Together we can Prevent Burns in Uganda

UGANDA BURNS AND PLASTIC SURGERY INSTITUTE (UBPSI) ANNUAL REPORT 2013-2014 Together we can Prevent Burns in Uganda 1

Word from the Chairman Board of Directors Hon Timothy Mutekanga Lwanga The Uganda Burns and Plastic Surgery Institute (UBPSI) makes 10 years on November 26th 2014 and as we move towards this landmark I would like to acknowledge our long standing partners namely the Government of Uganda through Ministry of Health, Mulago Hospital, The Stichting interplast Holland, Makerere College of Health Sciences and Interplast Uganda. During these last 10 years the Burns Unit has made big strides in the treatment and management of burns not only in Mulago but all over the country. We receive patients from all over the country so the effect is countrywide. There have been challenges along the way both at the board level and the running of the Unit. During this time the board has changed leadership 3 times first with the demise of our first Chairman the late Father Albert Byaruhanga who died in a tragic road accident. Father Albert was succeeded by Mr Dirk ten Brink who also provided leadership until when he had to leave the country back to the Netherlands. The mantle was then handed down to myself until to date. Other long serving board memebers have left during this time for various reasons. The selfless efforts and dedication of all the board members past and present is hereby acknowledged and appreciated. The main challenge has been the funding to run the Burns Unit. Over time our faithful donors The Stichting Interplast Holland have reduced on the funds they provide for this noble cause. Finding alternative sources of funding proved to be difficult due to the credit crunch and donor fatigue. Initial efforts spear headed by H.E. The president of Uganda are under way to transit the Burns Unit into a government funded unit. This will hopefully be an answer to the funding gap currently in place. Special thanks to the medical and support staff of the UBPSI who have continued to work very deligently even when circumstances are not the most favorable. They have exhibited a high level of professionalism and they are very appreciated. The management of Mulago hospital for the continued support and in times scacity and shortages. We appreciate this partnership. Lastly I would like to thank both our international donors Stichting interplast Holland and Cordaid for their continued support during this time and our local partners the Petrocity Enterprises for their monthly contributions towards the treatment of burns patients. Tim Lwanga Mutekanga, MP Uganda Burns and Plastic Surgery Institute UBPSI) and Interplast Uganda 2

Word from the Head of Unit Dr Robert Ssentongo The Uganda burns and Plastic surgery unit (UBPSI)was set up in 2003 to support Mulago Hospital complex in its efforts to respond to an Identified need in specialised Burn care, plastic and reconstructive surgery. It is a tripartite initiative by Ministry of health Uganda, Interplast Holland, and Makerere University Medical School, later College of Health sciences. The stated objectives were: Objectives of the Uganda burns and plastic surgery institute 1. To contribute to the reduction of morbidity and mortality from burns injuries in Uganda in order for individuals to attain full productivity, and reduce on foreign exchange expenditure incurred in treatments abroad. 2. To introduce methods of treatment which will decrease the level of disabilities and deformities resulting from burns, injuries and congenital birth defects. 3. To provide optimal medical and surgical treatment, care, and rehabilitation of Burns patients and plastic surgically correctable afflictions to all patients that need it. 4. To educate and train Health professionals in the best practices of treatment, care, reconstructive surgery and rehabilitation of patients with burns and related afflictions. 5. To train nursing staff in the various levels of health care in the country in burns and wounds management and prevention. 6. To develop treatment protocols 7. To develop and disseminate Educational programmes on Prevention, and first Aid care of burn injuries 8. To carry out Burn injury prevention campaigns all over the country to reduce on the incidences of Burn. Along the way the functioning of the institute has been incapacity by Expiry of funding period by the main donor(interplast Holland) after 10 years. Increase in number, severity and complexity of patients attended to at the institute Increase in scope of cover including response to mass burn casualties like the recent Namungoona petrol tank burn Disaster Insufficient resource allocation through Mulago Hospital and Complex to cope with the above. Need to respond to likely fire accidents, a consequence of Oil exploration and mining in Uganda 3

Inability to fund the need for research, and training in plastic surgery and burn care. Insufficient inpatient and operating room space to cope with the increased patient load. The Uganda Burns and plastic surgery institute supported by the Executive Director Mulago Hospital has responded by requesting for Prioritised, Direct funding/ ring fenced funding to the Unit to insulate the unit from unfavourable competitive fund allocations as has been occasioned by other urgent needs that face Mulago Hospital from time to time. Discussion along this line has already been initiated, and His Excellency the president has requested the permanent secretary Ministry of Health to facilitate the process This is intended to allow un- interrupted supervised, programmed development into a semi - independent Uganda Burns and plastic surgery institute at Mulago. On behalf of all the staff of the UBPSI I would like to thank the above mentioned tripartite initiative by Ministry of health Uganda, Interplast Holland, and Makerere University Medical School, later College of Health sciences for the I would also like to express my appreciation to the staff of the Burns unit both the health workers and the support staff who have continued to provide exemplary service and care to our patients and the population of Uganda. Robert Ssentongo Head of Unit/Consultant Plastic Surgeon Uganda Burns and Plastic Surgery Institute. 4

Foreword This is the annual report of the Uganda Burns and Plastic Surgery Institute (UBPSI) for the period from July 2013 to June 2014. During this period the Uganda Burns and Plastic Surgery Institute has continued to grapple with the continued shortage of funds with the expiry of funding period by the core funder Stichting (Foundation) Interplast Holland. The period covered in this report opened with the aftershock of the Namuwongo fuel tanker explosion which saw 27 patients admitted to the Burns Unit most of whom were beyond recognition. This incident brought the Mulago Hospital and especially the Burns Unit into spot. The Inadequacies of the unit were highlighted especially on the occasion of the visit of H.E The President of Uganda Yoweri Kaguta who visited the Burns unit. The president was indeed impressed by the work done by the medical and support team working in such constrained circumstances both in terms of resources and manpower. The president from the statehouse budget directed the provision of some support in terms of specialized equipment, drugs and sundries. The Hospital director also managed to harness whatever little resources were at his disposal to support the Burns unit during this critical time. Of the 27 patients that were admitted 9 were saved. This might look like a small number but given the extent to which they were burnt the medical team did a very exemplary job to be able to save the 9 patients. This incident although a very sad one did highlight the plight and constrained circumstances under which the Burns unit and the whole of Mulago Hospital operates in. The UBPSI supported by the executive director of Mulago requested for prioritized direct funding to the Burns unit so that it would be insulated from the unfavourable competitive resource allocations with the other departments in the hospital. H.E the president of Uganda also initiated discussions for the Burns Unit to be elevated to an autonomous institute within the Mulago hospital structure just like the Heart or cancer institutes. This however is yet to materialize as government systems are a process. An application for this has already been made by the board and submitted to Ministry of Health. The president invited Dr Rein Zeeman and there were 2 meetings held with H.E the president of Uganda. The first one was held on 18th April 2014 between H.E and Dr Rein Zeeman at State house Nakasero. The second one was held on 26th April 2014 at statehouse Entebbe. In attendance H.E the president,the permanent Secretary MoH Dr Asuman Lukwago, the board chairman Hon Tim Lwanga, Dr Rein Zeeman, Dr Robert Ssentongo, Ms. Marjo Aerts and Stephen Kato. The president directed the Permanent secretary to fast track the process of turning the Burns Unit into a fully-fledged institute with a direct vote from the ministry of Finance. This has been an ongoing process and like many government processes it takes time. Hopefully we shall see it bear fruit some day. 5

H.E the president meeting Dr Zeeman and Ms Marjo Aerts Away from this highlight and despite the shortage of funds the Burns unit has continued to admit and provide medical care as is its mandate. The period saw a total of 814 patients admitted and a total of 515 operations were carried out both in the Burns theatre and the main theatre. The statistics here below give a clear picture of the load in terms of patient care and number of patients taken care of. It s also in comparison to the previous years. Stichting Interplast Holland continued to support the UBPSI activities. Euros 20,000 was provided to support patient care in terms of drugs and patient food and administration costs. Stichting Interplast Holland in partnership with Cordaid provided funds for the Burns Prevention Programme (BPP). The programme has grown in terms of numbers sensitized and area covered. There is a report for the Burns prevention program about burns and how to prevent burns. It also shows the areas that have been covered by the programme. Stichting Interplast Holland has continued to send its team mainly comprising of Dr Rein Zeeman and Ms Marjo Aerts. They provide support to the UBPSI in terms of medical care, training and administration. 6

UBPSI kitchen staff making meals for patients. The Uganda Burns and Plastic Surgery Institute has also continued to partner with the Smile Train organisation which provides funds for the elimination of cleft lip and palate. The partnership is mainly under the stewardship of Dr Robert Ssentongo the head of the Burns Unit. Operations are carried out all over the country where these children with clefts can be found. We would also like to thank our partners Stichting Interplast Holland for the continued support and for the valuable in partnerships for they have cultivated for the UBPSI with other organisations like with the Cordaid. We would also like to thank the Smile Train organisation for continued partnership. Petro city Uganda has continued to make a monthly contribution to the running of the Burns Unit for which we are very thankful. A vote of thanks goes to the board of directors of Uganda Burns and Plastic Surgery/Interplast Uganda and Interplast Holland for their invaluable sacrifices in terms and time and insight. You are all very much appreciated. Stephen Kato Finance and Administration Manager Uganda Burns and Plastic Surgery Institute 7

REPORT OF THE BURNS PREVENTION PROGRAMME, UGANDA Preamble In this report the Burns Prevention Team (BPT) share with our stakeholders the fruits of the Burn Prevention Program in and around Kampala in 2013/2014. The demand for the activities of the Burns Prevention Programme is growing as many schools and communities place in more requests for burns prevention sensitization sessions. The number of sessions are 60 per month, thanks to the financial support of Foundation Interplast Holland. In the future the Program is going to be set up with a National View with support of the Ministry of Health, Uganda. Prevention is the key; Burn Prevention is better, and cheaper than cure! The target group of the program at this moment are children younger the 6 years old. The statistics show most admissions at the Burns Unit are children younger than 6 years old: More than 500 cases yearly! This means children with burns are disabled for the rest of their lives, and are kept away from public life. The causes of burns are the instable, unsafe cooking places, and fire in bedrooms because care takers don t blow out the candle before they leave the bedroom with the sleeping children. Most of the burns patients are very poor, and live below the poverty line in the slums and villages of Uganda. In interviews with people they always tell they recognize the problems of the burns victims, and the causes of burns. A House to House visit part of a Community session by a Burn Prevention Officer BPO - in Bwaise 8

Achievements Very many sessions have been done despite some challenges, we have reached schools, Local council meetings, sensitized at marriage introduction ceremonies, places of worship, formal and informal gatherings; generally we are everywhere. A school session Community Sessions in 2013/14 School Sessions in 2013/14 District Sessions Audience Sessions Audience Kampala 545 33302 Wakiso 122 7479 Mukono 2 122 Total 665 40903 51 8087 The Burn Prevention Team is very happy to see the changes of behaviour of people in the Communities. People spread the news in their environment to make the cooking places safe by fencing them, or keep away their children from the cooking places. Some people choose for a stable sigiri. Community Leaders tell in an interview they monitor less house fires. Also the First Aid after burns improves: More victims admitted at the Burns Unit got the right First Aid at the spot of the incident, and went to a Health Care Centre/Hospital immediately. That s the reason more cases are admitted at the Burns Unit in Mulago Hospital now. In a few years this number will reduce if the Burn Prevention Program continues in future. 9

A woman in Bwaise shows other women the hand left and explains them the Burn Prevention Message The Burn Prevention Program has good outcomes till now. In future the house to house message has to continue, because according to the literature this gives the best results in sensitization. Next to it this messages need to be confirmed by TV and Radio spots. Burns can really easily prevent, research has already proved it and it has worked elsewhere; why not in Uganda. Urgently partnerships are needed from the Ministry of Heath, the Ministry of Gender, the Ministry of Education and Sports, and NGOs so that : Together we Prevent Burns in Uganda! 10

Statistics Annual Report 2013-2014 1. Burns ICU Number Year July-June Admissions of patients F M Transferred patients Discharged patients Discharged against medical advice Pat. Died Days at the ward totally** 2006-2007 104 53 51 24 18 62 1440 of 90 pat. 2007-2008 93 44 49 39 4 3 47 972 of 89 pat. 2008-2009 46* 21 25 9 4 0 26 574 of 42 pat. 2009-2010 105 48 57 29 20 2 43 814 of 90 pat. 2010-2011 103 35 68 23 14 4 36 1181 of 79 pat. 2011-2012 120 54 66 29 53 2 36 834 of 80 pat. 2012-2013 126*** 51 75 36 25 2 39 847 of 90 pat. 2013-2014 105 42 63 33 13 0 59 1410 of 95 pat. Fig. Admissions Burns ICU Remarks: *Because of renovation exercise the ICU was closed for half a year. **From the other patients we don t know the number of days because it was not recorded exactly. ***During the month October the Burns ICU was closed because of pseudomonas Average adm. days per patient 16 10.92 13.67 9.04 14.95 10.43 9.41 14.84 Year June-July 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 Bed No data 2.8 3.4 2.65? 3.41 3.54 4.15 Occupancy 1 Fig. Average Number of patients daily at the Burns ICU 1 From 10 patients the average admission days of the other patients are counted. Age of the pat.: 2010-2011 2011-2012 2012-2013 2013-2014 <5 years old: 56 pat. (54%) 64 pat.( 53%) 69 pat.( 55%) 46 pat.(44%) 5-14 years old: 6 pat. (6%) 17 pat.(14%) 15 pat.(12%) 19 pat.(18%) >14 years old: 41 pat. (40%) 39 pat. (33%) 42 pat.(31%) 37 pat.(35%) Unknown: 3 pat. (3%) %TBSA** Year* 0-10% 11-20% 21-40% 41-60% >60% Unknown 2011-2012 0 15 46 18 20 21 2012-2013*** 0 24 64 10 16 12 2013-2014 8 10 42 25 11 9 Remarks: 11

*From the 1 st of July till the 30 th of June **TBSA: Total Body Surface Area ***In October 2012 the Burns ICU was closed. Patients were admitted at Holland Ward; other patients were admitted at Ward 3BP Fig. TBSA of the admitted patients Cause Year* 2010-2011 16 F:6 /M:10 Hot Liquids Flame Acid Paraffin/ Petrol/Gas 19 F:7/ M:12 4 M:4 Electricity Others Unknown 2 M:2 62 2011-2012 42 F:24/M:18 4 F:3/M:1 6 F:3/M:3 2 M:2 2012-2013 53 F:22/M:31 2 F:2/M:0 2 F:2/M:1 6* F:0/M:6 4 F:0/M:4 57 F:25/M:32 2013-2014 34 F:20/M:32 43 F:12/M:31 5 F:3/M:2 9 F:2/M:7 9 F:0/M:9 5 F:5/M:0 Remarks: *Accident at the Northern Bypass: Bodabodas and Fuel tank truck. Five victims with more than 70% TBSA Fig. Causes of burns at the Burns ICU 2. Holland Ward Number Year July-June 2007 Feb-July* Admissions of patients F M Transferred patients Discharged patients Discharged against medical advice Pat. Died Days at the ward totally 2 142 62 80 9 121 6 6 2,185 of 125 pat. 2007-2008 318 141 177 8 290 19 9 5,228 of 246 pat. 2008-2009** 360 165 195 1 224 25 60 6,312 of 298 pat. 2009-2010 400 180 220 4 297 18 16 6,637 of 320 pat. 2010-2011 464 224 240 10 353 29 28 8,039 of 388 pat. 2011-2012 421 176 245? 297 19 8 5,606 of 307 pat. 2012-2013 354*** 119 235? 209 9 13 3,697 of 231 pat. Average adm. days per patient 17.45 21.25 17.53 20.74 20.71 18.26 16.00 2013-2014 450 201 249? 371 16 22 8,889 of 409 pat. 21.73 12

Remarks: *Holland Ward was opened the 1st of February 2007 **Renovation exercise at Burns ICU. Patients were admitted at Holland Ward ***In the month October 31 burns patients were admitted at 3BP because of Pseudomonas at the Burns ICU. Four of them had burns more than 20% TBSA. Fig. Admissions Holland Ward At ward 3BP 37 patients were admitted, because the Burns ICU was closed and intensive care patients were admitted at Holland Ward in October and November 2012: - 27 patients had a TBSA% burns less than 20% - 9 patients had a TBSA% burned in between 21 and 40% - 1 patients had a TBSA% burned in between 40 and 60% There were 23 patients younger than 5 years old. Nine of them were older than 14. Normally they would have been admitted at Holland Ward. Year 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 June-July Bed 18 21 22.6 26.3 21.2 15.5 24.1 Occupancy 1 Fig.: Patients per day at Holland Ward 1 From 41 patients the average admission days of the other patients are counted. Age of the patients: 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 <5 years old: 214 patients 249 patients 236 patients 198 patients 256 patients 5-14 years old: 85 patients 36 patients 57 patients 38 patients 55 patients >14 years old: 101 patients 164 patients 128 patients 118 patients 139 patients Unknown: 25 patients %TBSA** Year* 0-20% 21-40% 41-60% >60% Unknown Not burns 2009-2010 251 77 24 1 42 0 2010-2011 244 80 64 2 63 11 2011-2012 271 85 13 1 51 0 2012-2013*** 205 95 4 23 26 1 2013-2014 307 87 9 3 44 Remarks: *From the 1 st of July till the 30 th of June **TBSA: Total Body Surface Area ***In October 2012 the Burns ICU was closed. Patients were admitted at Holland Ward; other patients were admitted at Ward 3BP Fig. TBSA of the admitted patients 13

Year* Cause Hot Liquids 2009-2010 273 F:141/M:132 2010-2011 262 F:144/M:118 2011-2012 239 F:106/M:133 2012-2013 177 F:52/M:125 2013-2014 277 F:123/M:154 Flame Acid Paraffin/ Petrol/ Gas** 71 F:40/M:31 96 F:45/M:51 17 F:6/M:11 33 F:18/M:15 75 F:38/M:37 11 F:5/M:6 23 F:8/M:15 15 F:7/M:8 9 F:6/M:3 17 F:8/M:9 5 F:4/M:1 7 F:3/M:4 16 F:6/M:10 Remarks: *From the 1 st of July till the 30 th of June **Since 2011 specified Fig.: Causes of burns of admissions at Holland Ward since 2009 Electr. Others 6 F:0/M:6 14 F:4/M:10 6 F:0/M:6 11 F:1/M:10 22 29 F:12/M:10 11 28 Unknown 145 F:64/M:81 122 F:40/M:82 54 F:27/M:27 3. Plastic and Reconstructive Ward 3BP Number Year July-June Admissions of patients F M Transferred patients Discharged patients Discharged against medical advice Pat. Died Days stay at the ward totally *** 2006-2007 182 85 97 0 182 0 0 1,168 of 84 pat. 2007-2008 154 83 71?? 0?? 2008-2009 210 102 108 2 169 0 1 1,952 of 172 pat. 2009-2010 218 112 106 2 144 0 3 1,356 of 148 pat. 2010-2011* 180 32 88 1 120? 2?? 847 of 123 pat. 2011-2012 387 178 209-355 3 0 1,958 of 287 pat. 2012-2013 347** 171 176? 250 1 0 1,495 of 247 pat. 2013-2014 259 122 137 4 172 2? 1,782 of 174 pat. Remarks: *Ward 3BP was closed because of renovation exercise from December 2010 till April 2011. **During the month October more patients were admitted at 3BP because the Burns ICU was closed. ***From the other patients the date of the last admission day was not mentioned in the medical file or admission book. Fig. Admissions Ward 3BP Average adm. days per pat. 13.9 11.3 9.2 6.9 6.8 6,0 10.2 Year 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 June-July Bed 6.5 5.5 5.1 7.2 5.8 7.3 Occupancy 1 14

Fig.: Number of patients at Ward 3BP daily 1 From 85 patients the average admission days of the other patients are counted. A severely burnt child in a lot of pain Year* 2009-2010- 2011-2012-2013 2013-2014 Diagnosis 2010 2011 2012 Post Burn Contractures 49 38 52 48 42 Burns 27 35 14** 54*** 40 Cleft lip and/or palate 35 25 83 93 60 Ulcers 11 7 26 8 7 Keloid 6 15 28 11 6 Others 90 58 184 131 91 Unknown 2 13 *From the 1 st of July till the 30 th of June **The burns patients are transferred to Holland Ward as soon as possible ***Burns ICU was closed during the month October. More burns patients 37 patients - were admitted at 3BP. These patients were not transferred to Holland Ward. Nearly all of them caused by hot liquids. Fig.: Admission Diagnosis at Ward 3BP yearly The number of burns patients/age 2012-2013 2013-2014 < 5 Years old: 27 patients 9 patients 5-14 Years old: 9 patients 5 patients >14 Years old: 18 patients 26 patients 15

4. Burns Theatre Number Year July-June Total of operated patients SSG Changing dressing Cleft lip or palate Debridement PBC Others Days of operation 2006-2007 356 147 74 135 105 2007-2008 189 83 37 69 91 2008-2009 213 54 29 130 94 2009-2010 312 118 64 25 103 136 2010-2011 257 167 22 19 16 14 19 122 2011-2012 470 126 122 79 19 5 124 158 2012-2013 465 158 38 95 19 3 152 164 2013-2014 337 154 24 80 17 8 54 126 Remark: Sometimes one patient needs more operations in one operation session Fig. Number of Operations at the Burns Theatre Average number of operations per day in 2013-2014 July-June: 2.7 5. Main Theatre Number Year July-June Total of operations SSG Cleft lip or palate PBC Keloid Others Days of operation 2009-2010 146 9 33 25 7 72 60 2010-2011* 106 19 13 37 2 35 * 2011-2012 197 69 61 19 13 32 81 2012-2013 176 22 28 22 6 98 74 2013-2014 178 28 25 45 7 73 64 Remarks: *December 2010 till April 2011 3BP was closed due to renovation exercise Fig. Number of operations at Main Theatre Average number of operations per day in 2013-2014 (July-June): 2.8 16

List of Directors and UBPSI info Board of Directors Hon Tim Lwanga Mutekanga * Ms Joy Batusa Nkambwe* Ms Joy Turyamwijuka Asiimwe* Dr Rein Zeeman** Dr Byarugaba Baterana* Dr Amandua Jacinto* Dr Joseph Byamugisha* Prof Nelson Ssewankambo Mr Lawrence Lugwana Kaggwa Dr Robert Ssentongo Chairman BoD Treasurer BoD Secretary BoD Chairman Stichting Interplast Holland Executive Director Mulago Hospital Complex Commissioner MoH Legal Advisor Dean Makerere College of Health Science Director Head of Unit and Medical Advisor *Ugandan ** Dutch Secretary Ms Joy Turyamwijuka Asiimwe P.O. Box 586, Kampala, Uganda Auditors Grant Thornton P.O. Box 7158 Kampala, Uganda Bankers Lawyers Stanbic Bank (U) Limited, J.B.Byamugisha Advocates Forest Mall Branch, 5 th Floor, EADB Building P.O.Box 7133, 4 Nile Avenue Kampala, Uganda P.O.Box 9400 Kampala, Uganda 17

REPORT AND FINANCIAL STATEMENTS FOR TWELVE MONTHS ENDED 30TH JUNE 2014 IPH = Interplast Holland) Jul '2013 - Jun 2014 Income Income IPH Core Fund 22,910,372.51 Cordaid Burns Prev. Program 29,082,494.75 Smile Train Camps 126,374,905.41 Petro city Enterprises 6,000,000.00 IPH - Burns Prev. Program 108,029,404.66 IPH - Food and Medical Fund 50,683,498.54 Total Income 343,080,675.87 Expense Medical Supplies Food and Medical Supplies 49,496,241.85 Burns Prevention Program 113,567,844.08 Smile Train Camps 113,022,488.19 Staff Salaries and NSSF Co. Cont. 62,503,664.00 Admin and Bank expenses 5,147,471.00 Repair and Maintenance 873,000.00 Total Expenses 344,610,709.12 Excess Expenditure over Income 1,530,033.25 Add changes receivables 79,355.00 Add changes payables 2,483,680.00 Less Fixed Assets purchased -5,150,477.00 Net cash increase for the year -4,117,476.01 Cash at the beginning of the year 57,535,174.61 Cash at the end of the year 53,417,698.60 18