There is a high incidence of burns in East Africa due to the need to cook on charcoal fires and use kerosene for lighting. Knowledge of first aid for burns is not well understood and therefore the severity and depth of burns are greater by the time people reach hospital.
In the village of Kilimatinde, not far from an obelisk that marks the geographical centre of Tanzania, is a hospital built in the early 20th century. The hospital, which is more like a big doctors’ surgery, deals with pregnancy, maternal care, snake bites and other accidents. It has a single generator and a solar fridge for blood. People camp out for days to see the specialist doctor who flies in once a month.
Local understanding around burns is limited. Whatever the problem, honey seems to be the answer. This is neither good for managing pain nor helpful in improving long-term outcomes*. Because there is plenty of honey available, it is applied liberally to burns. The injury is then wrapped up tightly, which only serves to keep the heat in.
When a girl burnt herself on scalding hot water at the village school, her burn was covered in honey and bandaged. Eventually, someone managed to take her into a kitchen and put the wound under a cold tap.
Running water is in short supply in Kilimatinde, but cold water is collected every day. A burn needs to be in contact with cold water as soon as possible and for at least 15 minutes; it needs to be kept as cool as possible in order to remove the heat before too much tissue damage occurs.
A burn needs to be in contact with cold water as soon as possible
Often in Kilimatinde, people suffering from burns need emergency care and long stays in hospital. But some do not survive, and most wounds become infected. Cleaning and dressing the wounds is painful and difficult due to environmental factors and lack of supplies. In order to heal, the body needs good nutrition. This is another problem for the patients, who need to bring their own food to the hospital.
The last burn case we nursed in the hospital was a young boy who cried out in pain and fear while his wounds were dressed. They took months to heal.
Family and friends at a cooking point near Kilimatinde hospital. Photo: Stephen Taylor
The Kilimatinde hospital plans to improve its care for burn victims by establishing a burns unit. It will include training staff to improve healing of tissues, without pain, preventing burn scar contractures (the tightening of the skin after a second or third degree burn) where possible and offering rehabilitation. The unit will be segregated by gender and have access to a shower for cleaning the wounds, cold treatment and a locked store of impregnated bandages which are treated with special chemicals to help the healing of burns and promote a more sterile environment. This should mean better, faster treatment, with improved outcomes.
The hope is for a reduced length of stay and pain-free wound care, reduced infection, and protection and restoration of function where possible. The environment in which patients are nursed and treated will be improved, and links to a training hospital in Moshi will help the team continue to improve and use best practice.
Emergency first aid for burns:
- Burns should be treated by immediate soaking in clean, cold or lukewarm water. This relieves the pain and reduces damage by cooling the skin.
- Never apply any cream or grease.
- Remove any clothing or jewellery near the burnt area of skin, including babies’ nappies. However, don’t try to remove anything that’s stuck to the burnt skin as this could cause more damage.
- Sit upright as much as possible if the face or eyes are burnt. Avoid lying down for as long as possible as this will help to reduce swelling.
*Honey can be used for the management of burns but it is not a first aid treatment.