Physiotherapy Trauma Talks
In Physiotherapy Trauma Talks we discuss the key roles that physiotherapists and other healthcare practitioners play in the management and rehabilitation of patients with traumatic injury. Experts in trauma care offer their insights about in-hospital patient care and post-discharge follow up service delivery. New research in the field of trauma care and rehabilitation is shared to provide answers to your questions.
Physiotherapy Trauma Talks
Burns Part 4: Insights from a Pediatric Burns Specialist with Eleonora Lozano
Eleonora Lozano, an experienced pediatric burn physiotherapist, shares her journey working with burned children at Chris Hani Baragwanath Hospital and Red Cross Children's Hospital, detailing the challenges and rewards of this specialized field.
Link to paper discussed in this episode: https://sajp.co.za/index.php/sajp/article/view/429/618
More resources on management of burns: ISBI Practice Guidelines | International Society for Burns Injuries
Podcast website: https://physiotherapytraumatalks.buzzsprout.com
Book: Cardiopulmonary Physiotherapy in Trauma: An Evidence-based Approach’ published by World Scientific: https://doi.org/10.1142/13509
Hi there, fellow physiotherapists. I am Helene van Asvegen, your host for Physiotherapy Trauma Talks, where we discuss everything related to trauma care. So if you are passionate to learn more about physiotherapy in the field of trauma to ensure that you provide the best possible care for your patients, then this is the right podcast series for you. Welcome back to our listeners and welcome to this last episode in our series about burn injuries and physiotherapy management of these. Today, I'm joined by Eleonora Lozano, who is a physiotherapist that has worked with children with burns injuries for several years. Eleonora, welcome to the discussion today. Good afternoon, leanne.
Speaker 2:Thank you. I'm looking forward to this as well. Thank you.
Speaker 1:Would you mind starting by telling our listeners what sort of drove you to work with children with burn injuries?
Speaker 2:I'm not sure if it's like generalizing, but for most people when you're going through school and you're exposed to physio, initially you're like, oh, I'll be like the next sports physio. That's how I envisioned going into physio as an undergrad and I remember going in my pediatrics block at Baragwanath Hospital and you walk into the Johnson and Johnson burns units and there was something there that just captured me. One of the doctors at the time said no, these children are like little KFC, little fried chickens, but we can get them through. And I don't know as horrible as that sounded, it stuck, stuck but it was just something that was so rewarding at that time working with these kids, getting them through and it was just something that I saw myself wanting to do.
Speaker 2:I put Baradun as a placement for commserv and I didn't get placed there, but I had an opportunity to work there the year after and even within, like the certain rotations, I did orthopedics for a while and I did art patients, but once I was in the pediatrics rotation and working in the burns unit, it was just something that I really I was drawn to it. I don't know if there's another way to put it and I do remember there was a change from being a student to working there more closely, full-time as a as a qualified physio, that the children would initially be very. We used to wear the blue uniforms, blue t-shirts, the navy pants and they would know that the physios were coming and they would cry. And we got to a point once we were working in the unit that they would want to run down to the physio, to gym, to come and to play us Like they weren't scared of the physios anymore.
Speaker 2:And that's when I was like okay it's just changing that and that's what fulfilled me as such. And then, following my time at Baragwanath, I had the opportunity to move down to Cape Town and I was working up until recently at Red Cross Children's Hospital and again I had a chance to work in the Burns unit there and just continue to just enjoy working there. But I'm also taking an opportunity to change not just physio's perspective but students learning from different therapists that Burns isn't as horrible as many people think it ought to be. I do think you know everyone has their niches and burns was my niche, but I also just wanted to share that passion with others.
Speaker 1:That's wonderful and I think you know people are often quite intimidated by treating children specifically with burn injuries, so it's great to have someone on the show today that really thrived in that environment, so I'm very happy that you can speak with us today. So in the previous episodes we spoke about causes of burn injury, but particularly focused on adult patients, and some of those causes might have been assault or being stuck in a vehicle that caught alight after an accident. From your experience in Johannesburg at Chris Harney Baragwanath Hospital and also down in Cape Town at the Red Cross Children's Hospital, what were the main causes of burn injury for the children that you were caring for?
Speaker 2:I'm not sure I think it has been touched on before, but just to you know, overall, statistically, in South Africa, the last bit of stats that we have is that 3.2% of the population are affected by burns and if we look from a pediatric perspective, it's the third most common injury cause of death in children under 18. And those that are great at risk are the children under five years of age, Our younger children, so your toddlers, and that the biggest percentage is your scald or your hot water burns, and the reason being they're a lot more explorative in their nature and completely unaware of the dangers that lie in and around the household. You think of informal settlements. People are cooking on stoves on the floor. So, as your little ones are learning how to crawl or learning how to pull to stand very likely will be pulling a cable or pulling a pot of water onto themselves. Their skin composition is a lot more fragile, so that hot water exposure affects them a lot more.
Speaker 2:Compared to adults, your older children tend to there's a higher percentage that we see are related to flame burns. And then, if we look at, you know, between genders, boys are a little bit. It tends to be 50-50 sometimes, but boys are more commonly affected than girls in the toddler years and then in the adolescent age, where girls are more in the kitchen or related to cooking activities, they tend to be a lot more injured. Having said that, though, boys can be the naughty ones where they'll be playing with firecrackers and get injured that way. And then, of course, unfortunately, we've also not necessarily assaulted as we see in adults, but we have a lot of non-accidental injuries in children being burnt purposely with straighteners, hot irons, cigarettes, all sorts of things.
Speaker 2:We see this, unfortunately. I have seen a couple of cases where children were purposely held in hot water, so both feet would have been burnt or hands as a form of punishment. So it's just, it's horrible in that sense. But when a child like that is being admitted, you've got to think about in their history, what are they presenting? What is the parent saying? What are the teachers saying if they've, or whoever's, found the child, and is it matching with how they're presenting? And you've got to have a suspicious you know thought in your mind that you can't just, oh, this just looks simple. It's like if something doesn't add up, you're almost playing detective, as horrible as that sounds. But yes, most hot water burns is the greatest proportion, and then you've got your flame and then, yeah, non-accidental, which varies.
Speaker 1:Yeah, I suppose in that case of the non-accidental injury, it's important for the physiotherapist to also stand up as an advocate for the child. 100%, yeah, as part of the team that's managing the case. Yeah, so, as a physiotherapist, in particular managing patients with burns who are very small, what is the goals of treatment, and would it be similar to that of an adult patient, or are there some nuances with pediatrics and children moving into adolescence that we need to be aware of?
Speaker 2:So I think, just to touch on the goal and you mentioned it now as well we're a part of the interdisciplinary team. It's not that the physio is more important than any of the other team. We're a team member, a team player, and the patient and the child in this instance is the center of it all. From our goals, you'd be seeing them from day one of admission doing your assessment. Do they need from a chest assessment? Is it indicated, is it required?
Speaker 2:Your goals of rehabilitation would be to assist the child and their family in achieving their maximum potential and physical function and in this instance, it's their developmental. Where are they developmentally? What were they like pre-burn? Are we looking at a six-month-old that was starting to sit, getting to a point of starting to crawl? Or are you looking at a toddler who was running, climbing stairs and jumping? So all those things is what you're aiming for. It's not different from an adult, because you're going to be aiming for your same function that you were prior to being burnt. You just have to look at that from a developmental point of view. Goals you're going to be helping them with appearance of their scars and helping and teaching the families how to manage that. And also, in some cases, if there's been permanent loss. It's not as common as in adults where you'll lose limbs or have amputations related to burns. But you've got to adjust and get the family to manage that, adapt with that and return to their skills and development and play. And principles with regards to that would be restoring maintenance of range of movement, improving managing their muscle strength and endurance, balance, coordination, proprioception.
Speaker 2:Yeah, as I say, starting from day one, icu or the ward, I think the only thing that might just change is that it's a fun and playful approach as opposed to. You know, we're doing bicep curls, for example, or you know, like a knee flexion extension exercises, everything you're incorporating in a bit more of a fun way. You're educating completely parents along the way, those that are interacting with the child Pain. That would be the same that you'd be doing in an adult. So you're using your observational scales, maybe a bit different where child the younger children can't verbalize how they're feeling.
Speaker 2:So you're using your Wong-Baker, your observation scales from a pain perspective, but you're going to ensure throughout, is their pain being appropriately managed during your treatment sessions, away from your treatment sessions, and if it's not, you're playing an advocating role to be like, hey, I think we need a little bit more. You know your punahou is not really doing anything or we need to have a little bit more, but I think, again, the goals would be the same. You're setting SMART goals with the family and with the child. You're going to be using your ICF framework or, if you're using GAS goals, you're going to be incorporating and using outcome measures as well. Yeah, so I think there's a lot of things that would be the same as done in adults, but you're just doing it in a bit more of a fun approach and incorporating the family as well. Yeah.
Speaker 1:Yeah, I think that is an important point because in many cases you would find that the child's caregiver is on the ward with them while they're in the hospital. Definitely, and how, from your experience, have you involved the caregivers in the child's management when you were still working clinically?
Speaker 2:I think that the biggest problem is when there isn't a parent or a caregiver at the bedside. Then it's just you and the child, or you incorporating another therapist. But if the parent is at the bedside, if you think about it, they become the therapist, so they're the one that looks after and cares for the child 24 hours in the day. So you can come in, for example, and be like, okay, well, let's do physio for half an hour or an hour. There's no point in you doing everything, as opposed to okay, mom, let me show you how are you doing the stretches. What activity have you done today?
Speaker 2:Because when you walk away, she can continue doing that and she can do that in the ADLs component of the child. So when the child is walking to the toilet, she can help them to walk rather than carry them to the toilet. If they've got lower limb burns, for example, or if the child is needing to feed themselves with their spoon. You know, incorporating the arm and doing the stretches and the play as much as possible at the bedside all the time. So it's a lot of people don't like to let go of. I'm the one doing everything. The parent can become the therapist in inverted commas in this instance, and you have to involve them. They have to be on board with making sure that their children hit all their goals.
Speaker 1:Yeah, yeah, and I think that's important, especially with you saying that they are with a child all the time. No-transcript. Have you found that parents have been willing to come on board and do a ward program with the children? What's your experience been with that?
Speaker 2:So I think initially it's a huge shock. There can be a lot of guilt involved in how the child got burned. For example, if the mom turned her back and the child fell in like there's a lot going on, it's sore. All of a sudden you're being admitted into a hospital. Your child has been scrubbed head to toe, they could be swollen. All of a sudden we've got bandages and the bandages also tend to look worse than what the injury is.
Speaker 2:So there's the moms and the caregivers are very, very, very overwhelmed. So you've got to be aware of that and walk them through that journey. So there's always that initial what are you doing? Why are you making them move? You know you guys are making them cry, they saw, but it's almost like you build that trust with them and they see the other.
Speaker 2:For example, if the child's come in and there's other children who've been there a while who are at the point where they're a little bit more functional and happier and moving, that helps as well. So they can see that there's buy-in to be like. Actually I need to do this for my child because if I don't, the child is going to be worse off, and I think that also comes in keeping with educating them, walking the journey with them, being being friendly, all all those things. It's not just being like hello, mommy, I'm the physio, this is what we're doing. It's very, very overwhelming in those those environments and you've got to, just from the get-go, just walk them through and say, like, this is what we're going to be incorporating.
Speaker 1:this is why, for example and we're just going to do this with you every day, little bit by bit- yeah, no, I think that's very important, and to help the caregivers and the family feel that their feelings is also understood in the context of the children's management, Definitely.
Speaker 2:And also, in touching on that, just flagging, for example, if the mom or dad isn't coping, to be like okay, what is it that you're feeling? Do we need to get you additional help? Do you need someone to talk to? Do we need to medicate? You know you've got to. You've got to also advocate for the parents if they're not coping in that situation too.
Speaker 1:Yeah, no, that's very important. So you mentioned earlier that it's often easier to do your treatment when the caregiver is present. How have you managed in situations where the caregiver was not around and you had to treat a child and that child is very stressed or anxious about you being there?
Speaker 2:thee? Yeah, I think it's also. It's one of those things where language often is a bit of a problem. So you, you know, as you, as you come through, and you, with your years of experience, you learn different languages and that makes a big, big difference. So to being able to say like, you know, yiza or Gorba, like, goes a little bit of a long way, and having a nurse on your side also helps.
Speaker 2:Or if there's another mom in the cubicle, for example, that can help you, just to say to the child listen, this is what we're going to be doing, don't be scared. And in those instances as well, if the child's on their own, I would get another child in with another mom so they don't feel like completely isolated. Or this is just all the focus and attentions on me. Reiterating, just making it fun. It's the language that you use. So let's just say, for example, this child that we're having a problem with likes a ball, bring the ball along to them and almost give them time to warm up to you. And it's not, you're never going in there. Let's just go, do your passive stretches and leave.
Speaker 2:You've got to build that up, that you are the friendly face, even though you're going with the purpose to make sure you're getting your range and your stretches and all of that also, just as I say how you, how you talk to the child, how you play and you engage. That's also some of the things. Something that you know you also learn over time is like, if you, as a therapist, are the stumbling block, step back and get another pair of eyes or another therapist on board. I like to think of it like I know my skills and, for example, if I was working in a private practice and I got referred a patient that I don't know how to treat, I would refer onwards of I'm actually not winning with this child, no matter all the little avenues or options I've done. Bring in someone else, incorporate whether it's another physio or an OT, just to be like is it me Versus? Can someone else come and actually just crack on with this child, if that makes sense?
Speaker 1:Yeah, no, that makes perfect sense and I think it's a very important point to share with the listeners as well. Where you've worked, in Johannesburg and in Cape Town, what was the sort of clinical practice with regards to frequency of treatment of patients per day? Would you see them once a day? Would there be days that you wouldn't see them for physiotherapy? If you could maybe just talk about that.
Speaker 2:So it is a difficult one because, working in government settings or state settings, you're stretched everywhere. It's not, yes, you're working in a burns unit but you could be covering other wards in other areas and there can be periods where other staff are on leave or you've got to prioritize. In an ideal setting, every single patient is seen every day, and certainly those that are larger percentages or difficult patients or they require in chest physio, for example, those are definitely would be seen twice a day or seen for longer. Both settings that I've worked with have physio students, so that's helped a lot from the point of view of they'd be getting double sessions, so they'd be seen by a clinician as well as a physio when they'd be doing their clinical blocks. So, if it makes sense, the minimum would be once a day. You would want more than that and you make a plan, but you also know how to prioritize your patients, so there would be some that you wouldn't have a chance to see every day, but you know that the patient is, the child is independent or the caregiver is independent and compliant with the home program, so you can touch base and be like okay, how are you managing? Today I'm seeing the child literally walking up and down the ward and they're managing. Okay, I would still flag that child, for example, and be like okay, today they're going to dressing change, I will see you in dressing room and try and catch it that way.
Speaker 2:We also try to incorporate as much as possible that the bed is their safe space.
Speaker 2:It's difficult if the patient is on lines and so you would try and not do stretches, for example, in the bed and you would try and do that in the dressing room or keep it to the gym.
Speaker 2:But in certain instances you know that's what you had to do, but you had to be aware of OK, make the bed the safe space and make the gym the fun area, for example, or you're doing stretches in the dressing room or in theatre. Doesn't always work that way, but that was just some of the things that we incorporated and, as I say, whenever there were students, that always helped. But again, falling back on teaching the parents to be the one that would be the therapist or doing the rehab with the child, to be the one that would be the therapist or doing the rehab with the child, if you think about it in the sense of not all the children would be seen on the weekend as well, so they'd be missing If you think about the seven-day week. They'd be missing that from a therapy point of view, so the caregiver gang would be carrying that over. So there's just some of those little strategies that we had in place to try and combat that, if that makes sense.
Speaker 1:Yeah, no, definitely Eleonora. Do you have experience of a particular patient who cooperated well with physiotherapy that you would like to share with our listeners?
Speaker 2:It's been a few years that I've been working in the. You know if I looked at it overall in the two burns unit, but for me, the case that stands out for me the most, and at the time it was, she was a 12 year old girl who was admitted to the unit at Red Cross during July of 2020. So during COVID times which was also just so, so crazy as it is, so crazy as it is and she had sustained 45% flame burns to her low limbs, her back, trunk, buttocks, face and arm and inhalation burns. So essentially that would make her a 55%. And I distinctly remember seeing. You know, I saw her for the first time in theatre because it was just part of the timing that she was being admitted and we could see her into theater and I had never seen Burns like that before and we just knew from the get-go if she made it, this was just going to be a huge MDT involvement. We were going to walk a very long journey with her and we did.
Speaker 2:Long story short, she spent six months with us in the unit before she was transferred to another facility for step down, but she underwent a total of 13 surgeries, which often, whenever you're having the surgeries feels like one step forward, two steps back and comes with the highs and lows. With the highs and lows, she ended up being a through knee amp on the left and an above knee amp on the right and requiring lots of skin grafting, a colostomy. There was lots, and what was different about her is by the time we got skin coverage on her legs and we could think about you know, she's an amp, we need to start mobilizing her. We were able to get a pneumatic limb system from Kurtiskea hospital because we didn't have that, because she was actually the size of a little adult and we got to a point where we could start to mobilize her and we got her standing going, going through parallel bars and I don't know who cried more between us her mom, her it was. There were five of us, five therapists that were involved in all of this, from OT and physio. It was a huge, huge team dynamic and we were also able to take her outside for the first time in three months and again with COVID, there was just so much going on. Mom couldn't really go back and forth with regards to visiting. There was a lot that we had to deal with. She unfortunately, her sister demised in the fire as well, so we had to deal with that. So she had a lot of PTSD related to her sister and I distinctly remember one or two of the sessions where we literally she just sat and she cried. It was. You know, it's hard to be like, oh, we have to come and do physio exercises today, but sometimes your patients actually just need you to hold their hand or hold them and they cry because there's a lot going on. And again, she was being seen by psychiatry and psychology and it was just one of those lows that we had to get through.
Speaker 2:Um, but the the success and the beauty of all of this was she was transferred to a step-down facility. She went home for Christmas in that, following new year she came back. She got prosthetic legs. She got reintegrated into school. You know they reversed her colostomy. She's been on radios. She's been an advocate for burns burn survivors. She's been an absolute yeah, like I don't want to call it poster child, but just the journey, that it's just a successful journey, as hard as it was. And yeah, she's just incredible. And even now I mean she's made it to grade 11. She participates in Paralympic sports. She's just, yeah, absolutely incredible.
Speaker 1:Wow, what a success story. And it's just a true example of how devastating a burn injury can be. Yeah, but then also the strength of her spirit to pull through all the challenges that she had, her resilience.
Speaker 2:Yeah, absolutely, and to be so successful.
Speaker 1:Yeah, how the members of the multidisciplinary team really helped her to overcome and be successful and reintegrate it into society. That's amazing. Yeah, so great. I know that you did some research while you were working clinically on virtual reality. Would you like to share a little bit about that with our listeners?
Speaker 2:Sure, yeah, it was just one of those when I was still working at Chris Harnie Barragona Johnson Johnson Unit. At the time there was and I mean still is a growing trend use virtual reality, um, as part of rehab and as part of burns rehab. And at the time, you know, the unit was donated an xbox connect and the what was more, because so you've got the xbox connect, for example, and then there's the nintendo wii. What we felt with the xbox connect is is you didn't have to use a device or hold anything so it picks up a whole body system via the infrared camera. So that we found was a little bit more advantageous, for example, to using a Nintendo Wii. And the reason why there's been like that at the time, the growth in looking at it for burns rehab is that it's facilitating movement, you know, and you're preventing your contractures while you know being distracted from pain and engaging in a lot of fun.
Speaker 2:And basically I wanted to see what this was. You know it was the first time doing it in the unit and how would the kids respond? I basically had two groups. You know your control group, which would be your standard. I'd get your standard physio protocol treatments and then the experimental would be that plus Xbox sessions, and in terms of outcome measures, I looked at range of movement. I used like a modified Wong Baker to look at fun and enjoyment. And then we use the activity scales for kids, the participation component, just to see, like, did it allow us to achieve the things? More so, the activity scales for kids, the participation component, just to see, like, did it allow us to achieve the things? More so, the activity scales for kids participation component allows you I was able to do this or there's all sorts of different measures. And then what we found was between the two groups, we had a significantly higher active range of movement between the two groups, but also between discharge and you know the next follow-up that we saw them and significantly higher levels of fun and enjoyment. And yeah, just in summary, we found it to be a beneficial adjunct to rehab. So it's not that the Xbox replaced anything, it was just in combination with what we were doing. It was a much better way of improving function, distracting from pain and having lots and lots of fun.
Speaker 2:And then, from that, what was quite cool is, you know, I was able to present some of these findings various burn congresses and whatnot and other units around the country, not just pediatrics. Even some adults would be like, okay, this is something we can incorporate. It's a low cost device. Yes, you can't buy it on Tinder, so certain you know like private funders would be like actually, this is a great idea for OTs to use or the therapies and the physios in these certain units. And yeah, it's just, it was cool, it's interesting, it's different. What I think just it's it was, it was cool, it's interesting, it's different.
Speaker 2:What I think what's also quite new is using virtual reality headsets during dressing changes. So that's also shown a lot of a lot of promise and I think there is some more research within so that the South African context that's using that. So using, you know, a virtual reality system during a dressing change so your children and your adults have no idea essentially, what's going on around them from like, a physical dressing perspective, but they're in a in a different world and it's showing great results with lowering anxiety and pain and actually coping with dressing changes yeah, sure, that's amazing and it just shows you what a wonderful organ the brain is, because if you just stimulate it in a different way, definitely the anxiety levels go down and the experiences of pain are much lower.
Speaker 1:So, yeah, that's, that's incredible. Eleonora, have you been involved in following patients up after discharge and seeing them as outpatients?
Speaker 2:Yes. So both the units that I worked with, they had outpatients departments or follow-ups. So even if, having gone from the child being admitted into the ward, they'd be followed up at an outpatient clinic, a child who didn't meet an admission criteria would be coming to an outpatient clinic. And you know there's a huge role to play as the physio in the setting where you need to maintain range or see what's happening. What's happening with the scars? How are they functioning? Have they returned to schooling? Are they coping? Is the the child coping? Are the parents coping? Are we at a situation where you know you've got more wound breakdown that they would need to be readmitted? And both outpatient clinics that I've been involved in, it's not just the physio that's there. You've got your doctors, your surgeons, your occupational therapists. There's the physio, the nursing staff, everyone's on board to be like okay, medically, how are we looking at therapy points of view, where are we looking at and then dressing and then off to pharmacy to get your meds? And also from the point of view of, okay, you're ready for discharge from this certain unit's outpatient department, but actually you need more OT or physio elsewhere. So where can we refer you onwards? So, closer to home, both the units in Joburg and Cape Town. I mean you were getting children from out of the province or just from outside of Cape Town or outside of Joburg, so you needed those networks to be like. Actually, I can refer you to this clinic that has an OT or has a physio and they do work in burns, or they can help with pressure garments or scar management. Or from the point of view of, actually you need to be booked in to see your plastic surgeons because you're going to need a contracture release, the reality is contractors do happen. You've got to look after the scars and you've got to be able to just follow them up and direct them into the pathways if that makes sense where they need to go.
Speaker 2:Something else that's worked really, really well is that what I know from a Cape Town perspective Red Cross is that everything was being sent to Red Cross and Red Cross couldn't cope. So a lot of outreach and education has gone into other hospitals where they can become little centers, burn centers, so that the load is not entirely on Red Cross. So nursing staff in those areas, doctors in the areas and physios and OTs have been trained. They're almost like I don't want to call it the Red Cross way, but they've done outreach to be like actually. I don't want to call it the Red Cross way, but they've done outreach to be like actually you can manage and if it's a problem, refer onward to your specialized center, which I think ideally is. What needs to happen is that the smaller areas need to have the skill as well and the specialized centers deal with the bigger cases, the more problematic cases, and I know we can apply that as overall health in the bigger scheme of things too, yeah, yeah, no, definitely.
Speaker 1:And do you know if there are support groups available for children with burns to help them to cope with the mental and physical challenges that the injuries imposed?
Speaker 2:So I think not almost like not publicly but in the same breath there are burn. So there's certain burn foundations so I know there's the Hero Burn Foundation, there's the Children's Trust that try and become like support groups. But there isn't that I can say like almost official parents themselves become support groups. But there isn't that I can say like almost official parents themselves become support groups. But certain units do have like they'll get the during more so during the admission time there'll be like the social workers involved and they're having support groups, but I don't think the support is as great once the child has been discharged. I certainly think it's an area that needs growth and it needs to be looked at going forward now. So it's always been like okay, you've survived, we've got you going. What is the integration and what are you managing? So it's more that support afterwards that I think needs work.
Speaker 1:Yeah, certainly in South Africa. I recently came across a paper that was published from America where they spoke about burn camps that children and their parents go to to learn these coping skills and that they all felt a great sense of belonging and companionship when they attended these burn camps, and it just shows you the importance of it. Yeah, so I agree with you. It needs to be facilitated better within the South.
Speaker 1:African health care system. Eleonora, thank you so much for your time today and for this lovely discussion that we've had. Are there any last thoughts that you would like to share with our listeners?
Speaker 2:I think the big thing that I think it's been touched on previously in one of your one, your other trauma talks is just that we need to be more involved in health prevention strategies. And if I think about it specifically from a burns point of view, you know how to make their home environment safe to avoid, you know, children being burnt, and that can be turning your pot handles a certain way, moving your cabling away when you're filling the bath to put cold water first and then hot water to appropriate first aid. I remember you know you start off and oh no, you're putting butter and toothpaste and makeup and all sorts of things for a burn. It's like actually no running tap water, no ice. I mean the recommendations are running water 20 minutes, which and then you apply it. From a South African context, majority of people don't have access to running water. So how you you can, you can like mitigate, that is, get a bucket of water, apply the in the water and try and keep changing that, apply a cold compress, keep trying to change the water and then covering the limb in cling wrap, clear plastic plastic rather than a dish towel or bandages or anything like that and then seek medical attention Something else that I've.
Speaker 2:You know, something I've learned along the years is burn shield. Burn shield works really, really great and keep it in your fridge or keep it in your car, because accidents do happen. I'll never forget we were going on holiday and my mother-in-law spilt coffee. You know, because you've got your flask and you spilt coffee and she sustained. You know coffee burn and we had BurnShield and that really, really helped because I mean, you're on a long journey, you're not really going to have access to running water and whatnot. So I like to tell people if they can put BurnShield in your fridge and have BurnShield in your car. You'll never know when you're going to need it, um, when anything like that can happen. Yeah and um.
Speaker 2:There's two things I just want to add. Is like from a burns resources point of view. You know you've come out with is the textbook. The international society of burns has practice guidelines. They've published two guidelines with regards to what the research is showing. They've also created what we call a book of innovations and we were part of that with a rehab team. The OTs and physios from around the world all got together and shared their ideas of not everyone has all the materials, for example, for splinting or for how to do pressure garments or for silicone, and it was all these ideas of these are what we've done. So that's just something I think people you know listeners could look into and that's also on the ISBI website. It's called the Book of Innovations. There's the South African Burn Society website and then a really great resource is the Australian and New Zealanders. They've got lots of resources and pamphlets and these are, and the Americans as well. They have time to do these things.
Speaker 2:Yeah, and then also just something that for for listeners that are that are involved in, you know, when you pass away, if you're an organ donor, you can actually sign up and be an organ and a tissue donor, and South Africa has a skin bank and the skin bank is in Pretoria and you know you can donate your skin when you pass away and that donor skin can be used for your burns patients, especially your bigger percentage burns, where they may not have all the skin, for example, split skin grafts, and you're just trying to get them some coverage. So I'm not sure if you were aware of that. And, yeah, that's just something else just to add, and I'm always available and happy to chat and I still believe that we're all constantly learning, and the more that we network and chat. That's how we learn from one another, and the patients benefit at the end of the day from that.
Speaker 1:Yes, indeed, and thank you for those wonderful suggestions. I'll put some links to these resources in the show notes of this episode for people to go and look at. Eleonora, thank you so much for your time and for sharing your experience and your knowledge with us. I appreciate it very much, eleon.
Speaker 2:thank you so much and thank you for the opportunity.
