‘Helping burns climb up the international agenda’ – Lancet profile of Tom Potokar (June 2016)
www.thelancet.com Vol 387 June 25, 2016 – Written by Tony Kirby
Tom Potokar was inspired to be a doctor after watching a Médecins Sans Frontières (MSF) documentary on Vietnamese boat people in the 1970s. Today, he is a consultant in burn injuries at Morriston Hospital in Swansea, Wales, and Director of Interburns (International Network for Training, Education and Research in Burns), a non-profit agency aiming to improve burns care and prevention in low-income countries, where most global burn injuries occur. According to Richard Nnabuko, President of the Pan African Burn Society, Enugu, Nigeria, “Tom has a passion for the burn victims of the low and middle-income countries of Africa and southeast Asia and for training dedicated men and women from these areas.”
That passion is informed by what he has seen in many different countries. Potokar studied medicine at the University of Birmingham and then took a house officer post in the now demolished Birmingham Accident Hospital, before going on to the Liverpool School of Hygiene & Tropical Medicine, where he gained a Diploma In Tropical Medicine and Hygiene. He was then recruited by MSF and subsequently posted to Cambodia, itself rumbling through the remains of a civil war. He came back to the UK for a diploma in anaesthetics but then returned to MSF, this time doing medical coordination in Bosnia and Herzegovina, former Yugoslavia, during the height of the war there. “It was a profound experience”, Potokar says. “We managed to access many hospitals and villages, places people thought we might never reach, getting vital supplies to them.”
After this role, and a subsequent medical coordination posting with MSF in Tajikistan, Potokar wanted to gain more practical experience in trauma care and secured work in one of the world’s busiest trauma centres, what is now the Chris Hani Baragwanath Hospital in Soweto, South Africa. “There were often 100 emergency patients a day, around 90% with stab or gunshot wounds,” he recalls. It was in Soweto that he became interested in burn-related plastic surgery, and so began a plastic surgery placement on returning to the UK. “Most specialists don’t like burns, preferring the more glamorous side of plastic surgery”, explains Potokar, “But in burn care you treat all ages and everything from very minor burns to catastrophic injuries from acute care through to reconstructive surgery.” He continued his training in Bristol, Cambridge, Liverpool, and his current base, Swansea, where he became a consultant in 2004. Soon after, he set up Interburns with a resolve to develop and improve burn care and prevention in poorer countries.
Inspired by Shobha Chamania, a truly dedicated burns surgeon in India, an initial link between Potokar’s own hospital service and her unit in Indore—now an Interburns Training Centre—has now grown into a global organisation with programmes in India, Nepal, Bangladesh, Ghana, Ethiopia, and the West Bank, among other locations. At a meeting in Nepal in 2012, Interburns developed consensus international standards with Potokar leading the development of a comprehensive integrated approach to quality improvement in burn care and prevention. This approach includes contextualised training materials, comprehensive assessment tools, training centres, and basic, essential, and advanced burn care programmes. “I feel it is high time for a shift in the approach to surgical development programmes, which in many cases fail to address the real needs”, he says. “Improving burns care requires a systems approach based on a public health model rather than a medical model. Key to the whole process of quality improvement in these difficult environments is a participatory approach where the mechanisms for overcoming barriers to effective care are realised by the staff themselves rather than imposed from outside.”
Among the priorities of Interburns are to raise awareness of burn injuries and prevention, particularly in the poorer regions of the world. “Our aim is to recognise and then improve the capacity and skills of burns services of all levels”, explains Potokar. “While major burn injuries need to be addressed, better quality care of the far more frequent moderate and survivable burns would have a huge impact on population health.” He adds that WHO has a part to play in this area, and is making progress through initiatives such as the Global Alliance for Care of the Injured to which he contributes.
Alongside his work for Interburns, Potokar has a busy clinical role in Swansea. All of this does not leave much free time, but Potokar has two teenage boys with his French wife Dominique, whom he met in Rwanda whilst working for MSF. In 2014, the family undertook a motorbike ride from Kathmandu to Dhaka which raised about £40,000 for Interburns. Many years of travel, particularly to the Indian subcontinent, have drawn him to be increasingly guided by Buddhist philosophy.
And what’s on his agenda for the future? “My main ambition now”, Potokar says, “is to create the first Centre for Global Burn Injury Policy and Research here in Swansea, focusing particularly on implementation science, but also health policy and systems research, health economics and prevention”. He adds “we need to put into action what we know works. However, securing funding is not easy, and there is a desperate need for philanthropists to target their funds to this neglected area.”