Smokey the Bear needs to visit Bangladesh

Day 18. Mosquito bites: back up to approximately 1,000,000(on account of accidentally resting my arm all night on the mosquito net which surrounds my bed) Symptoms of Food poisoning: at a minimum.

Day 2 at the Burn Unit. Started with morning report of the overnight events. A patient died overnight, 35% body surface covered with burns, age of the patient was 25--most likely secondary to the patient waiting too long to receive treatment after such severe burns. A few things I learned today at the burn unit: This Burn Unit is the only one of its kind in Bangladesh. It is run by the government (once again, minimal financial help), it is understaffed and overpopulated. There is no sustainable campaign for burn prevention nor is there much counseling done with patients upon their admission mostly because of time constraints and limited staff as mentioned before. Comorbid conditions such as Diabetes, TB, Hypertension, etc., are not always treated properly while patients are admitted and may consequently contribute to decreased survival. Patients are treated with antibiotics immediately because there are no isolation rooms or barriers between patients to decrease cross contamination-this is merely b/c of the patient volume versus space available. Health care is a right not a privilege and so no physician in this hospital can deny treatment to a patient--hence the cycle. Medications for pain management are not always readily available. The idea of palliative care is not entirely established here.

I sat in the Emgergency department today and saw patients with the physicians there. There were three physicians there from 9am to 2pm, after 3pm espcieally there are two physicians to run the ENTIRE hospital. In most government run hospitals the majority of physicians finish rounding and seeing patients by 2pm and then go to a private hospital or private office to see their own patients. In any case, as I examined patients with the other doctors I re-learned the system to estimate the percentage of body surface effected. I learned that the threshold to admit here is >10% burns in children and >15% in adults, admission is mostly to resuscitate fluid status and administer antibiotics. Most of the patients we saw today were presenting days or even weeks after the initial burn. The burn site on most of these patients looked grossly infected. The problem is that most of these patients are travelling from very far to reach this hospital. Once again, they cannot afford the emollients or bandages needed (since the hospital cannot provide everyone with these).

The saddest story I heard today was from a 27 y.o. woman who was burn about a year ago while giving birth. She delivered the baby and meanwhile a piece of her clothing caught fire, her entire right side was burned, the baby too was badly burned. Both the mom and baby were sent to separate hospitals at the time, the mother was discharged a month later the baby was too, six months after the incident the baby died of septicemia--unable to take breast milk from the mom because of the severity of the burns on her chest, the baby was not receiving proper nutrition and could not fend off the infection. The mom presented today a year after the incident with severely thickened scar tissue over the area of the burns, which she could have avoided had she followed up correctly, but unfortunately she lives far away and her husband is not very cooperative and threatens to leave her and marry someone else on a daily basis. But her dad drives a babytaxi for a living and does not make a lot of money so she can't really afford much in the way of treatment anyhow. In lower socioeconomic status couples this tends to often quite commonly because the wife becomes such a "financial burden" that the man cannot afford to maintain treatment, etc.

The power in Bangladesh goes out quite often, this incidentally is a cause of many burns because families without generators will light candles or start up a fire to permit light and stay warm. Furthermore little children of women who work as cooks in houses are burned very frequently because they are playing around the kitchen or boiling water or food is spilled on them. Most of the women I saw today had scald burns from spillage in the kitchen. Because of the mosquitos here coils are burned to keep them away and mosquito nets are draped over beds, often times the net catches fire from the coil and can cause burns that way as well. In the farmlands the rice milll ash is dumped in an open area. Kids often play near them, will accidentally step or run over a pile of hot ash and burn their feet. The concept of fire hazard or safety doesn't seem to be very prevalent. Furthermore the concept of seeking immediate attention and the complications from burns are completely unknown to the uneducated. Skin thickening, keloids, awful scars, infections, etc occur and disfigure people for life. The incidents leading to these burns are not common in the US and so I found it interesting to note them today, furthermore the important thing is that prevention can only happen with an understanding of what risk factors are present in a certain community. It is so important to know the patients, where they come from, what they do, their socioeconomic status etc. Treating a patient is more than just treating the disease.