Tackling inequality in burn injury prevention and treatment

Plastic surgery techniques to treat trauma injuries were initially developed during the 1^st and 2^nd World War and refined by future generations of surgeons, giving us the knowledge and expertise to repair and reconstruct some of the worst burn injuries imaginable.  Experience has led to a strong understanding of how to effectively manage burns from first aid at the point of injury, through to hospitalisation, surgery, nursing care, rehabilitation and re-introduction into society.

Despite almost 100 years of experience, preventing burn injuries and improving patient outcomes still remains a major challenge within poorer parts of the world and in regions in conflict.  In many instances, there is nobody or very limited numbers of staff with knowledge or training in managing a burn.

Burn care is expensive, with the cost of managing a major burn injury in the UK typically costing more than the annual budget for a whole hospital department in some parts of the world.  Further barriers to effective prevention and treatment include competing demands, lack of evidence of effective prevention models, fear, corruption, a lack of knowledge.  In high conflict areas, there is regular damage and disruption to hospitals, power supplies and transportation alongside security issues and staff shortages. 

• Basic Training – a mixture of first aid and injury management (identifying burn depth, cleaning wounds, dressing wounds, advice on moving/elevating, identifying problems and referring patients on to the correct services)- aimed at out patient management of burns
• Intermediate Training – a more comprehensive training programme for patients that require hospitalisation, looking at nursing care, surgical management, team working, communication & leadership
• Advanced Training – advanced nursing, surgical care & rehabilitation

In scaling up the activity across healthcare systems within countries, a training the trainer scheme has been rolled out, with local medical practitioners now exchanging the knowledge and expertise they have gained with peers across medical practices and hospitals. 

In one example, when working to improve surgical care in a hospital in Nepal, he worked with a faculty that included colleagues from Afghanistan, Bangladesh, Ethiopia, Ghana, India, Nepal, Nigeria, Palestine and South Africa.

In addressing the challenges created by inequality, Professor Potokar has looked beyond introducing new techniques, treatments, materials & training at a local level, to working with communities and Government bodies to effect change on a much larger scale. 

One example is the work with the Ethiopian Federal  Ministry of Health on a National Strategy, looking at how to effectively prevent and manage burn injuries across an entire country - from understanding how patients are being injured and identifying ways to reduce this, to looking at existing care, facilities, referral systems, transportation, resourcing & training, rehabilitation & re-integration of patients back into society.  This has encompassed research into understanding the economic effect of a burn injury on the patient, their family, their friends and the wider health system.