Treating Burn Patients in Rutshuru
November 24th, 2009
Guerilla warfare has replaced armed clashes in North Kivu, Democratic Republic of Congo, and villages are now being set on fire regularly. The combatants launch an attack and spread terror, looting and setting fire to houses. That is how this young woman became trapped in the flames in her home. She has second-degree burns over 40% of her body and has been treated at the Rutshuru hospital in the burn unit for four long months.
Burns can also be accidental. There is no electricity in North Kivu villages and everyone gathers around the fire at night. When someone with epilepsy has a seizure and convulsions, he or she often falls into the fire and is burned. Young children may fall into the kettle of corn or manioc mush that their mother has set to cook on the hearth. Such accidents are particularly common in the displaced persons’ camps scattered throughout this eastern province of the DRC, a place torn by armed conflict, where living conditions are extremely rudimentary.
Meshak is 3 years old. He was burned when he overturned over a pan of mush. The little boy was hospitalized in late July in Rutshuru, where he arrived with second-degree burns over 30% of his body. He is in the unit that MSF set up specifically for these patients. But the treatment is long because he lost a lot of fluids at first. He required two transfusions and was then fed through a nasogastric tube. Like most young burn patients, he has anemia, which weakens the immune system. But he’s eating well now and is gaining weight.
Léonie is three months older than Meshak. She has third-degree burns over 60% of her body and has lost a lot of weight. When she was admitted in mid-August, she weighed 16 kilos. Two months later, her weight dropped to 9 kilos. Her burns are dressed regularly in the operating room, “under anesthesia,” the nurse notes. “Otherwise, she screams.” However, Léonie is not out of the woods yet.
“The problem is that burn patients generally have a lot of infection when they arrive,” explains Richard, the physician anesthetist at the Rutshuru hospital, who is responsible for the burn unit. “When their wounds are debrided - that is, cleaned – they become like a third-degree wound. There is no more epidermis or dermis and it bleeds.” Once the wounds are cleaned and the dressings in place, the surgeons can perform a skin graft, but the patient must have areas of healthy skin.
The opening of the burn unit in August was a major advance. The unit makes it possible to isolate burn patients from others and maintain them in an aseptic environment. To enter the rooms, for example, mothers must wear special shoes and a hospital smock (the burn unit houses several very young children). There are fewer adults, but they also need care, like this young woman whose face was burned almost entirely. To help her gain control over the movements of her mouth, a physical therapist visits her regularly. The therapist is also helping a boy regain mobility in his legs. The MSF psychologist meets with these very fragile patients to help strengthen their connection to life.
Françoise
As they fled, armed men set fire to her house after looting the village. Trapped inside, Françoise, a young mother, received second-degree burns over her back, both arms, head and the upper part of her face. One of her children died in the fire. Françoise was transferred to the Rutshuru hospital in an MSF ambulance with her other child. However, he died soon after. Françoise spent nearly a month in the intensive care unit, lying on her stomach. She was then treated for three months in the burn unit. Her prognosis was grim, but she received all available care: wound debridement, skin grafts, physical therapy and sessions with a psychologist. She left the hospital in September. She is still disabled, with little mobility in her right hand, but has regained 80% mobility in her elbow and shoulders. And she is walking.
