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Logo of Phnom Penh Post newspaper Phnom Penh Post - The nightmare challenge of treating burns

The nightmare challenge of treating burns

The young boy's head was lolling back. His eyes were wide and rolling crazily from

the morphine that dripped slowly into his bloodstream. It had been two days since

his left arm was amputated at the elbow, and he was still drifting through a haze

of quasi-consciousness.

Thy Thea, 17, from Saang district, Kandal province, rests in Kantha Bopha IV's burn unit after skin graft surgery. He and his eight-year-old sister were both severely burned when a petroleum lamp she was holding got too close to the gasoline he was pouring into the family's generator.

Nine days previously he had been brought by ambulance from Kandal Stung district,

Kandal province, to the burn unit at Preah Kossamak Hospital in Phnom Penh after

his 14-year-old body was ravaged by a massive electrical burn.

A power line had fallen on the construction site where he was working and he came

in contact with the live end. The electricity shot into his arm - burning deeply

into muscle, tendons and bone - then out through his legs, which were scorched with

second and third degree exit burns. Now, after emergency treatment, post-operative

surgery and amputation, he lay in a private room in the burn ward, completely swathed

in bloody bandages and surrounded by his family.

"Electric burns are the most common wounds we treat here, but most do not have

this extremely high voltage," said Dr Em Samney, chief of the burn unit and

pediatric surgery at Preah Kossamak Hospital.

"This was a fourth degree burn and it exploded his arm. We get only five cases

each year that are that deep.

"After the scarring he may need more surgery. But he is a strong boy, he'll

recover well."

Samney, trained in Moscow, has been a burn specialist in Cambodia for 14 years. His

10-bed burn ward, staffed with three doctors and five nurses, was the first public

burn facility in the country. According to Samney, Kossamak treats 90 to 95 percent

of all the adult burn victims in Cambodia.

The Office of International Surgery (OIS) reports that there are more than 2,000

burn deaths and over 30,000 serious burn injuries each year in Cambodia.

Prevented a gang from mugging an elderly man, the gang returned and doused him with acid. Unable to afford proper emergency care, he developed "keloids," genetically influenced hypertrophic scars. Years later, he had them cut off in a series of major skin grafts and plastic surgery operations. This greatly improved his appearance, left. Most of Cambodia's more than 30,000 annual burn victims are not so fortunate.

The World Health Organization (WHO) reports that fire-related burns represent a significant

global health burden, ranking ninth among leading causes of death among children

5 to 14.

Across town at the free children's hospital Kantha Bopha IV, a walk through with

its director, Dr Beat Richner, illustrates OIS figures that claim two-thirds of Cambodia's

burns injuries are to children under 10 years old and two-thirds of those are under

five.

Kantha Bopha IV's 32-patient burn ward in the intensive care unit is filled. According

to Richner, the three Kantha Bopha hospitals in Phnom Penh treat 10 to 20 burn cases

each day and average 300 to 400 per year. Richner's Siem Reap hospital averages 160.

"In the past almost all burned children died from infections even if they had

small, one or two degree burn infections," said Richner, who has worked in Cambodia's

medical community since 1992.

"Because of the climate and hygiene you must be much more aggressive with antitbiotics

here than in Europe or the west. There is a huge need for blood banks, plasma and

medicine. Ninety percent of burn patients won't have the money to get proper treatment."

Opened in January 2006, Kantha Bopha IV has eight surgeons working in two-man shifts

24 hours a day. Medical treatment for children under 15 is free.

On this day, a two-year-old boy lies in the burn unit with his body 80 percent covered

with second and third degree burns sustained by tipping over a pot of boiling water.

His father, who sits at the bedside, brought him the two hours from Kampong Speu

town on the back of a motorcycle.

"When a seriously burned child arrives they go straight to the front of the

line and the [intensive care unit]," Richner said. "Trying to treat these

injuries at home is a catastrophe."

In the report Burns in the Developing World by Rajeev Ahuja, the author writes, "Developing

countries have a high incidence of burn injuries, creating a formidable public health

problem. High population density, illiteracy, and poverty make burns an endemic health

hazard. Burn victims often become social outcasts - only three percent of disabled

children in developing countries attend school."

During his career, Samney has seen an increasing number of Cambodians burned in industrial

accidents involving electricity, gasoline, alcohol and flame. He told the Post that

many parents lie about the age of their child to get them employed and this, combined

with lack of supervision and lack of construction codes, has produced appalling injuries.

"I feel very sorry for my patients," he said during a tour of the Kossamak

burn ward.

"When I first started I could not look at them. When we changed the dressing

on the wounds, even when they had powerful painkillers like morphine, they would

scream, and scream so loudly you could hear them through the walls and more than

200 meters away."

A range of burn specialists explained that there are four types of burn the human

body can suffer - flame, water, chemical and electrical. Burns have four degrees

of severity: first degree is superficial, second blisters the skin, third burns into

the fat layer, and fourth into muscle and bone. Samney explained that treatment during

the emergency phase is critical, but serious cases can require as many as five additional

surgeries to remove constrictive scarring called contracture and administer skin

grafts. Complicating matters is the fact that Cambodians are genetically disposed

to develop "keloids," or large, thick, "hyperthropic" scars,

that must be excised to permit body motion as the scars shrink over time. The threat

of infection is constant.

Acid burns have been much publicized for their devastating physical effects, but

according to the OIS, they account for less than five percent of Cambodia's serious

burn cases.

"Before, most of the severe burns we saw were caused by acid, but it is decreasing,"

Samney said. "Now we see more burns by hot water or electricity. Normally, all

the hospitals send burn victims to us. We are free of charge but the patients must

buy their own medicine and they have to pay a lot."

The cost of proper burn treatment, especially in the reconstruction phase, which

ranges between $50 and $100 per case, is far too expensive for the average Cambodian.

Many rural villagers attempt to treat the injuries with traditional medicine.

"Most poor people with chronic burns try to treat it at home. In the country

people wrap the wounds in covers; this is stupid," Samney said. "Some people

believe that milk or urine from a cow will make the wound feel cooler: it can lead

to infection and death."

The prevalence of young victims and lack of prevention prompted the OIS, in conjunction

with the Children's Surgical Center in Phnom Penh, to launch a burn prevention project.

With funding from the British and Australian Embassies, the group created burn prevention

public service announcements aimed for children aged 8-12. The first aired in October

2005.

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