MANAGEMENT IN KATH, KUMASI- GHANA, 1954 2017 KATH BURNS MANAGEMENT - - PowerPoint PPT Presentation

Kwame Nkrumah University of Science & Technology, Kumasi, Ghana

EVOLUTION OF BURN INJURY MANAGEMENT IN KATH, KUMASI- GHANA, 1954 – 2017

KATH BURNS MANAGEMENT EVOLUTION

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AUTHOR & PRESENTER

Professor Pius Agbenorku Division of Plastic & Reconstructive Surgery Department of Surgery Komfo Anokye Teaching Hospital School of Medical Sciences College of Health Sciences Kwame Nkrumah University of Science & Technology Kumasi, Ghana

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Pan African Burn Society

PABS Vice-President …. Professor Pius Agbenorku

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Introduction

• Burns management; a holistic approach
• Burn prevention policies
• Infrastructure
• Effective standardized treatment

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Introduction

• Burns, a disease burden in Low to Middle Income

Countries (LMICs)

• WHO: strengthening burn care
• Ghana; Komfo Anokye Teaching Hospital (KATH)

and the Korle-Bu Teaching Hospital

• KATH, the only tertiary hospital in the middle belt
• f Ghana is of key interest

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Introduction

• Since KATH inception, burn teams have developed the

best approaches toward effective burn management: putting up state of the art burns center

• Staff training
• Developing effective burn protocols, among others

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Aim

• Report on the evolution of burn injury management at

the Komfo Anokye Teaching Hospital (KATH), since the hospital’s commissioning in 1954 till present

• Future projection

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Method

Phase 2 Phase 3 Phase 4 Phase 1 Phase 5

?Nothing Proposal for BICU Projections New BICU (A&E) Revolutionary phase

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Phase 1

• Inception of KATH (1954) to 1993
• Burns patients in “all-in-one” surgical ward
• Lack of adept staff
• No effective record keeping

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Nothing special

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Phase 1

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Such degree of burns could not be managed well

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Suspected results

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Phase 2

• From 1993-2001
• First Plastic surgeon employed (1993)
• Dr. Pius Agbenorku
• Burns team was formed
• Minor and advanced surgeries begun

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Meshed Split-thickness Skin Graft

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Phase 2

• Inception of record keeping
• Decreased mortality and burn contractures

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However,

• ‘All-in-one ward’
• Cross infection
• Septicemia

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Phase 2

• Separate Burns ICU

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Phase 3 (Revolutionary Phase)

• From February 2001- May 2009
• Space made available and refurbished into

BICU: Ward D2C (February 2001), now Old BICU Ward D2C

• First ever BICU in Ghana

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Old Burns Ward D2C

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Phase 3

• 3 Surgeons and 6

specially trained Nurses

• Anaesthetic

machine

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Patients on admission at Burns Ward D2C

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Patients on admission at Burns Ward D2C

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Such burns and worse could now be treated well

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Advantage of the Ward D2C

*

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Epidemiological study of burns in Komfo Anokye Teaching Hospital, 2006–

• 2009. DOI: 10.1186/s41038-016-0041-0

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Rotary International

• Dundee and Kumasi Rotary clubs provided
• Grant for:
• Surgical equipment
• Training and re-training staff in UK
• Patients assistance fund

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Plaque at Ward D2C

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• Prof. A. M. Morris
• Consultant Plastic

Surgeon and President

• f ReSurge Africa

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Phase 3 summary

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Phase 4

• Ultra-modern

Accident and Emergency (A&E) Centre

• Commissioned:

May 2009 till date (2017)

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Phase 4

• The biggest A&E Centre in West Africa at the time (April 2009)
• Houses:
• New Burns Intensive Care Unit (NBICU)
• Plastic Surgery
• Neurosurgery
• Orthopaedics
• Trauma Surgery and Emergency Medicine

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New BICU

• On the first floor
• f the A&E

Centre

• 6 room suites for

patients

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New BICU Reception

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Front desk of NBICU

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Room suite for each patient

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Each Unit is fully equipped with:

Single bed Life support system for each bed, including acute care physiological monitoring system and pulse oximeters

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Patients on admission under close monitoring

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Phase 4

• Four operating rooms on the First floor of the A&E
• Theatre 1 with 2 operating beds is dedicated for both burns and plastics

surgery

• NBICU is managed by highly skilled professional medical doctors and nurses

with the requisite expertise in burn management

• Currently, 5 plastic surgeons, 4 senior residents, several junior residents doing

3 months rotations and 14 trained burn nursing staff

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Phase 4

• Advanced burn care management for patients

with varying degrees of burn injuries requiring specialized treatment and usually patients in critical condition requiring close monitoring

• Standard BICU protocol

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Advantages of the NBICU

• Mortality rate in 2007-2009 for Ward D2C and that for

the new BICU from 2009-2011, Agbenorku et al recorded a decreased mortality rate (12.7 %) and decreasing negative burn sequelae for the new BICU

(Agbenorku P. Modernized standards in burns management: A comparative study in Komfo Anokye Teaching Hospital, Kumasi, Ghana. Burns 2013;39(5):990-6 http://dx.doi.org/10.1016/j.burns.2012.12.011)

• Convenience in moving patients from the NBICU to

the Operating Theatre; both the Operating Theatre and the NBICU are on the same floor. This was one of the biggest challenges faced in Phases 1, 2 and 3

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Advantages of the NBICU

• The old BICU: Ward D2C, now serves as a general

burns ward which receives patients with improved burn conditions from the NBICU

• Research activities still continue with better records

keeping

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Prevailing Challenges at NBICU

• Absence of theatre space solely for burns injury

management

• Funding for Burns Treatment
• Lack of Occupational therapy, Physiotherapy

and Rehabilitation Centre

• Funds for research

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Phase 4

• These notwithstanding, burns management has improved

remarkably since the establishment of the A&E BICU

• If the challenges in Phase 4 are met, KATH Burns Centre will

be a world class burns centre, providing complete burn care to burn victims in and around the country

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Phase 5 (Projection)

• Plastic Surgery and Burns Centre with:
• Burns dedicated Operating theatres
• Physiotherapy, Occupational therapy and Rehabilitation centers all housed in
• ne unit
• Ultra-modern pediatric burns ward and recuperating center
• Hopefully, these will be housed in the proposed 16-floor storey building

including

• ther

departments (Plastic Surgery, Transplant Surgery, Cardiothoracic & Vascular Surgery and Neurosurgical divisions)

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KATH and KNUST School of Medical Sciences

• Since Phase 2, the unit has taken both fourth year and

sixth (final) year medical students of its affiliate University (KNUST) through their regular practical rotations, didactic teachings as part of a training module.

• Outstanding beneficiaries: Dr. P E Hoyte-Williams, Dr.

Edmund Turkson, Dr. Boutros Farhart, Dr. Emile Tano, Dr. Zainab Schumacher and many more

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KATH and Residency Education in Plastic and Reconstructive Surgery with Ghana College of Physicians & Surgeons and the West African College of Surgeons

• In the year 1998 the RPSBU got its full accreditation for residency

training from the West African College of Surgeons and then from the inception of the Ghana College of Physicians and Surgeons (2013)

• In 2015, the RPSBU graduated its first fully locally trained Plastic and

Reconstructive Surgery Specialist, Dr. P E Hoyte-Williams

• The unit is yet to graduate two other candidates who are currently in

their final year

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KATH and Residency Education in Plastic and Reconstructive Surgery with Ghana College of Physicians & Surgeons and the West African College of Surgeons

• Two other doctors have also been enrolled recently into the

Senior Residency Program and are set to complete in 2018

• The unit is hopeful to produce at least twenty (20) Plastic and

Reconstructive Surgery Specialists within the next decade

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Awards

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Awards

• Pan African Burns Society; Dr. Fareeda Agyei

“Management of severe burn injuries with topical Heparin: the first evidence-based study in Ghana”

• n behalf of the Unit. Best Junior Resident

Presenter 2012

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Awards

• Professor Pius Agbenorku was appointed as an Editorial Board Member for journals:
• Annals of Burns and Fire Disasters in 2010
• Burns and Trauma J in 2012
• Plastic & Aesthetic Research in 2015
• Etc, etc
• Earlier: ASPS International Scholar Award 1999-2000 to Plastic Surgery Centers of Excellence ….

UMHS Arn Arbor; Columbia Univ Harlem Hospital, New York; Southfield Plastic Surgery, etc.

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Publications

Over 150 articles produced by staff of the Division: General plastic surgery Orofacial clefts Breast diseases Burns: research, acute, reconstruction Trauma

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A few of burns publications:

1. Agbenorku P, Akpaloo J, Farhat B. Burn disasters in the middle belt of Ghana from 2007 to 2008 and their consequences. http://dx.doi.org/10.1016/j.burns.2010.03.017 2. Agbenorku P, Akpaloo J, Yalley D, Appiah A. A new era in the management of burns trauma in Kumasi, Ghana. Ann Burns Fire Disasters 2010;23(2):59-66 3. Agbenorku P. Experience in the management of axillary post-burn scar contractures http://dx.doi.org/10.4314/njpsur.v6i2.63646 4. Agbenorku P, Akpaloo, J. Epidemiological study of burns in Komfo Anokye Teaching Hospital, 2006–2009. DOI: 10.1186/s41038-016-0041-0

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Burns publications contd.

• 5. Agbenorku P, Fugar S, Akpaloo J, Hoyte-Williams PE, Alhassan Z, Agyei F. Management of

severe burn injuries with topical heparin: the first evidence-based study in Ghana. International journal of burns and trauma. 2013;3(1):30-36

• 6. Agbenorku P. Burns functional disabilities among burn survivors: a study in Komfo Anokye

Teaching Hospital, Ghana. International journal of burns and trauma. 2013;3(2):78-84

• 7. Agbenorku P. Modernized standards in burns management: A comparative study in Komfo

Anokye Teaching Hospital, Kumasi, Ghana. Burns. 2013;39(5):990-6. http://dx.doi.org/10.1016/j.burns.2012.12.011

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A few list of publications

• 8. Brussellars J, Agbenorku P, Hoyte-Williams PE. Assessment of mortality prediction models in a

Ghanaian burn population http://dx.doi.org/10.1016/j.burns.2012.10.023

• 9. Agbenorku P. Early childhood severe scalds in a developing country: A 3-year retrospective
• study. Burns & Trauma. 2013 Dec 18;1(3):122
• 10. Negble M, Agbenorku P, Ampomah EA, Hoyte-Williams PE. Nursing severe burn injury

patients: Emotional impact on nurses. International Journal of Medicine and Medical Sciences. 2014;47(1):1430-3 11.Bayuo J, Agbenorku P. Nurses' perception

• n

morphine usage in burnshttp://dx.doi.org/10.1016/j.burns.2014.10.031

• 12. Agyapong M, Agbenorku P, Oduro I. The effect of dietary intake of antioxidant micronutrients
• n burn wound healing: a study in a tertiary health institution in a developing country. DOI

10.1186/s41038-015-0012-x

• 13. Agbenorku P.The Burns Menace: Antibiotics for the Fight against Burns Bacterial Infection, a

Systemic Review. DOI: 10.4236/ss.2016.712071

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Major Challenges faced during the Evolution Period

• Opposing views
• Finance

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Lessons Learned

• Hard work and discipline
• Do not despise small beginnings
• Progressive work and perseverance is key
• Dialogue and Networking

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Securing Funding

• Do not be too quick to seek funding from

international bodies

• Dialogue
• Try to present preliminary results

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Securing Funding

• Fund providers should be informed that:
• Investment
• Recognition
• Residents training

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Perpetuation of KATH BICU

• Regular maintenance of infrastructure and changing old

equipment

• Training and retraining of our health personnel
• Encouraging our final year medical students to pursue FGCS

(Plast), FWACS (Plast) as their specialty

• Engage junior colleagues in consulting, decision making and
• utreach programs
• Increasing burns research

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CONCLUSIONS

• Improved burns management
• Burn care professionals are also encouraged to undertake

developmental burn care projects no matter the challenges

• The experience gained so far has better equipped us to mentor

upcoming burn centers and healthcare providers across the globe; most importantly in Africa. Hopefully in the near future when the prevailing challenges are met, KATH BICU will be a reputable international burns center, providing complete and the most effective burn care and management

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REFERENCES

• 1. Van der Merwe AE, Steenkamp WC. Prevention of burns in developing countries.

Annals of burns and fire disasters. 2012; 25(4):188

• 2. World Health Organization. The WHO plan for burn prevention and care.

Switzerland, WHO publications; 2008

• 3. Agbenorku P, Akpaloo J, Yalley D, Appiah A. A new era in the management of

burns trauma in Kumasi, Ghana. Ann Burns Fire Disasters. 2010; 23(2):59-66

• 4. Agbenorku P, Edusei A, Ankomah J. Epidemiological study of burns in Komfo

Anokye Teaching Hospital, 2006–2009. Burns. 2011; 37(7):1259-64. Agbenorku P. (2013)

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REFERENCES

• 5. Agbenorku P. Modernized standards in burns management: A comparative study in

Komfo Anokye Teaching Hospital, Kumasi, Ghana. Burns. 2013; 39(5):990-6

• 6. Agbenorku P. Burns functional disabilities among burn survivors: a study in Komfo

Anokye Teaching Hospital, Ghana. International journal of burns and trauma. 2013; 3(2):78

• 7. Agbenorku P, Agbenorku M, Fiifi-Yankson PK. Pediatric burns mortality risk factors

in a developing country’s tertiary burns intensive care unit. International journal of burns and trauma. 2013; 3(3):151

• 8. Brusselaers N, Agbenorku P, Hoyte-Williams PE. Assessment of mortality prediction

models in a Ghanaian burn population. Burns. 2013; 39(5):997-1003

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REFERENCES

• 9. ReSurge Africa (2010-2014)

http://resurgeafrica.com/organiser/arthur-morris/ Accessed 21st December, 2016

• 10. WHO/EHT/CPR 2004 reformatted(2007)

http://www.who.int/surgery/publications/Burns_management.pdf Accessed 21st December, 2016

• 11. Agbenorku P, Agbenorku M. Experience in the management of axillary post-burn

scar contractures. Nigerian Journal of Plastic Surgery. 2010; 6(2)

• 12. Agbenorku P, Fugar S, Akpaloo J, Hoyte–Williams P.E, Alhassan Z, Agyei F.

(2013) Management of severe burn injuries with topical heparin: the first evidence– based study in Ghana. International journal of burns and trauma. 2013; 3(1): 30-36

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Thank you

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