22 February 2018
Project: Accra Burn Centre Project (ABC Project)
Partners: Greater Glasgow and Clyde NHS Trust | Reconstructive Burns and Plastic Surgery Centre, Korle-Bu Hospital, Accra
When: September 2015 – April 2017
Burns are a global public health problem, accounting for an estimated 180, 000 deaths annually. The majority of these occur in low- and middle-income countries and almost two thirds occur in the WHO African and South-East Asia regions. Non-fatal burns are a leading cause of morbidity, including prolonged hospitalization, disfigurement and disability, often with resulting stigma and rejection.
In 1997, the Reconstructive Plastic Surgery and Burns Centre at Korle-Bu Hospital in Accra, Ghana was opened. It was the first Burns/Plastics Centre in Ghana. A Scottish surgeon from Canniesburn Unit, Glasgow Royal infirmary aided with the creation of the centre and initially, the work of the Centre was supported by visiting doctors from Glasgow and elsewhere in UK, but progressively, Ghanaian staff have been trained to carry out treatment. There are now five specialist burn surgeons in the Centre, and patient treatment is carried out entirely by Ghanaian staff.
The existing burns unit is composed of three tiny rooms which house around 12 patients each. Patients receive extremely proficient and skilled surgical care. However, infection risk is very high and patient privacy is non-existent due to close proximity of patients.
The risk of infection is furthered by the severe shortage of trained burns nurses. It is not unusual for one nurse to be looking after 12 severely-injured patients. As a consequence of short-staffing, patients develop complications due to inadequate monitoring, sporadic delivery of treatments and infrequent dressing changes.
The project aimed to improve care for burns patients in Ghana through the training of nurses and the development of patient safety guidelines and procedures.
Activities and the role of nurses
The programme implemented a radical programme of nurse training which aimed at establishing a cadre of professional nurses who remain within Burns care. Through targeted nurse training including nurses seconded to South Africa for four-months of specialist training, the establishment of a Diploma in Burns Nursing at Korle-Bu University and the completion of Ghanaian nurses undertaking a Graduate Certificate in Burns and Plastic Surgery at the University of Glasgow, the project looked to disseminate learning through a Training of Trainers model as returned nurses passed on their skills and knowledge to their fellow colleagues.
The partnership also developed and disseminated guidelines on the; Implementation of Patient safety procedures. These established protocols and clinical governance procedures for all aspects of multidisciplinary burn care, and are being used in the Accra Unit and disseminated to other units and local hospitals/clinics treating burns in Ghana.
Who has benefitted and what has been learned
Although the training of ten specialist burns nurses was initially planned, a further 198 nurses have received training through the dissemination of colleagues learning.
Over the course of the programme, the nurses’ training and expertise seemed to have improved significantly. As Agatha Ashia, Lead Nurse, Burns Unit, Komfo Anokye Teaching Hospital, Kumasi notes, following the Burns Diploma Course explains;
“The course has brought positive changes in the skill of the nurses who participated. Assessment of burn patients using the ABCDEF of primary survey is effectively done.With regard to wound dressing, nurses have knowledge about the rationale for the use of the various wound dressing agents and are able to choose the appropriate agent based on the characteristics of the wound. The place for early excision and grafting in burns was made clear during the course. Nurses are very keen and advocating for excision and skin grafting for patients. Overall the training has been helpful to the burns unit in Kumasi because of the positive changes noted and improvement of the standard of care rendered to the burns patients.”
The training also led to further improvements in the use and implementation of pain management, rehabilitation and the nutritional status of burns patients has been improved. Patients and relatives are now educated on the importance of nutrition in burns and advised on the benefits of a healthy diet for recovery.
There were also notable benefits and learnings for the UK volunteers who helped to train during the project. Pauline Komesli a Staff Nurse in the Burns Unit at Glasgow Royal Infirmary noted:
‘I thoroughly enjoyed my visit to Ghana and was very grateful of this opportunity. Not only did it give me a great insight into the course which I found very interesting and insightful, I also enjoyed the practical side with the change to participate in dressing changes and watching plastic surgery. I also found the nurses and medical staff from Ghana very welcoming and friendly individuals. I was nervous prior to going but instantly felt at ease. Going home this has made me more appreciative of the resources and finances we have in the Burns Unit back home. I am more culturally aware of the different thoughts and beliefs. By participating in the delivery in lecture of the national early warning score for deteriorating patient and the workshop of finger dressings in Accra this has gave me more confidence with public speaking and teaching which will benefit me though out my nursing practice. Also sharing my experience with colleagues and students has been a benefit to our own unit. I loved this experience and will always remember it. I was grateful of having this opportunity.’