“Burn injuries scar your body and without appropriate care, scar your heart forever, no matter if you are the patient, parent, grandparent or caregiver”
~ Dr Nikki Allorto

Burn injury will scar you for the rest of your life

When I started my surgical training I wanted to be a plastic surgeon and make people look beautiful. But in my first year of training as a surgeon, I had to look after burn patients and everything changed.

I remember…

It was a small ward of three beds in a corner of the hospital. I remember the kids screaming in pain from dressing changes and this trauma went on for weeks and sometimes months because that’s how long they were in hospital for.

I felt helpless in the face of all this pain and suffering. I found it really difficult to work in that little unit and I was not sure how to manage the patients properly or how to alleviate their pain. I wondered if there was a better way to manage this problem and did seek advice from my seniors at the time, but no one seemed to have any ideas of how to improve patient care in this area.

In that moment I realised that someone had to do something about this situation and that became my cause and my career choice.

Neglect at a deep level

As I continued through my surgical training it dawned on me that neglect of burn patients runs on a deep and established level. There are many factors that contribute to this neglect in a third world country such as a lack of training for doctors as well as nurses, inadequate equipment, and unsuitable environments for good patient care. Binding all of these challenges together with the emotional strain incurred by all the caregivers in this area, the problems seemed insurmountable. I finally understood why it was easier for most to not care and try and stay as uninvolved as possible.

The physical trauma of burn injury is one thing but understanding the emotional injury affecting patients and caregivers is quite another thing. It not only affects the vulnerable like children and grandparents, but also the young healthy adults who are the providers for their family. Burns are an accident that can happen to any of us, as most are caused through accidents in and around the home.

Facing your own fallibility

Part of dealing with these patients means facing your own fallibility as a young adult where you may not feel at risk for other diseases too young for cancer or heart disease, don’t smoke or drink and drive. It therefore becomes difficult to maintain one’s professional detachment from the patient because it could be you or your child, or a loved one, which is a frightening feeling. Being constantly exposed to the ongoing and complex pain of the patient, seeing them on a daily basis, often for long periods of time as burn injuries take a long time to heal, is a heartbreaking journey.

The operative work is difficult the theatre has to be as hot as 30 degrees and involves physical work, changing position of the patient and big dressings. It is not glamorous like breast surgery and heart surgery. It is not nice and neat with fancy equipment like eye surgery or ear nose and throat surgery. You have a big knife cutting off layer by layer of burnt skin in a hot theatre with lots of bleeding and you have no specialised training for this type of surgery because this is simply not available in South Africa at the moment.

It is far easier to just leave the patient in the ward, and let the nurses do dressing changes and eventually the dead tissue will fall off. Many patients die while they endure this type of therapy as infection sets in and this becomes unmanageable.

Doing it alone

Over the years I have sought knowledge and developed of my skills by travelling to other countries where burns are well cared for and by attending courses and congresses. I have experienced how good care of the burn patient can alleviate pain and suffering and in turn becomes an extremely rewarding journey for the caregivers as well. So my challenge was to improve burn care in South Africa, starting with the hospital I worked in. I became responsible for all the burn patients. I was alone with very little professional support but I felt passionately about what I was doing and that I was slowly making a difference to my patients.

At the time I thought that I could do it alone, believing that I was capable and driven and hard working and that this was all it would take.

Then five children died in five days. I was devastated because I felt responsible and a failure. They were children with burn injuries that were manageable even in our system, and they should not have died. I was depressed and felt guilty about their deaths. The nature of the injury is such that they are with you in hospital for a long time and relationships are formed. My grief became overwhelming as I considered my inability to give these patients the care they deserved and at the very least a comfortable and dignified death.

I am healthy, fit and active. I have never missed a day of school or work. I was never sick and never had an operation. It was a formidable experience to have been physically incapacitated by a slipped disc with pain so severe I was confined to bed for three months. People asked me what crazy activity I was doing to cause a slipped disc. I don’t think anyone believed me when I said it was no activity. I had been carrying the responsibility and guilt for failure to those burns patients for too long. The three months of bed rest gave me the chance to overcome those feelings and to focus on a way forward.

Deep passion has not wavered

My deep passion to improve burn care in South Africa has not wavered, however I do now realise that I cannot do this mammoth job alone. I understand that it was not my fault that those patients died, and that it is the whole burn care system that needs to be improved so I started the Burn Care Trust.

The task ahead for the Burn Care Trust is to raise awareness about the burn care system in South Africa and to gain support from the South African public in order to bring about the revolution needed in this area.

We need doctors and nurses to feel inspired to follow a career in burn care and to be adequately equipped and supported with the technical and emotional skills necessary to provide a great burn care service. Alongside this we also need improved infrastructure and equipment in order to facilitate these changes.