Burns Intensive Care Unit, Kumasi, Ghana

ReSurge Africa sets up Burns Unit in Kumasi

Kumasi Burn Intensive Care Unit (BICU) Ghana, Opened 1st February 2001 at Komfo Anokye Teaching Hospital (KATH), Kumasi.

The BICU is now a thriving 8 bed unit with a staff of 3 Surgeons, 3 trained Burn Ward Nurses and a full staff of other ward nurses employed by the hospital. See Surgery publications from this unit, and Burns Research from this unit

In 2009 the New Accident Unit was opened at KATH and now provides an additional 4 bed ICU solely for burns with adjacent operating theatre. The original BICU has now become a step down unit to treat women and children with burns whereas the male patients mostly are treated in the general surgical wards. As the workload has steadily increased there is a pressing need for further development with an integrated unit to treat Burn and Reconstructive surgery patients.

The total numbers of operations per year on in-patients is >1000 of which one third are burn related.

45% of the burns patients are children under 5 years old.

In the first 9 years over 1350 patients have been admitted and treated in the Burns Unit. The overall survival rate is 90%. In addition an additional 300 seriously injured burns patients under the care of the Plastic Surgery team had to be admitted to the general wards when there was no space left on the Burns Unit. This workload is comparable with the number of burns patients treated in Scotland each year.

Since the BICU has opened the standards of Burns care has improved out of all recognition.
The presence of a prestigious unit in Kumasi has gradually led to the development of a team of dedicated staff and the Grand Round every Monday is joined by a physiotherapist, pharmacist and visiting clinicians.

Summary

In summary the result of this project has been a resounding success and illustrates the benefit of targeted local expertise. For the initial expenditure of about £100.000 and the continued staffing and facilities provided by the hospital a service has been established that gives improved continuity of care for upward of 150 inpatients with major burn injuries per year.

History

In the early 1990s, ReSurge Africa (then IRPS) was founded with the aim to establish a Service for Reconstructive Surgery for Ghana. The first priority for the work was concentrated in the capital Accra at Korle Bu Teaching Hospital where a specialist Unit was being planned.

As a result of the Project being established in Accra 2 Ghanaian Plastic Surgeons, Dr Pius Agbenorku who was being trained in Poland and Mr Tony Laing who had been trained in the UK were attracted back to Ghana. Dr Agbenorku was assigned to Kumasi by the Ministry of Health. (Kumasi, is the capital of the Ashanti Region of Ghana with a population about 3 million people and is 250 kilometres (4-5 hours travel by road from Accra.)

Resources were scarce and Dr Agbenorku was expected to work single-handed and establish a unit in Komfo Anokye Teaching Hospital (KATH) in Kumasi. In June 1994 Arthur Morris, Consultant Reconstructive and Plastic Surgeon at Dundee and ReSurge volunteer was asked by the founder of ReSurge, Professor Jack Mustarde, to visit KATH. He was to evaluate the problems with a view to helping establish a Unit in KATH in parallel with unit well under way in Accra.

It was obvious that ReSurge funds and Volunteer manpower would not be sufficient to allow a similar stand-alone unit to be developed. As KATH was a more modern type of integrated Hospital with University Medical School and Nursing School, in discussion with the local administration and medical staff, it was decided to try a different approach. There was no dedicated burn unit so a Burns Unit was the main priority to collect and treat patients with severe Burns into one site because until then they were treated in several different and widespread parts of the Hospital, usually in open wards according to bed availability.

A new Burns Unit - the 1994 plan

Progress was slow, it was not easy to enlist help and funding for a provincial centre while so much energy was directed to the new hospital in the capital. However, the Department of Surgery and Hospital Management at Kumasi was very supportive and it was decided to press ahead with the plan as quickly as possible.

Arthur Morris decided to enlist the help of his Rotary Club in Dundee to raise funds for a three-part scheme:

  • Volunteers would attend at KATH on a regular basis to help teach local staff, medical and nursing and perform some surgery.
  • At the same time Nursing staff would be trained in the basics of Plastic and Burn ward and theatre work in Dundee.
  • Funds would be raised to fully equip a small Burn Intensive Care Unit and an operating theatre which the hospital authorities would provide and staff.

Raising the money, 1995

  • £26,000 was raised by Rotary District 1010 (North and East of Scotland) who made the Kumasi Project one of its main recommendations for District donations.
  • £22.000 was granted by Rotary International
  • There were also many contributions made from individuals and organisations throughout Scotland which greatly helped in the overall funding.
  • ReSurge Africa also contributed equipment to a value of £15,000 and multiple other donors of equipment of about £15,000 added up to a grand total of £65,000.
  • In addition there were many donations of hospitality for volunteers and some free air travel courtesy of KLM and sutures from Ethicon Ltd.
  • Dundee Teaching Hospitals generously provided accommodation at basic charges and training at no cost and the project is extremely grateful for all the staff, nursing medical and managerial of the Plastic Surgery Unit at Dundee Royal Infirmary and latterly Ninewells Hospital who gave so freely of their time.

Training

Surgeon Dr Pius Agbenorku attended training conferences in the UK in 1998 and 2001 (British Association of Plastic Surgeons). Dr Agbenorku was initially single-handed in Kumasi and although he had a variable but small number of surgical trainees working for him. He was not joined by Consultant Reconstructive Surgery colleagues until 2004 when Emmanuel Adu was transferred from Accra to Kumasi by the Ministry of Health. In 2005, they were joined by surgeon Joseph Akpaloo. The credit for the provision of the bulk of Plastic Surgical care in KATH is almost entirely due to Dr Agbenorku. See burns publications by Dr Agbenorku; and wider reconstructive surgery publications by Dr Agbenorku et al

In 1997, 1998 and 2000 two nurses from Kumasi were trained for 4 months each in Dundee (six in total). These enthusiastic trained ward nurses made an immediate impact in improving patient care so that there was a core group of experienced staff who were already in place when the BICU was opened on 1st February 2001. There is a great need for further training to keep the staff up-to-date.

The ongoing input of ReSurge Africa volunteers in Kumasi provides courses, one-to-one training.

Training workshops and continued volunteer involvement are essential in future for on the spot training to medical, nursing and ancillary staff to maintain the expertise of the staff at KATH as well as the surrounding areas. For example a Wound Healing Workshop in Kumasi in 2004 attracted over 200 medical and nursing delegates from Ghana with representation from every single region. This gave theoretical and practical training for staff who work at small peripheral clinics and community hospitals.

The Future

A good start has been made but there is a need to provide comprehensive ongoing care for burn and trauma patients as well as the whole range of reconstructive surgery problems. A more integrated new build of facilities is the way ahead which will provide surgery and rehabilitation for inpatients as well as out-patients.

See Thanks to all who have helped Ghanaian burns unit evolve, Courier, 15 February 2011

Main Photo: Kumasi surgeon, Pius Agbenorku, the driving force behind the Kumasi Burn Intensive Care Unit, and theatre staff. Photo © Arthur Morris,

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