Burn victims need health care [Archives:2006/914/Health]
By: Amel Mohammed Ariqi
Three months ago, 35-year-old Ahmed Alzaidi saved his neighbors' lives when he put out a fire that flared up in their cottage. He got three children and their mother out of the cottage; however, he couldn't protect himself from the heat of the flames. He was taken from his home in Marib to Al-Jumhuri Hospital in Sana'a where he passed away. “He died because of lack of medicine and health care in the hospital,” his brother said sadly. “However, he was not the only one suffering burn pains here are a lot,” he added.
Victims every day
Alzaidi is one of many victims who die from burn-related injuries. Dr. Saleh Alaidhani, deputy director of Al-Jumhuri's burn and disfigure treatment center, confirmed that the hospital daily receives many patients suffering disfigurement resulting from burn accidents. “Eighty-five to 90 percent of patients are victims of a gas leak leading to an outbreak of fire. Hot liquids, direct contact with hot liquids, hot solids, caustic chemicals and electricity are other causes leading to burn injuries,” he said. “Most victims are from rural regions,” he added.
According to Alaidhani, the Al-Jumhuri center has 24 beds in addition to surgery and intensive care. He confessed the center's capacity is not enough to receive all patients. “We receive only the emergency cases whose injuries are within the first 48 hours. Patients who arrive later and suffer heat destruction of the skin and infection, mostly are sent to a hospital that has a section, containing 40 beds, for this purpose,” he said.
The Al-Jumhuri center has three departments: men's, women's and children's. Most victims are women.
Alaidhani said there are no specialized burn centers in Yemen except his and another in Taiz. Both centers are new and need expert staff. “Despite the fact that, internationally, for every three million people, there is supposed to be a special center to treat emergency burn cases. The center must be connected with hospitals in the same region containing at least 10 sections ready to receive these victims,” he said. “In Yemen, where more 19 million people live, there are just two centers,” he added.
Gas leaks cause many victims' injuries. Three such victims were in the women's department.
The plight of 26-year-old Warda was very serious. She couldn't see, hear or speak. Her blind mother was the only one to tell her daughter's story. “My daughter is the mother of four children. We live in a village. When my daughter was injured, we traveled a long distance on a very long road and spent a long time reaching this center, since there is no doctor specialized in treating burns.”
Chief of nurses Abdulkhaliq described Warda's situation as “very serious” in that 93 percent of her body is burned. “We have no idea yet if she can survive,” he added.
Asia, 28, is the mother of four children. She insisted she didn't smell the gas when she struck a match to cook dinner. “It took three hours to reach this center,” she said.
When she arrived, she suffered great pain, as her burns exceeded 83 percent, according to Abdulkhaliq. “Her survival is a miracle,” he added.
Fatama, 17, was luckier, according to Abdulkhaliq, since she hurt only her hands “She will go home soon,” he noted.
Alaidhani said many victims insist they don't know how to deal with a gas leak. “Most victims are women who cook using gas. Because of the lack of awareness, most women have no idea how to act in such circumstances.”
Hamdi, age 3, was injured while playing beside firewood his mother used for cooking. Abdulsalam, age 4, was injured by hot liquids, whereas 35-year-old maintenance worker Ismail was injured by electricity. “There are no safety programs that can significantly reduce the incidence of burn injuries in Yemen. Mass media does not play an effective role in this regard.”
According to Alaidhani, national television and radio programs, whose audiences are mostly from rural regions, do not provide enough information in this regard.
Disappointment and stress
Abdulkhaliq noted the depression and hopelessness many victims experience, particularly women, who are terrified of the marks and deformity that burns leave.
Alaidhani mentioned the importance of psychological treatment, saying, “Psychological treatment must be associated with physical treatment, particularly for burn victims. Such treatment will help to raise their spirits and reflect positively on their condition.
“Unfortunately, the center has no psychologists. There are also no specialists in natural therapy to rehabilitate patients,” he added.
Also a burn and plastic surgery consultant, Alaidhani confessed that plastic surgery is very new in Yemen and field experts are very few. “However, the most important thing victims arrive is to treat infection, the most common cause of death for extensively burned victims, as bodily fluids and minerals are lost through the wound. The heart, lungs, liver and kidneys are affected by infection and fluid loss, so we focus on saving victims' lives first.”
Burn treatment, as Abdulkhaliq said, depends on the extent of burns. Burns covering 15 percent or less of the body's surface usually are treated by removing dead tissue, dressing with antibiotic cream and administering oral pain medication. Burns of 15 to 25 percent often require hospitalization to provide intravenous fluids and avoid complications. Burns of more than 25 percent usually are treated in specialized burn centers where aggressive surgical management is directed toward early skin grafting and avoiding complications such as dehydration, pneumonia, kidney failure and infection. Pain control with intravenous narcotics frequently is required. The markedly increased metabolic rate of severely burned patients requires high-protein nutritional supplements given orally and intravenously. Extensive scarring from deep burns may cause disfigurement and limited joint movement. Therefore, plastic surgery often is required to reduce scarring effects.
Abdulkhaliq also noted the stress he and his center colleagues felt due to staff shortages. “We are only four nurses in this center, working 24 hours a day, trying to cover the needs of patients.”
More is needed
It is difficult to find studies focusing on Yemeni burn victims, as there are no prevention activities. Many victims asked why they must travel to receive medicine, in stead of being treated in thier local hospital. Doctors and nurses confessed that many times they were unable to deal with many cases due to the shortage of medicine or experts. Alaidhani said, “These people are victims not just of the incredible burn pains, but they are the victims of others' ignorance.”