponsorship. He also thanks Professor Ladé Wosornu for editorial suggestions.
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