We arrived to round with the Yellow Firm Surgical Team at 0900 on January 5th. The hospital is an enormous, old, and hard to navigate building with lots of open breezeways to help with the stale, humid heat. The University Teaching Hospital was built 40 years ago, just after the Zambians won their independence from the British. The hospital is a 900 bed facility, currently housing about 1200 patients. Family members litter the grassy areas outside in a makeshift waiting-room.
Code Cart
We met 5 young burn victims during rounds today, aged 2 years old to 5 years old. All were burned in the kitchen by scalding hot liquids, 2 by hot porridge, one by hot tea, one by hot water, and one was pushed into a pot of hot rice. Generally these patients wait several days to come into the hospital to seek care for their injuries, until they start to develop infections. The burns we encountered ranged from 10% total body surface area to 45% total body surface area. Burns are treated topically by saline soaked “nappies” (washcloths) and twice daily hydrotherapy. The patient’s families are responsible for buying the nappies and the soap for the hydrotherapy. Pain medications ranged from three times daily oral paracetamol (acetaminophen) to an oral elixir called Brustan that was a mixture of ibuprofen and paracetamol, to IV or IM pethidine (meperidine) for wound care.
Lweendo
Lweendo is a 3 year old girl who sustained a 45% total body surface area burn from hot porridge. She presented to the University Teaching Hospital 3 days after her burn occurred after being referred from an outside hospital with signs of burn wound sepsis. She was first encountered by our team on 1/5/09 and had a fever and was breathing very fast. She has full thickness burns to both of her legs, her arms, her abdomen and chest, her back the back of her head, and her perineum. The unit uses metal frameworks above the child to keep the bedding off their wounds and dressings. She was admitted to University Teaching Hospital on 1/4/10, and after 3 days of IV antibiotics, IV fluids, and twice daily wound care with saline soaked nappies, she suddenly collapsed, and Lweendo died on 1/7/10.
Wound Care
Patients with burns undergo wound care twice per day. They are taken to the tub room first at 0700, then again at 1400. Wounds are vigorously scrubbed with soap, water, and cloths (wouldn’t want to see what a Zambian nurse could do with a norsen!), then the wounds are redressed in the saline soaked nappies. The family is taught wound care within the first few days of admission because there may only be 1 or 2 nurses for an entire floor (24ish pts?). They are taught to change out the nappies any time there is any blood soaking or other soiling. Once the slough (or eschar) has all come off the family is taught how to apply silvadene, and so long as a graft isn’t needed and the patient is sent home.
Patients with burns undergo wound care twice per day. They are taken to the tub room first at 0700, then again at 1400. Wounds are vigorously scrubbed with soap, water, and cloths (wouldn’t want to see what a Zambian nurse could do with a norsen!), then the wounds are redressed in the saline soaked nappies. The family is taught wound care within the first few days of admission because there may only be 1 or 2 nurses for an entire floor (24ish pts?). They are taught to change out the nappies any time there is any blood soaking or other soiling. Once the slough (or eschar) has all come off the family is taught how to apply silvadene, and so long as a graft isn’t needed and the patient is sent home.
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