Hospital burn units

Burn treatment only in Dhaka

Burn treatment only in Dhaka
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There are no intensive care units in some hospitals. The entire burn unit is closed down in some places. Services have been halted where there are no ward boys. Some places have only a single physician.

This is the nationwide state of treatment for patients burnt by fire, electricity or acid.

After 124 people died in the Nimtali fire back in 2010, initiative was taken to open burn units in 14 government medical college hospitals around the country. But the state of 10 of these hospitals shows that the initiative has not been a success.

It is only when there is a fire that the matter of treatment for burn patients is brought to attention. The matter came to attention again recently, following the explosion in a mosque in Talla of Narayangani. Following the incident, till Wednesday so far 31 persons burnt in the incident have died. Five are still undergoing treatment at the ICU of Sheikh Hasina Burn and Plastic Surgery Institute in the capital city.

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Concerned persons say that while the risk of fire is everywhere, burn treatment facilities are Dhaka-centered.

Samanta Lal Sen, coordinator of the Sheikh Hasina Burn and Plastic Surgery Institute, on Tuesday met with the secretary of the health ministry’s health service division, Abdul Mannan, to discuss the matter. Abdul Mannan told Prothom Alo that the health ministry had been committed to implement the prime minister’s directives in this regard but, like everything else, work in the burn units had come to a halt with the outbreak of coronavirus. Now the work would resume, he said.

He said that 100-bed full-fledged burn and plastic surgery units would be installed in 8 divisional towns of the country. Also, there would be burn units in every medical college hospital.

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According to records of the Sheikh Hasina Burn and Plastic Surgery Institute, 64,893 burn patients were treated at the emergency and outpatient department in 2019. And 8,934 patients were admitted to the hospital.

A dismal picture

Seven days after the explosion in the Narayanganj mosque on 4 September, five persons were injured in an accident on 11 September at a steel mill in Tongi, Gazipur. The injured were admitted to Sheikh Hasina Burn and Plastic Surgery Institute. Two of the injured died.

Early Tuesday morning, a fire broke out in the Kar Bhaban (tax office building) of Barisal. The additional tax commissioner Shaon Chowdhury would live in the dormitory there. Shaon Chowdhury was first admitted to the Barisal Sher-e-Bangla Medical College Hospital. As his condition deteriorated, he was brought by ambulance to Dhaka in the afternoon.

Director of Sher-e-Bangla Medical College Hospital, Bakir Hossain, said, “When Shaon Chowdhury’s oxygen level fell, it was decided to send him to Dhaka. We didn’t want to take any risk.”

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An 8-bed burn unit has opened at the Sher-e-Bangla Medical College Hospital on 21 March 2015. Later it was expanded to 10 beds. However, the authorities increased it to 30 to 32 beds to accommodate the burgeoning number of patients. This there are posts for 8 physicians and 16 nurses and brothers (male nurses) for this unit.

Senior consultant and head of the department, MA Azad, had been in charge of the ward from the very beginning. Then associate professor Sakhawat Hossain was posted there too. After the unnatural death of the department head MA Azad in April, the department’s functioning came to a halt. Sakhawat Hossain had been on leave since March and is still on leave. So the department has been fully closed since April.

Director of the hospital, Bakir Hossain, said burn patients are now treated in the surgery department. And serious cases are sent to Dhaka.

A 13-bed burn unit was set up at Chattogram Medical College Hospital in 2008. Then in 2012 this was made into a 26-bed department. The department has posts for one professor, one associate professor, one assistant professor, two registrars and three assistant registrars. But there is only one associate professor and one assistant professor. There are only three persons in the five posts of registrar and assistant registrar. There is no medical officer and only 13 nurses.

The patients in the department are double the number of beds. A visit there on Sunday revealed extra beds even crowded the entrance of the department. There were 48 patents on that day. While patients whose respiratory tracts had been damaged needed treatment in ICU, the department had no ICU facilities.

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In Khulna, two hospitals treat burn victims. The burn unit at Khulna Medical College Hospital started on 25 December 2013. It has 36 beds now. There are posts for 5 physicians at the unit, but there is only one working there. The unit has no ICU.

Head of the unit, Toriqul Islam, said, “At present I am alone running the unit. I make rounds, I wrote the orders. I can manage that, but I can’t perform surgeries single-handed. That is where I get stuck. I am managing somehow with the help of the interns, but even that assistance is not always available.”

A 20-bed burn unit started up at the Shaheed Sheikh Abu Naser Specialised Hospital on 1 February 2017. The unit has no ICU.

Head of the unit, Sheikh Nishat Abdullah, said unless at least 6 ward boys are appointed on an emergency basis, it will be impossible to give round-the-clock service at the unit. Sources say most of the 20 beds remain vacant.

The burn unit at the MAG Osmani Medical College Hospital started in 2011. Speaking to Prothom Alo, the unit’s assistant professor Md Abdul Mannan told Prothom Alo, “Frankly speaking, I treat the burn patients at his hospital all on my own. A physician of the surgery department helps me out. If the burns areover30 per cent, the patient is sent to Dhaka.”

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The burn unit at Mymensingh Medical College Hospital began in 2015 and the department began functioning in 2017. It has 32 beds and 5 physicians. Patients with 25 to 30 percent burns or more, are sent to Dhaka.

Rangpur Medical College Hospital’s burn unit opened in 2013.It was 35 beds. It is located in the main building alongside the emergency department. Meanwhile, 6 of the 9 physicians’ posts and 8 of the 20 posts for nurses are vacant. Head consultant of the unit MS Hamid said, along with the crisis in physicians, there is also no equipment. There are no patients in the unit at present.

The burn and plastic surgery department at Rajshahi Medical College Hospital started up in July 2014. There are only 3 physicians in the posts for 9 and 6 nurses in the posts for 24. Head of the department, Afroza Nazneen, said the functioning of the burn unit has been hampered due to coronavirus.

In international standards, such an institute should have 4,040 various posts. The government has approved of even less than half. Then again, not all the posts are filled.
Tanveer Ahmed, associate professor, Sheikh Hasina Burn and Plastic Surgery Institute

In Dinajpur, M Abdur Rahim Medical College has no separate burn unit. In 2014 a 20-bed burn unit was started on the ground floor of the hospital, but it lacks the required equipment. Patients are sent to the Rangpur Medical College Hospital from here.

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The burn unit at Cumilla Medical College Hospital started in November 2012. The patents by far outnumber the 12 beds. The one post of professor at the unit is vacant, the two posts of associate professor are vacant and the three posts of assistant professor are also vacant.

Superintendent at the Bogura Mohammad Ali Hospital, ATM Nuruzzaman, said since January there has been a newly constructed building for the burn unit. A letter has been sent to the health ministry asking for the required human resources, operating theatre and necessary equipment. Till now no posts for physicians, nurses and health workers have been created. No equipment has been allocated either.

Burn patients from the surrounding districts come to the surgery department at the Shaheed Ziaur Rahman Medical College Hospital in Bogura. It does not have any separate specialised burn unit and so if the patients are in a bad condition, they are sent on to Dhaka Medical College Hospital.

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Crisis at the Sheikh Hasina Burn and Plastic Surgery Institute too

Though the Sheikh Hasina Burn and Plastic Surgery Institute is the only resort for serious burn victims, the 500-bed hospital has a crisis of human resources. Associate professor at the institute, Tanveer Ahmed, told Prothom Alo that in international standards, such an institute should have 4,040 various posts. The government has approved of even less than half. Then again, not all the posts are filled.

The institute on Tuesday gave an account to the health ministry of 1,122 approved posts. But only 464 of these posts are filled. That means, 59 per cent of the posts remain vacant.

Public awareness essential

Officials at the Sheikh Hasina Burn and Plastic Surgery Institute have said that alongside such institutions, public awareness must also be mobilised. There is no use in simply building big institutions. The incidence of burning must come under control.

Associate professor Tanveer Ahmed, talking to Prothom Alo, said that the Acid Survivors Foundation had worked at raising public awareness against acid violence. In 2010, there would be around 300 to 350 acid victims under treatment. In 2019 this fell to 20 to 23. This decrease was due to social awareness.

Physicians at the institute said that from November to March, there are more burn injuries from hot water, hot food or from fire. These victims were mostly women and children. From April to October more of the patients were burnt by electricity. The institute’s records show that the incidence of cylinders and air conditioners bursting has increased. There is also an increase in electronic equipment exploding.

Samanta Lal Sen said, people’s awareness must be raised about these issues. Implementation of the relevant laws must also be ensured. Then people will come less to the hospitals.

* Staff correspondents of Chattogram, Khulna, Sylhet, Mymensingh, Rangpur, Barishal, Rajshahi, Dinajpur, Cumilla and Bogura helped in the compiling of this report.

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