Ubpsi Annual Report

UBPSI ANNUAL REPORT

JULY 2016 to JUNE 2017 Table of Contents

1. Foreword

2. Word from the Chairman Board of Directors

3. Word from the Head of Unit

4. Statistics Clinical services

5. The Burns Prevention Programme Report

6. Directors and UBPSI info

7. Financial report

FOREWORD We are happy to present the annual report of the Uganda Burns and Plastic Surgery Institute (UBPSI) for the period from July 2016 to June 2017 The Government of Uganda through the management of Mulago Hospital has continued to provide a ring fenced budget for the exclusive use on the Burns Unit. We must keep in mind the recommendation that there be a deliberate effort to build capacity at the Burns unit in preparation for the transition into an autonomous unit. The dream still remains is to eventually become an autonomous unit with a self-accounting status. Also during this period Burns had moved from Mulago to the Kiruddu campus. The move was in May 2016. The transfer to Kiruddu has had both advantages and disadvantages but on the whole the Burns Unit has continued to serve its core mandate of treating all the Burns and Plastic patients that are presented. One of the challenges is the long distance between Kiruddu and Mulago. This means that the staff take time travelling back and forth. Secondly the fact that some services remained in Mulago. It has been difficult to get these services over to Kiruddu campus. On the other hand Kiruddu being a new hospital compared to the dilapidated structure that Mulago was, the level of patient care has greatly improved coupled with the new and improved equipment that comes with the new structure. Kiruddu has also provided bigger space for the patients. A case in point is that in Kiruddu we are able to run two operating theatres concurrently which means more patients are operated and are able to go home earlier than before. Kiruddu has also offered our own storage space which means that our supplies are kept and managed separately away from the main hospital supplies. In this period the Burns unit has continued to treat and operate on patients. A total of 834 patients were admitted on the Burns unit compared to 820 patients during the previous period. The burns theatre alone operated on 387 cases during this period. Hot liquids continue to be the leading cause of Burns and the highest percentage of Burns patients are still children below the age of 5. During this period we received visitors both highly specialised teams to support and train our staff. We received a visiting team from the Columbia University who partnered with our medical team on the ground for a week. We also received and experienced senior Plastic Surgeon Dr Brian Sommerland from the Great Ormond street Hospital in UK who also came under the auspices of the Smile Train. He carried out surgeries and also trained our local staff. During this time we also received Ms Bettina Ader a psychologist and pain management specialist from the Netherlands. She worked with and supported the nursing team on pain management and donated some equipment for Children in pain and toys. The members of parliament also took off time to visit he hospital and were particularly impressed by the good work in the hospital and the Burns Unit The detailed statistics report is part of this annual report.

The Burns Unit also continued to carry out the Burns prevention programme in communities around Kampala, Makindye and Wakiso with funding from the Stichting (Foundation) Interplast Holland. Dr Rein Zeeman from IPH and Mr Richard Amadro are still heading this programme. During this time the programme changed its strategy moving from direct sessions carried out by the Burns Prevention officer. Instead Burns prevention volunteers were trained and sensitized and these act as Burns prevention ambassadors in their areas of work and aboard. Many of these are teachers and community leaders. These have in turn taken on the mantle of spreading the Burns prevention message. During this time we have also seen the advent of Burns Prevention clubs in schools just like the other clubs which are part of the school programmes. It is hoped that these clubs will strengthen the team of burns prevention volunteers to preach the message of Burns Prevention. With this new direction therefore the number of BPOs was reduced leaving the programme with the core staff. We also hope that in future we shall be able to work with some already existing structures like the Village Health teams to help us carry the Burns prevention message alongside the other programmes. Our future plans also include creating new partnerships with organisations with the same interest like ours. Total Uganda and Nurture Africa are some of the organisations that have shown interest. It is hoped that this programme which has been uploaded by many as a good programme will continue and indeed be funded alongside the clinical side of the Burns Unit. The report for the Burns prevention is included in this report. Also as part of the activities UBPSI in partnership with the Smile Train organisation continued to send out a team headed by Dr Robert Ssentongo to different parts of the country to operate on cleft lip and palate patients and other related cases. Places in which the team has operated include Iganga, Kamuli and Lira in the northern Uganda. Dr Rein Zeeman took up his appointment with the Ministry of Health and he has been working alongside the team of surgeons on the Burns Unit. He has greatly supported the medical team both in the clinical work and training SHOs who go through the Burns Unit from time to time. Although Stichting Interplast Holland continued to support the Burns unit through donation of medical equipment. An anaesthetic machine and two theatre operating lamps were procured through this continued support. We are very grateful for this continued support. Our appreciation Petro city Uganda who have continued to make a monthly contribution to the running of the Burns Unit for which we are very thankful. A vote of thanks goes to the board of directors of Uganda Burns and Plastic Surgery for their invaluable sacrifices in terms and time and insight. You are all very much appreciated.

Stephen Kato Administrator Uganda Burns and Plastic Surgery Institute

Kirudu campus-Mulago Hosptal where the Burns Unit is currently located

Statistics Annual Report 2016-2017 1. Holland Ward

Admissions F M Trans- Discharged Discharged Pat. Number of patients ferred patients against Year Died patients medical July -June advice

2009-2010 400 180 220 4 297 18 16

2010-2011 464 224 240 10 353 29 28

2011-2012 421 176 245 ? 297 19 8

2012-2013 354*** 119 235 ? 209 9 13

2013-2014 450 201 249 ? 371 16 22

2014-2015 436 189 247 5 359 11 26

(12 Not Burn)

2016-2017 332 167 165 321 11

Burns Patients on the Holland ward

Age of the patients: Patient Age <5 years old: 5-15 years old: >15 years old: UN KNOWN

2010 -2011 249 pat. 36 pat. (14%) 164 pat. 15 (3,3%) (53.7%) (35.3%) 2011 -2012 236 pat. (56%) 15 pat. (7.8%) 128 pat. (30.4%) 2012 -2013 198 pat. 198 pat. 118 (33,3%) (55.9%) (55.9%) 2013 -2014 256 Pat 256pat (56 139 (30,9%) (56.9%) .9%) 2014 -20 15 230 pat 230 pat 147 (34,7%) 7 (1,7%) (54.2%) (54.2%) 2016 -2017 177 pat 177 pat 112 (33.7%) (53.3%) (53.3%)

A child Burns patient on the Holland Ward. Nutrition is key in the treatment of Burns

Percentage TBSA – Total Body Surface Area - burned

%TBSA** 0-20% 21-40% 41-60% >60% Unknown Not burns

Year*

2009-2010 251 77 24 1 42 0

2010-2011 244 80 64 2 63 11

2011-2012 271 85 13 1 51 0

2012-2013*** 205 95 4 23 26 1

2013-2014 307 87 9 3 44

2014-2015 298 76 12 4 36 12

2016-2017 199 71 16 0 10 36

Causes of Burns

Cause Hot Liquids Flame Acid Paraffin/ Electr. Other Unknown Petrol/ Adm. patients Year* Gas**

2009 -2010 273 71 11 6 22 29 F:141/M:132 F:40/M:31 F:5/M:6 F:0/M:6 F:12/M:10

2010 -2011 262 96 23 14 11 28 F:144/M:118 F:45/M:51 F:8/M:15 F:4/M:10

2011 -2012 239 17 15 5 145 F:106/M:133 F:6/M:11 F:7/M:8 F:4/M:1 F:64/M:81

2012 -2013 177 33 9 7 6 122 F:52/M:125 F:18/M:15 F:6/M:3 F:3/M:4 F:0/M:6 F:40/M:82

2013 -2014 277 75 17 16 11 54 F:123/M:154 F:38/M:37 F:8/M:9 F:6/M:10 F:1/M:10 F:27/M:27

2014 -2015 260 77 12 8 14 12 53 F:120/M:140 F:31/M:46 F:4/M:8 F:6/M:2 F:2/M:12 F:23/M:30

2016 -2017 240 47 3 1 5 36

2.Burns ICU Admissions F M Trans- Discharged Discharged Pat. of patients ferred patients against Died Number patients medical Year advice July -June 2009-2010 105 48 57 29 20 2 43

2010-2011 103 35 68 23 14 4 36

2011-2012 120 54 66 29 53 2 36

2012-2013 126*** 51 75 36 25 2 39

2013-2014 105 42 63 33 13 0 59

2014-2015 114 62 52 36 12 1 59

2016-2017 174 74 100 45 43 86

Age of the Patients on the Burns ICU

Patient Age <5 years old: 5-15 years old: >15 years old: UNKNOWN

2010 -2011 56 pat. (54%) 6 pat. (6%) 41 pat. (40%)

2011 -2012 64 pat. (53%) 17 pat. (14%) 39 pat. (33%)

2012 -2013 69 pat. (55%) 15 pat. (12%) 42 pat.(31%)

2013 -2014 46 Pat (44%) 19 pat (18%) 37 pat (35%) 3 pat. (3%)

2014 -2015 57 pat (50%) 10 pat (8.8%) 47 pat (41.2%)

2016 -2017 88 pat (50.6%) 13 pat (7.5%) 73 pat (42%)

A child patient in the Burns ICU

Percentage TBSA – Total Body Surface Area - burned

%TBSA** 0-10% 11-20% 21-40% 41-60% >60% Unknown

Year*

2011-2012 0 15 46 18 20 21

2012-2013*** 0 24 64 10 16 12

2013-2014 8 10 42 25 11 9

2014-2015 8 19 46 22 16 3

2016-2017 12 25 70 35 17 15

Cause Hot Liquids Flame Acid Paraffin/ Electricity Others Unknown

Year* Petrol/Gas

2010-2011 16 19 4 2 62

F:6 /M:10 F:7/ M:12 M:4 M:2

2011-2012 42 4 6 2

F:24/M:18 F:3/M:1 F:3/M:3 M:2

2012-2013 53 2 2 6* 4 57

F:22/M:31 F:2/M:0 F:2/M:1 F:0/M:6 F:0/M:4 F:25/M:32

2013-2014 34 43 5 9 9 5

F:20/M:32 F:12/M:31 F:3/M:2 F:2/M:7 F:0/M:9 F:5/M:0

2014-2015 51 43 6 6 3 1 4

F:28/M:23 F:25/M:18 F:3/M:3 F:3/M:3 F:1/M:2 F:1 F:2/F:2

2016-2017 80 66 3 0 4 11

3. Plastic and Reconstructive Ward

Admissions F M Trans- Discharged Discharged Pat. Number of patients ferred patients against Year Died patients medical July -June advice

2009-2010 218 112 106 2 144 0 3

2010-2011* 180 32 88 1 120? 2? ?

2011-2012 387 178 209 - 355 3 0

2012-2013 347** 171 176 ? 250 1 0

2013-2014 259 122 137 4 172 2 ?

2014-2015 270 118 152 1 269 0 0

2016-2017 328 128 200 258 0 11

Diagnosis

Year* 2009 - 2010 - 2011 - 2012 - 2013 - 2014 - 2016 - 2010 2011 2012 2015 2017 Diagnosis 2013 2014

Post Burn Contractures 49 38 52 48 42 41 65

Burns 27 35 14 ** 54*** 40 5 123

Cleft lip and/or palate 35 25 83 93 60 63 6

Ulcers 11 7 26 8 7 15 35

Keloid 6 15 28 11 6 6 5

Human Bite 15 No data

Degloving 37 No data

Others 90 58 184 131 91 72 91

Unknown 2 13 16 3

Patients on the Plastic and Reconstructive ward

Age of the Patients on Plastic and Reconstructive Ward

Patient Age <5 years old: 5-15 years old: >15 years old: UNKNOWN

2012 -2013 27 9 18

2013 -2014 9 5 26

2014 -2015 2 3

4. Burns Theatre

Total of SSG Changing Cleft Debridement PBC Others Days of Number Year operated dressing lip or - rec. operation patients palate surgery July -June 2009-2010 312 118 64 25 103 136

2010-2011 257 167 22 19 16 14 19 122

2011-2012 470 126 122 79 19 5 124 158

2012-2013 465 158 38 95 19 3 152 164

2013-2014 337 154 24 80 17 8 54 126

2014-2015 447 180 0 93 52 28 94 134

2016-2017 387 180 5 13 26 35 128 158

A Patient in the Burns Theatre being prepared for an operation

Average number of operations per day in July-June 2016-2017: 3.3

Visiting Dr Brian Sommerland carrying out an operation and training

Visiting Canadian team from the Columbia University

The Head of Burns Unit Dr Robert Ssentongo and medical team leading the visiting members of Parliament around the Burns Unit

BURNS PREVENTION ANNUAL REPORT JULY 2016 TO JUNE 2017

1. Introduction

The Burns Prevention Programme has continuously progressed and is now refocusing from project to programme. For five years since 2012, the Burns Prevention Project’s activities were solely managed by only the trained Burns Prevention Officers (BPOs). The Burns Prevention Management is now training relevant community members to help fellow community members out of community challenges.

Recent developments In March this year the management designed a programme to train primary teachers from selected schools in Kampala division were most burns patients come from according to patients’ data analysis in 2016. These divisions are namely: Makindye division and three schools primary schools were purposively selected; Kibuye Church of Uganda Primary School, Mirembe Kampala Capital City Authority (KCCA) Primary School and Marvin Primary School. Another division is Kawempe division and the schools selected were; St. Martin Primary School in Mulago, St. Paul’s Primary School, Kawempe KCCA Primary School, Kawempe Muslim Primary School, Kazo Junior Primary School, Kazo Mixed KCCA Primary School, Kazo Church of Uganda Primary School, Kazo Central Primary School, Hormisdallen Primary School and Nabweru Primary School a new entrant. Other three schools have been having challenges but are yet to take an active role. These trained teachers were passed out as Burns Prevention Volunteers and done valuable activities to sensitize schools, churches and communities. This is registering tremendous success as shown in the table on the next page:

Training of Burns Prevention Volunteers at Kolping Hotel Bwaise BURNS PREVENTION ACTIVITY STATISTICS 2016/2017 (JULY 2016 TO JUNE2017)

SESSIONS NUMBER DIVISION School 87 Kawempe: 39 sessions by Makindye: 27 Joseph & Charles Wakiso district: 21 School 122 Kawempe: 98 sessions by sessions Volunteers Makindye: 24 & BPP Club sessions members Community 192 Kawempe: 83, sessions by Wakiso district: Joseph & 32, Makindye: 26, Charles Nakawa: 51 Community 6 Kawempe 2, sessions by Makindye: 4 BPP Volunteers & BPP Clubs

NANSANA BPP OFFICE ACTIVITIES 2016/2017 ACTIVITIES NUMBERS Office visits 51 Sessions 123 done during visits Homes 123 sensitized People Total: 492 sensitized Female: 433 Males: 59 NOTICEABLE CHANGES AS A RESULT OF BPP ACTIVITIES SNo. Previous New behaviour practice 1. Cooking in open Some places where parents/caretakers children play have shifted to from; 35 Unsafe corners where cooking places children do not where noticed play from (cooking) 2. From our casual Further conversations; conversations 57 people said among 16 people they were using after sensitizations tadooba/candles indicate change of when power behaviour; was off. parents/caretakers either blow off candles or do not leave them with children

3. The Burns Prevention Motto; “Together we can prevent burns”

Community challenges call for community involvement to solve community challenges. That is what burns prevention programme majorly advocates for. This practice is yielding results. Community members are made to appreciate burns challenge and the possibilities to overcome this challenge, the response has generally been positive. Other community based organisations like the Slum Dwellers’ Federation Kawempe division branch has appreciated the approach and is willing to join hands with the Burns Prevention Programme to solve the burn problem majorly among children five years and below. Also the Village Health Workers in Rubaga division are ready to join the struggle, our part is to train them on how to go about the sensitization on burn prevention sensitization.

A Burns prevention School club being addressed by Dr Rein Zeeman looking on is Charles and Joseph from the BPP Programme. 4. Conclusion

Burn survivors in poor countries are vulnerable to stigma, exclusion and a life of poverty. They are frequently from poor communities and do not have the financial means to pay for surgery and other treatments needed to achieve functional and aesthetic improvements after the initial healing and grafting. They fall behind in their schooling or lose their jobs. Although disfigurement is a common sight in many poor countries, it is nevertheless a cause of stigma and avoidance, sometimes perpetuated by cultural beliefs. Prevention is the key; truly the best way to treat a burn is to prevent it from happening in the first place. Effective prevention programmes will face similar barriers to implementation as those efforts to improve acute care but prevention is much more cost-effective and will clearly reach greater numbers of people. Prepared by, Joseph Ssentongo, Administrator Burns Prevention Programme.

Burns Prevention Programme Team

Governed by the Board of Directors UBPSI

Stewardship: Dr Rein Zeeman Interplast Holland

Managers: Mr. Richard Amadro

Administrators: Mr. Joseph Ssentongo

Coordinator: Mr. Charles Kyakulaga

Finance: Stephen Kato

List of Directors and UBPSI info

Board of Directors

Hon Tim Lwanga Mutekanga * Chairman BoD

Ms Joy Batusa Nkambwe* Treasurer BoD

Ms Joy Turyamwijuka Asiimwe* Secretary BoD

Dr Rein Zeeman** Chairman ‘Stichting Interplast Holland

Dr Byarugaba Baterana* Executive Director Mulago Hospital Complex

Dr Joseph Byamugisha* Legal Advisor

Prof Nelson Ssewankambo Dean Makerere College of Health Science

Mr Lawrence Lugwana Kaggwa Director

Dr Robert Ssentongo Head of Unit and Medical Advisor

*Ugandan ** Dutch

Secretary

Ms Joy Turyamwijuka Asiimwe

P.O. Box 586,

Kampala, Uganda

Auditors

Grant Thornton

P.O. Box 7158

Kampala, Uganda

Bankers Lawyers

Stanbic Bank (U) Limited, J.B.Byamugisha Advocates

Village Mall, Bugolobi Branch 5th Floor, EADB Building

P.O.Box 7133, 4 Nile Avenue

Kampala, Uganda P.O.Box 9400

Kampala, Uganda