Practice development
MULTIDISCIPLINARY TEAMS The author had seen similar cases to that of the seven-year old boy [Figs 2-4] during her time in Manchester Children’s Hospital. In the author’s experience, in the UK, patients of this age range with similar wounds would receive an enormous amount of multidisciplinary input during their slow but steady recoveries. A lack of multidisciplinary teams has a
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1. The lack of multidisciplinary teams in Ghana has a significant impact on burn wound outcomes
2. During the author’s time in Ghana, she witnessed the detrimental
impact that a lack of basic wound dressings can have on a patient, in
terms of infections and longer-term consequences
huge impact on burn wound outcomes in Ghana. An example of this was the case of a 21-year-old woman who was admitted for a revision of her contractures [Fig 5]. The lack of a multidisciplinary team exacerbated the need for revision surgery, which could have been avoided by employing physiotherapy, occupational therapy and early education regarding normal and hypertrophic scarring. Many other patients with loss of function, due to contractures, were seen in the Ghanaian outpatient clinics due to the fact that, post- injury, they had no follow-up service for physiotherapy or occupational therapy. During the author’s placement, the
majority of patients attending Korle Bu for long-term plastic surgery issues sought advice for contractures. This would not have been the case if there had there been physiotherapists and occupational therapists available to support the patients post-injury. This demonstrates the value of these areas of treatment, and emphasises the negative effect that a lack of post-operative care can have in the long term.
BASIC CARE The author also witnessed the impact that a lack of basic wound dressings can have, such as infections and longer-term consequences, including, sub-optimal wound healing leading to poor scarring, which may have significant functional and psychological consequences. There is a plastic surgery service in Korle
Bu, but it is in high demand since it is the only place in the country that offers this kind of treatment. Despite being a top teaching hospital, Korle
Bu often lacked the most basic amenities, such as running water and electricity. During her placement, the author was often required to pour jugs of water over the surgeons’ hands. They would use this water as a preoperative scrub when the water supply was down. At other times, she had to wear a head torch in order to illuminate the operating table when the electricity had cut out and the generator would not start.
34 Wounds International Vol 3 | Issue 3 | ©Wounds International 2012
Figure 5 – Young woman undergoing revision surgery for a post-burn contracture. Here the flap has already been transferred from the chest and has been sutured in place.
As previously mentioned, the local
community hospital had only three doctors, all of whom were carrying out the duties of accident and emergency consultants, general medics, obstetricians, gynaecology consultants and general surgeons — as well as being on call for every other speciality, almost all of the time. Also, Ghana is a very religious country and a large proportion of the population are devout Christians. Religion is clearly a very important part of daily life, both in and outside of work, and it was not uncommon for doctors to answer the author’s medical queries with phrases such as, ‘I will be guided by God’ or ‘God will find a way‘.
CONCLUSION There is constant groundbreaking research taking place in the developed world, which all clinicians can benefit from. Despite often feeling really quite useless as a junior doctor and listening to people being less than positive about aspects of their work, the author found that experiences such as these are a reminder that small things can make a difference and, by being aware, remaining up to date and taking care to avoid wasting resources, even inexperienced clinicians can make an impact at a basic level.
AUTHOR DETAILS Rebecca Heath, BSc, MB ChB, MRes is a foundation year two doctor at Wythenshawe Hospital, Manchester
Stuart Enoch, MBBS, MRCSEd, PGCert (Med Sci), MRCS (Eng), Ph.D is the Programme Director at the Doctors Academy, Cardiff and Clinical Lead at the Centre for Studies in Wound Care and Burns, India
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