Burn Program History
The history of Physicians for Peace (PFP) burn care program began in Nicaragua with a visit by organization founder Charles E. Horton, MD in 1992. Based on medical education needs identified at that time, a team of plastic surgeons traveled to both Managua and Leon in 1994 to advance medical expertise in the management of burn care and to upgrade patient care within a burn unit built by the founder of Asociación Pro-Niños Quemados de Nicaragua (APROQUEN), Ms. Vivian Pellas.
In 2001 Dr. Ruffin returned to Nicaragua to the hospital where burn reconstruction work occurred five years before. Dr. Ruffin recognized that the problem of burns, especially in children, is significant in Nicaragua. In the United States the ratio of burned adults vs. children is almost 70/30. In Nicaragua, the figures are reversed. Open fires and scalds are the most common causes. Clothing is light, porous, and flammable, as is the mosquito netting used extensively throughout the 4 to 5-month rainy season. Burn prevention education, the use of flame retardant clothing and teaching the local population how to contain fires are all necessary preventive measures and programs that have experienced little success in this developing country. The basic conditions in the rural areas of the country are very limited, which is predominant cause of burns in Nicaragua.
Burns that heal slowly over two weeks are prone to develop dense scarring that over time will contract and deform grotesquely. When external compression is applied early to the burn scars, thickening and contracture is minimized. Most commonly and conveniently a custom-fitted elastic garment achieves this compression. These compression garments can be made for a total body or for segments such as an arm or a leg. It takes up to 18 months of almost continuous wear to achieve the desired effect, and replacement garments are frequently needed. Although surgery is an option, once scarring has occurred it offers only limited success. Of course, the availability of surgery relates to money, trained personnel, equipment and patient access to care, so this treatment option is not always a practical solution in Nicaragua.
In February 2002 PFP assisted in the development of the clinic in Nicaragua to produce in house, custom-fitted elastic compression garments which, with extended wear, will flatten and soften or when used early, prevent the occurrence of deforming burn scars. For the face, a thin transparent mask of flexible plastic-like material (UVEX) is custom designed and fitted on the patient. The supplies, including sewing machines, special elastic material and threads in a quantity to make over 1000 sleeves, leggings, vests and gloves were acquired and delivered. The elastic compression garments can be made in an hour or less and the facemasks require about two hours.
On the first day of the clinic’s operation at the Velez País Hospital there were 120 patients with burn deformities awaiting treatment. Over three days they were examined, measured and fitted. The teams of physical therapists, seamstresses and other local healthcare providers from the cities of Leon and Managua were invited to participate. A team of 15 remarkable Nicaraguan professionals were introduced to the process initially and trained. The local team quickly became independently expert in making professional quality compression garments.
The volume of compression garments turned out to be overwhelming for a regular sewing machine, so an industrial sewing machine was donated to the clinic, and the seamstress, who had prior experience on that very model, continued production without complications. Another UVEX technician was also identified and trained.
This program teaches valuable skills and techniques that can be applied to the reduction of scar formation in burn patients while providing jobs for local seamstresses producing the compression garments - a win-win situation for all participants in the program.
The burn care program expanded over the next five years to include:
- The development of the Central American and Caribbean Association for the Prevention and Treatment of Children with Burns (known as the Asociación de Hermandad)
- Hosting the first annual meeting of the Asociación de Hermandad
- Partner burn organizations throughout Central America, including:
Costa Rica
Dominican Republic
- Santiago
- Santo Domingo
El Salvador
Guatemala
Honduras
- San Pedro Sula
- Tegucigalpa
Nicaragua
Panama
- Numerous annual training missions including:
- Burn nurse education and training
- Burn rehabilitation education and training
- Burn surgery education and training
- Numerous annual shipments of burn care supplies to partner organizations
Future plans include additional meetings and expanded training as well as the identification of a regional training center and new partnerships and linkages with other international and national organizations. PFP hopes to present research findings at national and international conferences to continue to advance burn care in Central America and the Caribbean.
For a detailed roadmap for our future, please review our 3-year action plan.
