First ever ABC Surgery programme trains 35 surgeons in Kirtipur, Nepal (November 2018)

November 30, 2018
Richard Bendell

Burn surgery is a critical aspect of effective burn care and in many countries globally, patients with burn injuries are operated on by surgeons with little or no specific training in burns surgery. To address this area of need, Interburns began development of an Advanced Burn Care module on Surgery in early 2018. This course was completed and the first training held at the Interburns Training Centre at Kirtipur Hospital, Nepal from the 19th-23rd November 2018. This international programme included general, plastic, and paediatric surgeons from Nepal, Bangladesh, Afghanistan, Ethiopia, Malawi, India, Nigeria, Uganda and the Occupied Palestinian Territories.

‘ABC Surgery’ completes the core trio of modules supporting the core members of the burn care team (surgeons, nurses and therapists). The module covers all key aspects of surgical care from the acute and emergency stages in the first 24 hours through to reconstructive surgery months or even a year post-injury. The majority of the faculty for the initial delivery of ABC Surgery also participated in a development workshop to create the ABC Module in May 2018. The faculty has a wealth of experience in delivering burn care and international training in a Low- and Middle-Income Country context. A total of 16 faculty (13 clinical and 3 support staff) were involved in the initial programme, to ensure the programme was as interactive as possible through a high faculty to participant ratio and build a large faculty of instructors to deliver future ABC Surgery programmes. Faculty were from 10 countries in Asia, Africa and the Middle East including Afghanistan, Bangladesh, Ethiopia, Ghana, India, Nepal, Nigeria, South Africa, the UK, and the West Bank.

The five day training programme was highly interactive with a focus on group discussions, roleplay, simulation scenarios and team work. Topics covered included the importance of surgery in burn care, surgical techniques such as escharotomy and fasciotomy, debridement and skin grafting, peri-operative planning and care, analgesia and anaesthesia, reconstructive surgery, and critical care. Participants learned how to treat extensive burns, burns in special areas (such as the face, hands and over joints), inhalational injuries, electrical burns, how to manage scars and deal with sepsis. A simulation scenario also covered mass casualty situations, a relatively common occurrence in many resource-poor countries, and how to effectively manage, triage and prioritise patients in these circumstances.

As well as covering a wealth of clinical topics, the programme addressed key questions of service delivery and leadership, as many of the participants are also the directors or chiefs of their burn units. This included aspects such as research and audit, quality improvement, patient safety, measuring mortality and morbidity, leadership and multi-disciplinary team work. The participants also discussed how to approach the issue of palliative care when a patient has non-survivable burn injuries, a difficult topic to address in many countries.

Like all Interburns programmes, the creation and delivery of ABC Surgery has only been possible due to the efforts of dozens of different people, including all our volunteer faculty who travelled from across the world to lead the training programme. The programme was developed primarily by Dr Amy Hughes, based on the framework created in the international consensus meeting held in Swansea, Wales in May 2018, with additional input from Tom Potokar and Sian Falder. The programme in Nepal was organised in partnership with Nepal Burn Society and Kirtipur Hospital, with all the local logistics coordinated by our Nepal programme manager, Anil Dhital.  Interburns would like to thank every member of our large and diverse team who came together to make this programme a success.

Interburns will be developing further ABC Modules on Reconstructive Surgery and Critical Care in the near future, as well as running further iterations of our Nursing, Rehabilitation and Surgery modules. The next ABC Nursing programme will be held in Addis Ababa, Ethiopia, in February 2019, with the second ABC Surgery also in Addis in the first quarter of 2020.