When David Grant walked the plastic surgery wards in Kenyan hospitals, he noticed most patients were burn victims.
“The high incidence of burn injuries and their acute management forces reconstructive surgeons to turn away other patients with non-burn related reconstructive needs, like cleft lips or cub feet or trauma patients from road traffic accidents,” says Grant, a Feinberg medical student and Satter Scholar researching burn injuries in low- and middle-income countries (LMICs) with the University of Toronto, the African Medical and Research Foundation and the University of Nairobi.
Roughly ten reconstructive surgeons serve Kenya’s population of more than 41 million to treat disfigurement resulting from congenital deformities, disease or injury. Severe physical deformities can impair a patient’s ability to work and participate in society, which Grant says is particularly devastating in poor and developing countries like Kenya.
He says many people in Kenya believe injuries from road traffic accidents or cooking or house fires cannot be prevented. Grant and his colleagues want to understand these attitudes and how to change them, so people will adopt preventative behaviors.
Stove designs have improved and jikos, charcoal stoves set on the floor, are used more often. Despite making the kitchen a safer place, Grant says burns are still so common that plastic surgeons are overwhelmed.
“The wards are literally packed with kids who have devastating injuries and scars that consume whole bodies and faces,” Grant says. “Our group’s and others’ efforts are now discovering that missing piece might lie in the attitudes that guide how people go about cooking in their congested environments. This makes sense when you think about how rich countries started stopping burn injuries or road traffic accidents decades ago.”
LMICs are just starting to take these approaches.
In Kibera, a large slum in the heart of central Nairobi, families live in small homes or shacks where everyone cooks, eats, washes, sleeps and socializes. They heat up water or milk in a large pot on top of a jiko.
Unintentional injuries can occur in these close quarters, especially among children.
“I heard of one young five-year-old girl who put her hands into [a] hot pot of oil, was startled by the pain and jerked back, spilling the whole pot of oil over her torso and upper limb,” Grant says. “Luckily the girl was taken to hospital straight away, and has not suffered contractual deformities. However she’ll soon grow up and as a young women might feel socially ostracized by the tremendous scars across her body.”
Grant is developing frameworks for prevention programs as well as improved data acquisition and surveillance tools to better measure the incidence of burn injuries.
“In regards to burn injuries, there’s plenty of room for prevention, and there’s hope,” Grant says.
Grant collaborated with other researchers to analyze expert interviews and reveal opportunities for targeted prevention, particularly cooking-related injuries in children.
Improper first aid is often used to treat injuries — if first aid is given at all.
“Patients most often use traditional remedies, like corn meal, urine, charcoal ash or mechanical grease that lead to infection,” Grants says.
These infections can delay wound healing and cause systemic problems for patients, which then drives up the cost of medical care.
Marketing experts, community health, proper first aid, basic improvements in charcoal jikos and electric cooking stoves, physiotherapy and tertiary prevention of burn-related disability can all help keep families safer, Grant says.