UNC Surgeons Open Malawian Burn Unit

By Ran Northam Posted July 14, 2014 at 4:52 pm

Two surgeons with the Jaycee Burn Center at UNC Hospitals recently returned from a two-week trip to Malawi in southern Africa where they opened a burn center in one of the poorest countries in the world.

Dr. Anthony Charles (Courtesy of UNC News Services)

Dr. Anthony Charles (Courtesy of UNC News Services)

“We go to Malawi not with the intention of essentially creating an American emergency room, we just want to make whatever they have there work, work better, and any new technology that we may bring is just to make life easier for everybody,” says Dr. Anthony Charles, the Director of the Adult ECMO Program and Associate Professor of Surgery with specialties in trauma, critical care, and acute care surgery.

***Listen to the Full Interview with Dr. Charles and Medical Director, Dr. Bruce Cairns***

ECMO is the process of extracorporeal membrane oxygenation or heart and lung bypass.

Dr. Charles is a native of Nigeria. He has traveled to Malawi since 2007 and says, although a lot of attention is given to HIV/AIDS in sub-Saharan Africa, trauma kills more people than HIV/AIDS, malaria, and tuberculosis combined.

Dr. Charles and Jaycee Burn Center Medial Director Bruce Cairns—who also serves as the faculty chair at UNC—were recently in Malawi for two weeks. The doctors made the trip to open and dedicate a burn unit and burn operating room in Malawi’s Kamuzu Central Hospital.

“I think one of the most unique things about that hospital in Malawi is that now you have an operating room within a burn unit, which most places—even in the United States—will envy,” Dr. Charles says. “It is our hope, because of the summer-hemisphere winter, that we can get patients in and out of the hospital as quick as possible, they can get their skin grafts done, and we can have this huge, huge turnover and get them back to recovery.”

Video from the Kamuzu Central Hospital

Video courtesy of the Jaycee Burn Center

To describe what a hospital is like in Malawi, Dr. Charles says to imagine you’re in an American hospital in the 1930’s. Malawi is also very densely populated with about 14 million people in nearly 46,000 square miles. That’s roughly equivalent to the size of Ohio with about 2.5 million more people and very few medical professionals.

“In Malawi, there are no more than 20 indigenous Malawian surgeons for a population of 14 million people,” Dr. Charles says. “You can imagine that for those that actually make it to the hospital and actually see a surgeon, they’re the lucky ones.”

Dr. Charles and Dr. Cairns say they both agree that support is needed from the UNC campus and throughout the nation to continue to help improve medical practices in Malawi.

Dr. Bruce Cairns (Courtesy of UNC News Services)

Dr. Bruce Cairns (Courtesy of UNC News Services)

“I think that there are a number of things that we would like to change, but it starts with resources and support,” Dr. Cairns says.

“Part of what we’ve done is, we started a surgery residency program to train Malawians to become surgeons and also support the clinical offices for better training,” Dr. Charles says. “I think doubling up on that effort and increasing the number of people that can provide care to their people is the magic sauce.”

Dr. Cairns says he wants to put the burn center out of business, but right now all 60 beds are full.

Walking through the Jaycee Burn Center, you don’t hear much sympathy being handed out; instead, there are smiles on the faces of the doctors and nurses and words of encouragement spread throughout.Dr. Cairns says that’s important to the healing process.

“When you’re a burn patient, you become a burn survivor for life because of the scarring—not just the physical, but the psychological as well,” Dr. Cairns says. “So, how we support the patient and their family during that time has a huge impact on how that burn will affect them for the rest of their lives.”

Dr. Cairns touts the fact that UNC has what he believes are some of the best occupational therapists and one of the best facilities to handle the delicate nature of the trauma, not to mention some of the top doctors.

The Burn Center has a family waiting room that was made possible by Duke Energy. It also has a playroom that helps in the physical and mental healing process.

UNC Jaycee Burn CenterDr. Cairns says a major contributor to the continued success of the Burn Center is the North Carolina Touchstone Energy Cooperatives.

Energy co-ops are private, independent, and not-for-profit. Dr. Cairns says he’s glad to partner with them because he knows if something were to change in the amount of support the Center receives, either from the state, or the hospital, the co-ops would be in full support.

He says his goal to put the Jaycee Burn Center out of business isn’t there yet.

“We are making progress,” Dr. Cairns says. “We will always continue to work on this, but it’s a constantly-evolving challenge.”

He says, for now, his goal is to educate and to work on preventative care so the beds don’t constantly remain full.

“The most advanced medical technology that we’ve ever developed is a vaccine, so it’s always better to prevent an injury than to treat it,” Dr. Cairns says. “But, we have to educate people about what the dangers are in the home—for example, grease fires—as well as the kinds of activities that might lead to an injury—for example, using gasoline on a fire will result in an explosion.”

“We have other challenges with technologies—microwaves, for examples—people don’t appreciate how hot the liquids can get,” Dr. Cairns says. “But more importantly, as our population ages, people aren’t as quick to react. So, we get a lot of people who are older who are getting burned in the kitchen.”

Fire patches hanging in the Jaycee Burn Center

Fire patches hanging in the Jaycee Burn Center

He says there are always a number of injuries after the Fourth of July celebration from fireworks, including the most recent one.

Dr. Cairns says UNC also gets the largest number of transfers from other hospitals, including Duke and WakeMed.

The Jaycee Burn Center treats patients from almost all 100 North Carolina counties. And Dr. Cairns says he wants to continue to make it easier for patients to receive the same quality care they receive in Chapel Hill elsewhere in the state.

“Ultimately we’re here to serve our patients, our citizens, our constituents,” Dr. Cairns says. “How to do that has been a challenge, because some of the services require a critical mass of people. So, we would partner, probably, with trauma centers as well as the UNC Health Care system facilities/hospitals that are a part of what we do here. Now that the electronic medical record is going to be uniform across the system, we’ll be able to work with those various facilities; hopefully we’ll use telemedicine and other strategies to be able to allow the patients to get the kind of care they need without having to travel so far from home.”

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