The One Who Heals
The Daily Star: It must have been a traumatic experience for you and your team to have to treat so many burn patients at the same time. What were the biggest challenges?
Samanta Lal Sen: The burn unit is always overcrowded with patients coming from all over Bangladesh. On an average, we have to accommodate 400/450 patients in a 300-bed hospital. During the three-month long political violence (from January till March), a total of 183 patients got admitted here. Obviously, it was a huge pressure for us.
After the horrifying Jatrabari arson attack, around 20 burn victims were brought here altogether for treatment. Had the doctors, nurses and other staff not been sincere enough, we wouldn't have been able to treat this overwhelming number of patients. The government also sent quite a few doctors and nurses to work here on deputation.
During that period, we came to work even at midnight. Whenever we saw on TV that someone outside Dhaka got burned in an arson attack and was being brought to Dhaka, we immediately left home for the hospital. Some of my colleagues couldn't hold tears after seeing the children who were so badly burnt. Sometimes it is difficult for us as well to face such a situation.
It is understandable when someone gets burnt while cooking, although a little awareness can change the scene. But it is totally unacceptable when someone throws petrol bombs on innocent people to burn or kill them.
TDS: Does the DMCH burn unit have all the necessary life-saving equipment and specialised doctors to treat the critically burnt patients? What were the major problems that you faced in providing treatment to the victims?
SLS: Children with more than 10 percent burns need to be admitted to a hospital, which is 15 percent in case of an adult. If the burn is more than 30 or 40 per cent, the patient needs to remain admitted for at least one and a half months.
We are unable to take care of the burn patients the way we should be able to. Maintaining the sterility of the place is a big challenge because it is always overcrowded with patients and attendants. Patients need to be kept at a safe distance from one another. As we can't ensure this, chances are high that patients will develop an infection.
Patients with inhalation burns need to be treated with a hyperbaric oxygen machine. If we had this machine, we would have been able to save some of the patients who died of respiratory tracts burns. Seventeen of the patients died of inhalation injury. The Prime Minister has made a donation to this unit with which we will buy this machine very soon. We also need burn tanks for dressing. The way we do the dressing now is not fully hygienic. Without proper dressing, we will not be able to control infections.
Most importantly, we must reduce the number of patients in order to provide proper care and reduce the death rate. But there is no alternative to decentralisation. We are planning to build burn units at all the medical colleges. We have burn units in Chittagong, Comilla, Sylhet, Rangpur, Mymensingh, Rajshahi etc. We need 400/450 doctors but we have only 52 qualified doctors at the moment.
Moreover, we will have to strengthen our burn prevention programme. What I saw in a hospital in Singapore was very inspiring: there was one burn patient in a five-bed unit. In order to make our people aware of the burn injuries, we have taken various measures including making documentaries and having posters and billboards at different places.
TDS: Do you have enough nurses here? Are they properly trained to take care of the burn patients?
SLS: In other countries nurses do the most important job in the process of burn treatment. Unfortunately, we are lagging behind in this respect. We need more dedicated nurses. In addition, we have to improve the nurse-patient ratio in our hospital. At present there are 70 nurses for 500 patients, whereas we need one nurse per five patients. However, we are trying to improve the quality of our treatment by providing our nurses with proper training.
TDS: What are some suggestions for the burn victims who went home after recovery? Are they aware of post-burn care?
SLS: The burn victims have to undergo treatment in several phases. The first treatment of burn is to provide the patients with treatment for shock. When a person gets burnt, the body starts to lose fluids. This is called the acute phase. Then comes infection control. The last phase is reconstruction, which includes skin reconstruction, post-burn physiotherapy, etc. Long term treatment is needed for patients with more than 30% burns. A patient may have to go through several consecutive surgeries. Taking physiotherapy and having regular follow-up are a must.
When the burns heal, scars remain. Sometimes the scars swell up and the joints get stiff, which is called contracture. This can be prevented through proper exercise. Usually patients come with hypertrophic scars or Keloid. Keloid is a medical condition where the skin gets heavy and itchy, which may lead to cancer. In order to prevent this and other problems, patients must have regular check-ups.
TDS: What about psychological counselling?
SLS: We have some psychologists working here. They give psychotherapy to the patients in phases. Patients always want to know how long it will take for them to get better, or if they will ever be able to get back to their normal life. The attending doctors have to counsel them instantly.
We have also made arrangements with the National Mental Health Hospital. Our patients can get psychological assistance there.
TDS: Would you like to share with us your plan about building a full-fledged plastic surgery and burn institute? What facilities will you have there?
SLS: We proposed to the government about building a burn institute with all modern facilities. The government has approved the proposal. This 500-bed hospital will be located near DMCH, because burn patients also need other treatments like general surgeries, orthopedic treatment, etc.
In the existing system, only three to four doctors can complete their masters in this institute. When we finally have a complete institute, more doctors will be able to do their post graduate here, and we will get more qualified plastic surgeons. We will also have a psychology department. The design has been finalised. Hopefully, the construction will start within this year.
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