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Haiti: Treating severe burns over the years
For the past five years, Dr. Erneau Mondesir has worked as the medical referent at MSF's Hôpital des Grands Brûlés de Drouillard, in Port-au-Prince, the only specialized center in Haiti to focus on the treatment of severe burns. Over the past year it has been affected by the COVID-19 pandemic and then by violent clashes in the streets, but is now continuing in a different space at MSF's Tabarre hospital. Dr. Mondesir describes the progress and the challenges.
What did this project look like five years ago?
When I started in 2016, I didn't know anything about burns. This is a pathology that very few people know how to deal with in Haiti, especially severe cases.
Five years ago, it was an embryonic project, which had to be nurtured.
A particular event made us known in the country, in March 2016, when a tanker truck exploded in the Central Plateau area.
The health facilities in the region sought to refer these severely burned patients, and they came across us.
"It is still a real achievement, and a great pride, to be able to offer this type of service in Haiti"
MSF was already well known in Haiti in emergencies, traumatology or maternal care, but not for burns. Then, we treated 20 patients at once, 16 of whom had very serious burns.
How has the management of burns evolved?
We received a lot of serious cases, so we naturally sought to improve the treatment of these patients, and to implement new techniques, such as the use of so-called artificial skin, from 2018.
This is a synthetic tissue, placed by a surgeon, which will facilitate the regeneration of the skin in very severely burned areas, and which makes it possible to consider skin grafts.
This is a technique that we have already used for nearly 20 patients, and which also works for those who develop post-burn complications.
For these cases, we call on a plastic surgeon, who comes specifically twice a year to treat these after-effects.
But it's also important to mention the expander—a technique we've used for two patients so far. The first was a 27-year-old young man who suffered a severe burn to his scalp.
It was going to be very difficult to use artificial skin and place a graft in that area, and it could also cause a permanent problem at the site of the burn. So we decided to use the expander for the first time.
"People with severe burns are very complicated patients, and for some, we know right away that there is no hope"
This is a delicate procedure, you have to prepare the area well to avoid any infection that could be fatal, then reopen the healthy unburned areas to place this expander, on which to stretch the scalp and cover the burned area.
It was a great moment for me! We wanted it to work so badly, we were so happy with the end result! It was a feat for everyone: surgeon, doctor, nurse, those involved in hospital hygiene ... to see that the patient was doing well, and that he did not develop an infection!
It is still a real achievement, and a great pride, to be able to offer this type of service in Haiti.
Are there only successes?
Unfortunately no! People with severe burns are very complicated patients, and for some, we know right away that there is no hope.
For those, we offer palliative care. It may sound normal, but culturally it is still a very taboo issue in Haiti.
Here, people prefer never to stop therapy rather than begin palliative care. … So we took the time to prepare the medical teams, to train them and to explain to them the medical interest of setting up palliative care.
It is about allowing patients who know will not live to spend their remaining time with dignity, and especially so that they suffer less.
How have the last few months been difficult?
2020 was a difficult year ... When the COVID-19 pandemic was declared in March, it was inconceivable for MSF not to intervene in this emergency.
In April, we stopped admitting burns to Drouillard hospital to turn it into a COVID unit.
All activities related to burns were transferred to Tabarre, another MSF hospital that usually takes care of trauma. It was important for us to still maintain the treatment of conditions other than COVID-19.
Then, the second difficult moment was in February 2021, after we had resumed burn care at Drouillard.
"Moving a hospital in an emergency requires a lot of energy, and a lot of careful thinking about patients' needs, especially for burn care"
The area immediately around the hospital became a zone of violent clashes.
Quickly, we realized that the security situation was too tense. And there we moved the whole hospital in 24 hours.
We went back to Tabarre, the other MSF hospital.
Moving a hospital in an emergency requires a lot of energy, and a lot of careful thinking about patients' needs, especially for burn care.
MSF has worked in Haiti for 30 years. Today, MSF provides life-saving and specialized emergency care to people with urgent medical needs due to violence, burns, traffic accidents or sexual assault. Since 2016, MSF's burns hospital has admitted more than 3,600 patients.