Introduction

The history of Burns and Plastic surgery services in Nepal was started in Bir hospital. The separate Burns and Plastic surgery unit was established in the year 1998 AD. It was proposed by Dr Keshav Das Joshi, senior consultant plastic surgeon. In his endeavor the first organized Burn Unit was established in 2000 A.D. with 10 beds including intensive care services in Bir hospital. The burns services are present need but there was no any thought or proposal for its upgrading. Upgrading of burns and plastic surgery is a need of the country. This unit is only a hope of the entire nation for burns and plastic surgery services in a minimum/free of cost.

The Burns and Plastic Surgery Unit have its two different wards for specialized services: Acute Adult Burn Ward and Plastic Surgery ward (Male and Female). Nurses and other staffs of this unit are trained and competent within burns and plastic surgery to care the patients. Many of them have specialist skills to provide special care.

Acute Burn ward is a comprehensive ward with an intensive care ward and separate room for each patient. There are two operative theatres but only one is in function due to lack of human resources. We operate twice a week, once a week for major surgery and the other day for intermediate and minor surgery. We run out- patients clinic twice a week.

We are also creating public awareness on burn prevention to reduce the burn incidence through NGOs / Press. Burn Victim Survivor Nepal is one of our friends to support in various works and services.

Existing situation of Burns Services in Nepal

Most of the hospitals in Nepal are either deficient or absent in facilities to treat burn injury. Patients with major burn injury need immediate specialized care to minimize morbidity, mortality and disabilities but it is lacking in Nepal. Every year more than 50 thousand people suffer from various types of burn injuries and most of them lose their life and rests are forced to survive with lifelong trauma. So time has come to upgrade the services of burns and plastic surgery in Bir Hospital and to make these services out of Kathmandu.

The plastic surgery

Patient of trauma who are in need of reconstructive services, skin cancer, post burn deformities and general plastic surgery cases are admitted in plastic surgery ward. Plastic surgery unit provides the general and reconstructive plastic surgery as per need.

The plastic surgery ward is taken care by the nurses and assistant staffs of the Urosurgery , Gastrosurgery and Paying surgery ward . There are no separate nurses for plastic surgery. The unit is facing lots of difficulties to maintain the services with existing human resource and facilities.

Objectives of Burns and Plastic surgery Unit Bir Hospital

• To train the health workers in Burn Prevention Program, to reduce the incidence of burns.
• To train doctors, nurses and general practitioners in Burn Care, Rehabilitation and Preventive aspects.
• To help to establish burn centers in district and zonal hospitals of Nepal. The centers will co-ordinate with the Burns and Plastic surgery Unit of Bir Hospital for specialized treatment.
• To conduct researches on burn care.
• To establish the relationship with various international burn centers to upgrade the knowledge and to improve the Burns and Plastic surgery services in Nepal.
• To renew the relationship with Royal Perth Hospital and Rotary international (They are continuously helping our burn ward since last decades).

Services of Burns and Plastic Surgery Unit

Academic activities:

• MCh plastic surgery Post graduate training is started with the collaboration of Phect Nepal.
• Training on Burn care is given to Post Graduate Surgical Residents of NAMS (National Academy of Medical Sciences).
• Medical graduates from abroad are doing their electives in Burns and Plastic surgery.
• Nursing students from different Nursing Institutes are trained during their internship. Elective clinical placements from different country .

Clinical activities:

• 24 hours Burn Patient care throughout the year.
• Burn patient get all modalities of treatment in this unit including Intensive Care services for acutely Burn Patients.
• Own operation theatre.
• Plastic and Reconstructive surgery.
• Physiotherapy service to Burn patients
• Oncoplastic surgery

Hospital beds for Burns and plastic Surgery Unit

Total allocated beds only for burns and platic surgery unit: 19 beds. Other patients can be admitted in Paying surgery ward and Private cabins. Specified beds are:

Acute Burn ward: 3 Intensive care beds and 6 sepate cabins

Plastic SurgeryWard: Male: these are general beds .5 (Five) beds; Female: 5 (Five beds)

Reconstructive surgery and cases with skin tumor are admitted in the plastic surgery ward. There are nine beds for acute burns. Plastic surgery cases can be admitted in paying surgical wards.

Details of the existing staffs