The main programme in Bangladesh is to train Bangladeshi Plastic Surgeons in the reconstruction of hand function after electrical burns and improve the long-term outcome of burns injuries, especially with regards to the reconstruction of electrical burns in the upper limb.
BFIRST was originally invited by Assistant Professor Tanveer Ahmed (on the right), who visited the Royal Free as a BFIRST Fellow and we were warmly received by Professor Kalam (Chief of the Department, on the left) and Dr Sen (in the middle), the previous (though very much involved) Project Director of the Institute of Plastic Surgery in 2015.
The project started when the plastic surgery unit was still situated at the Dhaka Medical College Hospital in Dhaka, which is a 5000 bedded hospital. Here is a picture of the daily admission from their Accident and Emergency Department and the 800 m corridor within the hospital and the plastic surgery entrance.
The plastic surgery unit was housed in a separate building with 100 beds, but regularly housed 500+ patients, most of whom had suffered electrical burns.
365.000 people suffer burns every year in Bangladesh. Half of these are children and 20% of these have a permanent disability as a direct result of the burn.
A third of burns as caused by electricity, which is easy to understand if you just look on the streets of Dhaka.
Here we are in 2015 (from left to right) Barbara Jemec, Consultant Hand Surgeon, Founder of BFIRST, London, UK, Claudia Malik, Consultant Plastic Surgeon, Ottawa, Canada and Andy Williams, Plastic and Burns Surgeon, London, UK and of course Dr Ahmed.
Why hands and burns?
Because of the many people who suffer burns injuries in Bangladesh every year and the many injuries which stem from electrical burns, nerves and tendons in the hand are literally burnt away, which if of course makes the hands useless.
In a country where the majority of people work in agriculture and service occupations, the use of your hands is paramount. Well in fact it is paramount to anyone, no matter what you do, but here a useful hand can be the difference between having to beg for food or holding down a job, so you can feed yourself.
You can reconstruct the function of these hands with tendon transfers - so using other tendons which are still intact, local flaps (coverage from the surrounding skin and muscles) and nerve grafts (from less important nerves in for instance the foot and leg), so they can become useful again.
The local surgeons are already very knowledgable and work to a high standard team and they are extremely hospitable.
We always feel welcome and appreciated.
We try and visit other hospitals, make connections and coordinate the training given by us and other NGOs.
NITOR Orthopaedic Surgeons
In 2016 we brought a Dermatome, a specialised knife which is used to take skin grafts for the treatment of burns. This knife can take very thin slivers of skin, so the areas heal better and scar better. The blades are meant for single use, and they are expensive at £10 per blade, but these blades will be reused, as we cannot afford to furnish all the blades.
The other part of our collaboration at the was centred on hand surgery, and to this end Zoe Clift, Hand Therapist joined the team from Derby to teach on hand therapy in 2017.
In 2018 the team changed to Julie Jones, Hand Therapist, Edinburgh who taught how the specific splints in hand therapy are made, and Rob Staruch, Plastic Surgery trainee, Oxford, UK. Rob was at that time writing his PhD, and was able to share his knowledge on statistics in publications, as one of the specifics the local team had asked about was to learn about how to publish.
We also ran a workshop for tendon transfers, which was attended by the whole department.
We hope to return in the not too distant future to work with Dr Ahmed and his team again.