On site, in the clinic
In the clinic, 80 burns and 51 other wounds were treated from January 1st 2015 onward (as at Dec 14th 2015). Most of the cases are self- referred or referred by a former patient. Others are treated by request of Govt hospital personnel via Helping Hands Ministry personnel (JGMH) and LDC Foundation, Botolan, of these some are treated in hospital or in the clinic or both.
Other wounds are predominantly persons with diabetic foot complications referred by their Doctor; ‘Road rash’ from motor vehicle accidents; ‘Pigsa’ (carbuncle/boil) and infected insect bites the latter two are self – referral or BHW referral.
Dressing changes amounted to over 300 in our ‘way too small’ but efficient and caring clinic space. Dressings for burns and wounds comply with International standards for burns care which include the use of anti-microbial, autolytic debridement speciality burns dressings with moisture to heal and infrequent dressing changes. Dressings are changed every 3 – 5 days for optimum benefit and healing. Contracture prevention and scar management begin on the first day with custom made splinting – often from cardboard boxes and maternity pads! Necessity is the mother of invention! Anti-biotics are very rarely given since the dressings are antimicrobial. Pain relief for the dressing changes and in between are of paramount importance and we are very grateful for the advice and experience from Dr Lindsay McBride Senior Anaesthetist with the Interplast team for his massive input to our Pain Policy document.
Thanks to a successful funding application with Helping Children Smile Inc, Australia, we now have 2 hospital beds, a mobile shadowless operating room lamp (for dressings) and an 18ltr table top autoclave.
41 clinic visits were made to the cleft clinic for pre and post op care.
In April, 13 children were screened for cleft lip and palate surgery, with 7 being admitted for surgery with the Operation Smile/KDF cleft Mission. The surgery took place on board the USS Mercy Hospital Ship which was docked in Subic Bay Freeport Zone in August.
20 Children attended the Zambales Speech Center for Children with Clefts for speech therapy on a weekly or twice weekly basis throughout the year.
ANZ Interplast Mission 2015, Benguet General Hospital, Baguio
During 3rd – 14th November, 10 cases were screened at the annual ANZ Interplast Burns and Plastic surgery mission, one 8 year old boy for cleft lip revision and 9 burns cases; for surgery which included debridement prior to skin grafting, hand reconstruction, major contracture release with skin grafting, and stump revision. The procedures totalled 35 on the 10 patients! This mission is the ONLY one that helps patients with burns related contractures. We are grateful to Lotus Hilfsprogramme e.V Germany for the 1000euros which is a great help toward taking our patients for surgery at this mission in Benguet Province. The cost averages at around 80,000 pesos, thus approximately 8000pesos per patient. This is very economical as surgical costs, if sponsored privately, could easily amount to over 40,000.00 pesos per patient. One 5 year old boy and his mother were ‘love-knapped’ from Benguet General hospital following major contracture surgery with the Interplast team in November. The child, from Itogan, Benguet Province was severely traumatised after sustaining a major burn after falling into a huge pan of boiling coffee at the wake of his grandfather. His subsequent treatment immediately afterward, in a big hospital in Benguet Province was very outdated and very stressful for him and his parents. After spending 10days at the clinic in Zambales, the little boy has been shown how he and his mum can take care of his skin grafts with love and care and how wearing his splints every night and doing his play physio every day can be a happy not sad time for all.
350 children were de-wormed throughout the year both in the clinic and at 2 other regular venues.
Overseas help for Filipino children with burns
One teenage girl continues her major burns reconstructive surgery in Australia, with 6 major procedures at the Concorde Burns Unit, Sydney with A/Professor Peter Haertsche and Prof.Peter Maitz. The teenager was seen by the ANZ Interplast team in Nov 2014 and flew to Australia in the January of 2015. The Children First Foundation and Interplast are co-sponsors of the surgery and perioperative care. The teenager had some the worst contracture after burns that Val had seen during her 30 years as a burns nurse; with the teens chin, chest and shoulders being ‘fused’ together at the sternum. She could not move her shoulders or arms as they were ‘stuck’ by the contractures. Eating was very difficult as her bottom teeth were situated way down on her chest and she could not look up due her skin being pulled down to her chest. Now this bright young lady can look up at the sky, open her arms wide and eats very well! It seems that she has found a gift for playing the piano whilst staying at the Children First Foundation Accommodation in Kilmore, Victoria. In addition, she also helps to encourage the other children to push on with their physio, since hers was SO intense but very much worth it!
Awaiting news of surgery in Australia with ROMAC (Rotary Overseas Medical Aid for Children) together with Professor Roy Kimble, Director of the Pediatric Burns Unit in Brisbane; is 10 year old Kyla Joy, who suffered an horrendous burn from kerosene which spilled onto her, when she was just 8yrs old. Outdated and inadequate treatment here in PI has left her with very severe contractures of the neck and arm, and major scarring on her chest and leg.
Volunteers in 2015:
RN’s Toni & Diana (Germany) Students: Josh, Anushka (Melbourne), RN’s Lynne & Colleen (W.A), RN Judy (Qld), Jeff (NSW), Dr Rachael Pickering (UK) + 4th year med student observers, Physical therapist Kitty (Canadian), Pharamacist Ellen (US Citizen) and Dr Myles Lear (Australia) Dental & Orthodontic assessments. Kat an O.T from Brisbane, keeps in regular contact by email to help with our cases and attended a 2 day OT Burns Splinting workshop at the Stuart Pegg Adult Burns Centre in Brisbane on our behalf. The Swinfen Charitable Trust (UK) Telemedicine Link provides lifesaving consultations with experienced Consultants throughout the year.
Over 400 people attended the BPTE sessions (Burns Prevention, Treatment and Education) conducted at various locations in Zambales including Barangy Halls and Schools. Val and Evelyn continue their presentations wherever and whenever possible in the hope that burns can be prevented and that if all else fails, correct first aid which can lessen the depth of a burn.
Burns Management seminars were held in various hospitals and private sector clinics based around Luzon – Isaac Catalina Medical Center, Balanga, Bataan; Maria Aurora Memorial Hospital, Baler, Aurora Province, and Jose B. Lingad Regional Dist Hospital San Fernando Pampanga Aurora Province. Closer to home, full day training session was held for all staff of the Children’s Recovery Unit, Cubi, SBMA, on ‘Care following a burn injury’. The ‘CRU’ as it is affectionately known, currently has 4 children with burns in their care and diligently bring them for their dressing changes and check-ups to the clinic, over one hour drive away.
Val also was a guest speaker at several locations in Australia notably: Sydney Concorde Burns Unit, St Vincent’s’ Hospital Melbourne, Kadasig Aid and Development Fundraising Dinner, St Francis the Saviour Social Justice Group, Montmorency RSL, , St. Marks Anglican Church Qld, St John Knights Templar, Qld, St Albans Anglican Church, Qld and the John Flynn Hospital Qld.
Three hospitals in Singapore, including the Intensive Care Burns Unit in Singapore General Hospital were the benefactors of training sessions entitled ‘Burns Management with Medical Grade Honey’ when Val was invited there in September.
Funding and supplies
Our truly grateful thanks to all of you, family and friends around the world, who have helped to raise funds/send supplies to keep us going in serving the poor and less fortunate with burns and cleft lip and palate in Zambales. We can’t do this without you!!
Through the primary help of Rotary Australia World Community Service, the ‘build the burns unit’ fund is growing, but still falls well short of target. The falling value of the $AUD and other currencies; and world disasters affect our funding. So many events and individuals need help. We understand that resources are stretched to the limit.
That said, we look forward to your continuing support to help those with burns and cleft lip and palate in Zambales in 2016. We’re counting on you!
Val Smith-Orr RN
ENB 264 Burns and Plastic Surgery
Clinical Nurse Specialist