Haiti: Treating severe burns

A physiotherapist helps a burn patient in Haiti

Haiti 2018 © Scott Streble/MSF

PORT-AU-PRINCE, Haiti, June 2, 2021—Doctors Without Borders/Médecins Sans Frontières (MSF) has fully resumed its program to treat patients with severe burns in Port-au-Prince, Haiti, following disruptions earlier this year.

On February 23, MSF had to urgently relocate patients and staff from its burns hospital in the city's Drouillard neighborhood due to armed clashes in the immediate vicinity. Patients were transferred to MSF's trauma hospital in the city's Tabarre neighborhood, but it has been a challenge to make space for new burns patients.

"People with severe burns are very fragile and prone to infections which can be fatal," said Dr. Anicet Umba, medical advisor at MSF's Tabarre hospital. "For this reason, we had to completely separate the paths that the trauma patients and the severe burns patients follow."

After major renovations to accommodate patients, MSF's burn care program is now fully open at the Tabarre hospital, with the same medical services that MSF previously provided in Drouillard. The total capacity of the Tabarre hospital is now 20 beds for burns and 50 beds for trauma patients. The hospital also provides outpatient care for burns and trauma patients once they have been treated and discharged.

Patients must arrive as soon as possible following a burn to limit the risk of infection, MSF advises. Beyond 48 hours is considered too late.

MSF continues to assess the possibility of continuing to provide treatment for severe burns in Drouillard, depending on the evolution of the security situation. MSF maintains an emergency service in its Drouillard facility to stabilize patients with burns or traumatic injuries. 

Treating severe burns over the years

Since 2016, MSF's burns hospital has admitted more than 3,600 patients. Dr. Erneau Mondesir, medical advisor of MSF's Drouillard hospital, describes the progress and the challenges of MSF's burn care program in Haiti in the following Q & A:

Erneau Mondesir stands in a hospital corridor and smiles
Haiti 2019 © Caroline Frechard/MSF

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. 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.

View of a hospital room for burn patients in the Drouillard Hospital of Médecins Sans Frontières in Haiti.
Haiti 2018 © Scott Streble/MSF

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 onward. 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. 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.

It is still a real achievement, and a great pride, to be able to offer this type of service in Haiti.

Dr. Erneau Mondesir, medical advisor of MSF's hospital for burn care

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 we 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. The area immediately around the hospital became a zone of violent clashes. Quickly, we realized that the security situation was too tense. And then 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.

Moving a hospital in an emergency requires a lot of energy, and a lot of careful thinking about patients' needs, especially for burn care.

Dr. Erneau Mondesir, medical advisor of MSF's hospital 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.