The main program in Bangladesh is to train Bangladeshi Plastic Surgeons at the Dhaka Medical College Hospital and surrounding hospitals in the reconstruction of hand function after electrical burns and improve the long-term outcome of burns injuries, especially with regards to the reconstruction of burns contractures and scarring.
We are expanding the scope of the programme as per the local doctors’ wishes and their need to improve their patients’ conditions. The next visit will include training in fat grafting, which is so important to soften scars, especially in Burns.
A touch of history
BFIRST was originally invited by Assistant Professor Tanveer Ahmed (on the right), who visited the Royal Free as a BFIRST Fellow and we were warmly received by Professor Kalam (Chief of the Department, on the
left) and Dr Sen (in the middle), the previous (though very much involved) Project Director of the Institute of Plastic Surgery.
The Dhaka Medical College Hospital in Dhaka is a 5000 bedded hospital; yes 5000 – it is vast. Here is a picture of the daily admission from their Accident and Emergency Department (left) and here is video (below) from the 800 m corridor within the hospital.
The plastic surgery unit is housed in a separate building with 100 beds, but regularly houses 500+ patients, most of whom have suffered electrical burns. There are patients in beds on the landing between the floors of the building. There are simply patients everywhere.
365.000 people suffer burns every year in Bangladesh. Half of these are children and 20% of these have a permanent disability as a direct result of the burn.
A third of burns as caused by electricity, which is easy to understand if you just look on the streets of Dhaka.
Andy Williams is a burns surgeon, originally from Australia , now a Consultant Plastic Surgeon at the Chelsea and Westminster Hospital in London. He has extensive previous experience in burns in Pakistan and teaches on several burns courses.
Barbara Jemec is a hand surgeon at the Royal Free Hospital, originally from Denmark, has been working in projects in WestAfrica and South America since 2004 and now in Bangladesh since 2015.
Together we make a team teaching hand surgery and burns.
Why Hands and Burns?
Because of the many people who suffer burns injuries in Bangladesh every year and the many injuries which stem from electrical burns nerves and tendons in the hand are literally burnt away, which if of course makes the hands useless.
In a country where the majority of people work in agriculture and service occupations, the use of your hands is paramount. Well in fact it is paramount to anyone, no matter what you do, but here a useful hand can be the difference between having to beg for food and holding down a job, so you can feed yourself.
You can reconstruct the function of these hands with tendon transfers – so using other tendons which are still intact, local flaps (coverage from the surrounding skin and muscles) and nerve grafts (from less important nerves in for instance the foot and leg), so they can become useful again.
The local surgeons are already very knowledgable and work to a high standard team and they are extremely hospitable. We always feel welcome and appreciated. We try and visit other hospitals, make connections and coordinate the training given by us and other NGOs.
In 2016 we brought a Dermatome, a specialised knife which is used to take skin grafts for the treatment of Burns. This knife can take very think slivers of skin, so the areas heal better and scar better. The blades are meant for single use, and they are expensive at £10 a blade, but these blades will be reused, as we cannot afford to furnish all the blades.
We continue to be in contact with the local surgeons throughout the year and already look forward to December 2017 for our next visit.