For the staff at the Alfredo T. Ramirez Burn Unit of the Philippine General Hospital, the boy has good prognosis, provided he is given the proper treatment. "Kids are very delicate because the reserves they need to counteract the effects of the burn are smaller than adults. But they do recover fast," comments Dr. Jose Joven Cruz, one of the burn unit’s three consultants, adding that 40 percent of the patients they admit are aged 18 years old and below.
Established in 1970 by the late Dr. Alfredo Ramirez after he trained in Boston, the PGH Burn Unit was the first-ever unit to be opened in the country. From a mere two-bed affair, it can now accommodate 11 patients. Though the number of patients they can admit seems small, the PGH burn unit plays a pivotal role during crises. Dr. Cruz says that the buck stops with their department. While there are about four other burn units in the hospital, they are the last resort, so to speak, for extreme cases.
This particular burn unit admits 300 to 320 patients a year, does 200 to 220 operations per year, and sees seven to 10 outpatients per day, or roughly around 3,500 outpatients a year. That’s discounting the difficult cases consisting of much bigger burns similar to the tragic Ozone fire, for instance.
Contrary to popular notion, a minor burn is characterized not by degrees but by the size of the burn. In adults, for instance, if more than 20 percent of the total body surface is affected, then that is considered a major burn.
According to Dr. Cruz, the No. 1 cause of burns in adults is flame, such as unattended kerosene lamps, house fires, leaking LPG tanks. In kids, the most common is scalding by hot liquid. Because of the dangerous nature of their jobs, electrical linemen are common burn patients. They get patients as far as Aklan and Laoag in Ilocos Norte. The burn unit’s youngest patient, says Dr. Cruz, was a newborn baby who was scalded and the oldest, an elderly patient in his 80s who got burned in a house fire.
People are well-advised not to take burns lightly. Dr. Cruz says that more deaths occur in burns than in dengue cases. "The problem is more than skin-deep, and affects all bodily processes as well as the organs, including kidneys, heart, lungs, and even the brain," explains Dr. Cruz.
A major burn patient also needs intensive rehabilitation, from physical therapy and occupational therapy to psychological counselling. Ideally, a patient suffering from major burns would heal from three weeks to a month. Unless a patient has been horribly burned, with 90 percent bodily surface affected which makes the prognosis really grim, the victim would have a greater chance of surviving.
For a staff of seven doctors, 17 nurses, six nursing attendants, one ward and five utility workers, this is quite a lot of work, considering the very lenient resources they have. They do want to see more patients being accommodated and the unit modernized.
But, as in any other subsidized hospital, resources are hard to come by. Apart from Cruz, other members of the consultancy staff are division chief Jeane Azarcon and Glenn Genuino, plus four plastic surgery residents, But, as Dr. Cruz laments, burn units are expensive to maintain because of its multi-disciplinary nature.
Dr. Cruz shares that in 100 patients, five percent can pay and stay in private rooms at the PGH. The others have to depend on the subsidized fees, which aren’t really enough. Dr. Cruz reveals that the government allots P1,700 for a charity patient per admission. They don’t have to pay doctors and hospital fees. Sadly, an antibiotic cream jar that all burn patients need costs a whopping P2,500, apart from other medicines.
Luckily for the unit, help comes in the form of generous souls, including the Chi Liam Tong charity group who gets the prescription of patients every Wednesday and buys those medicines to give to the patients. The same thing happens whenever the Shriners group comes by: This group of businessmen provides for the medicines of children patients. Similarly, several organizations from the University of the Philippines conduct fund-raising activities with the burn unit as beneficiary. "One doctor from the US even gave $10,000 for the burn unit," shares Dr. Cruz. There is also a trust fund for patients. Social workers would interview patients and decide whether the latter are to be subsidized further.
This month, through the assistance of Speaker Jose de Venecia whose youngest child died in a tragic fire last year, the unit is undergoing a face-lift of sorts. The unit will be repainted and tiles changed, oxygen and suction wall units replaced with new ones – refurbishment the burn unit badly needs at present.
"We have submitted a masterplan years ago and in that plan, the burn unit could handle 24 patients in all, from the original 11. We need to modernize the unit for we are 30 years back compared to the facilities in the US," says Dr. Cruz. Unfortunately, after consultations with several experts, they found out they would need to – pardon the term – burn $500,000 or about P25 million to have a state-of-the-art burn unit comparable to those abroad. With PGH getting a P1.2-billion annual budget from UP – and getting lower as the years pass it seems – that dream would perhaps have to take a backseat for a while. In the meantime, the doctors would have to make do with what they have… and they seem to be doing a pretty good job at that, too, and this includes reconstruction surgeries.
What usually happens during an emergency is that doctors try to resuscitate the patient, checking the breathing, giving fluids, before transferring them to the burn unit where the wound is dressed with cream. After a week or so, if doctors see there are areas that need surgery, then a tangential excision – or skin grafting – is done. According to Dr. Cruz, the thick skin from the thighs, legs, and back are preferred because "these are areas where it’s easiest to harvest skin."
Admittedly, Dr. Cruz’s greatest frustration is the lack of donors for the burn unit’s skin bank. Yes, Virginia, doctors can use the skin from other healthy individuals who are expected to die soon, and use it as a temporary "second skin" for the victim for up to five weeks. When the burn has completely healed and new skin has began forming, the temporary skin covering could be taken off. But because of cultural beliefs or aesthetic reasons, or perhaps a trauma from watching Silence of the Lambs (remember the killer who likes to skin his lady victims?), not a soul has expressed a willingness to donate skin. To think that the skin bank at the PGH burn unit was opened in 2001, with seed money given by the Burn Foundation of the Philippines. The skin bank team, says Dr. Cruz, has close ties with the transplant team of the National Kidney Institute.
Of course, they can use modern technology and grow – and havest – skin artificially, like what’s being done in the US now. But the catch is, one needs $1 million to start this kind of skin bank. Dr. Cruz, who took his burn fellowship at the State University of New York at Stonybrook in Long Island, says that the living skin bank technology began in 1975 in the US and has been used in kids who got badly burned since 1989 in the US.
Dr. Cruz says that burns are preventable injuries. In a country that celebrates a Fire Prevention Month, it’s best to observe safety precautions carefully. For instance, says Dr. Cruz, if you discover your LPG tank is leaking at night, never ever make the mistake of switching on the lights as starters could react to the gas, or even light a candle for that matter. "The best thing to do is to open all the windows and doors to let the gas out, and if necessary, get out of the house as fast as you can."
For kids who love to fly kites this summer, using the ribbons from an old cassette tape is a major no-no. The tape contains copper which conducts electricity. If the kite gets caught in a live wire, whoever’s holding the string is sure to be a goner. "Burns from flame are much worse than hot liquid burns," says Dr. Cruz.
Still the best way is to bring a burn victim to the hospital immediately. A lot of times Dr. Cruz and his staff admit burn patients only to find coffee, toothpaste, vinegar, ginger, guava leaves, even kerosene (!) applied on the wound as first-aid attempts. For minor burns, he says one can put the wounded part under running tap water and wash it with mild soap. After drying, it’s advisable to put antibiotic cream. "This is to stop the burning process," he says. No, ice is not necessary.
Dr. Cruz is realistic enough to say that it’s impossible to bring back the original state of the skin of burned victims. The affected area would normally be darker. For the doctors, 60 percent healing is remarkable enough especially for adult patients. Those with enough moolah, however, can always opt to go to the US and avail themselves of the artificial skin grafting technology. For those who couldn’t, they’d have to live with the trauma of having to experience hellish pain. And this is what the Alfredo T. Ramirez Burn Unit, which is celebrating its 25th anniversary this year, is trying to minimize, if not prevent.
"A burn is the most painful of injuries. It could be the worst thing that could happen to you because you get scarred for life," says Dr. Cruz.