Abstract: Outreach Programme to Improve Burns Management in the Northern Cape Province: Pilot Project

OUTREACH PROGRAMME TO IMPROVE BURNS MANAGEMENT IN THE NORTHERN CAPE PROVINCE: PILOT PROJECT

M.Giaquinto-Cilliers, T.Mathe, S.Sheik, G.Kanakang

Kimberley Hospital Complex

OBJECTIVES: To utilize the outreach program via the Air Mercy Services (AMS) to: 1) Map the quality of care given to burn patients and 2) train health care professionals in the Northern Cape Province (NCP) on burns prevention and burns management, in order to improve the referral of patients to Kimberley Burns Unit (KBU), and provide better quality of care to burn patients within the Province.

BACKGROUND: The NCP is the biggest Province in South Africa in land mass and the distances between major towns to the referral tertiary centre, Kimberley Hospital Complex (KHC), are long and result in delays in patients reaching adequate treatment by road transport/ambulances. The AMS is based in Kimberley, and the outreach programme is used to fly out some specialists to the major distant towns, and fly in patients in need of emergency care. KBU is the only referral centre for burn patients within the NCP and most referrals reflect the lack of experience of health care personnel in the management of burn injuries. Education on burn injuries is needed in order to: improve the referral of patients who need admission in a burns unit, improve the pre-hospital management of burns, improve the acute treatment of burns, improve the outpatient care and to promote burns prevention.

METHODS: From 13^th July to 17^th August 2011, a team consisting of one or two doctors and one or two nurses were taken by the AMS to five main towns of the main districts of the NCP: Calvinia and Springbok (Namakwa District), Upington (Siyanda District), Kuruman (John Taolo Gaetsewe District) and De Aar (Pixley Ka Seme District). Nurses were responsible for lectures given to home based care givers on measures to prevent burns. Doctors were responsible for the training given to Emergency Medical Services (EMS) personnel on pre-hospital management of burn injuries and the acute management of burn injuries and outpatient treatment of burns training given to medical and nursing staff. General written guidelines were given on the occasion of the training.

RESULTS: 91 care givers were trained in burns preventative measures and they were requested to implement the measures amongst their communities. Fourteen staff members from EMS, 12 doctors and 59 nurses were trained, and the sessions were interactive.The mapping of available beds for treatment of burn injuries has shown that in most regional and district hospitals, patients are admitted in general wards with no dedicated equipment or trained staff. One dedicated room for admission of burn patients was available in Calvinia. A dedicated burn ward with ten beds in Upington and two beds in Kuruman are planned for 2012-2013. The majority of district hospitals and community health centers in the Province lack equipment for the management of burn wounds (electrical dermatomes, manual dermatomes), skills to handle the equipment (medical officers trained in skin grafting) and advanced dressings to speed up the wound healing process.

DISCUSSION: Feedback received was promising. A communication channel was opened to allow more interaction between the remote places and KBU, resulting in better triage of patients for further treatment and promoting reduction of costs associated with transport of patients for unnecessary consultations and admission. A blog with all the information and documentation was also created to strengthen that communication.

CONCLUSION: This pilot project in the NCP has shown that the training of professionals working in remote areas can be achieved through outreach opportunities and improvement of care will result in appropriate referrals to Kimberley Burns Unit.