Burns Care Services in Gaza, a forgotten national public health priority

In Gaza, the precarious humanitarian and economic situation means that burns injuries remain an ever-present danger. High reliance on gas stoves and heaters and candles for light during regular electricity outages present direct risks to families, in addition to the threat posed by industrial accidents and even military bombardments. Women and children are particularly at risk, with a significant proportion of burns injuries resulting from scalding at home.

With limited local capacity to effectively treat these injuries, many patients continue to be referred out of Gaza for care elsewhere in the occupied Palestinian territory (oPt) or abroad, causing potential delays to treatment and discomfort of pain to transferred patients.

Medical Aid for Palestinians (MAP) and our partners Interburns are working tirelessly to develop and improve burns care services in Gaza and across the occupied Palestinian territory (oPt) as a whole. This ambitious programme of work includes supporting health workers such like Dr Hussein Shanti to travel abroad for specialist burns care training.

We caught up with Dr Shanti, who is halfway through a four-year specialist plastic and burns surgery training programme in Egypt, to hear what he has learned so far, and how he will apply his new skills and knowledge to provide specialist care to his patients in Gaza.

Can you tell us a little about yourself Dr Shanti?

My name is Hussein Shanti, I’m Palestinian doctor from Gaza. After I finished medical school, I did a one-year training internship in the Ministry of Health (MoH) in Gaza and then worked as a doctor in the Emergency and Surgery Department at Al Shifa Hospital and Al Aqsa Hospital for two years.

Why is there a need to develop the skills of plastic and burns surgeons in Gaza?

The political context in Palestine in unstable and very complex, which decreases access to specialised health care services. This has led to increased suffering among patients with complicated tissue loss, limbs injuries and complicated fractures – cases which require specialist care in both plastic and reconstructive services. In addition, severe electricity shortages in Gaza force people to use alternative lighting methods, such as candles and gas, which increase the number of patients with extensive burns injuries in our emergency rooms. This in turn has amplified the need for critical and specialist medical care for patients. There is also a big gap in the number of specialised plastic and burns surgeons working in the Palestinian Ministry of Health to deal with this high caseload.

Is it difficult for Palestinian health workers in Gaza to access training opportunities?

Palestinian doctors face serious problems accessing training programmes in plastic and reconstructive surgery. First of all, there are no adequate programmes offered by the Palestinian Medical Council in plastic and reconstructive surgery, so doctors have to try and travel outside Gaza. There is also significant competition among health workers seeking plastic and reconstructive training, due to the high number of medical residents in Gaza. For example, it took me at least one year to get the initial acceptance of the Egyptian fellowship programme in plastic and reconstructive burns surgery. As a result, most surgeons currently working in burns units are only working on the basis of external educational courses, meaning that they are not specialised or consultants in plastic and burns surgery.

What was the process like for you to apply to travel and train in Egypt?

In early 2017, I was selected by MAP and the Ministry of Health for a burns training scholarship. I applied for the Egyptian fellowship centre in Cairo. After that, I had to wait for one year, which included waiting to be accepted on this programme, receiving an acceptance letter and getting permission to travel to Egypt.

At the end of 2018, I was accepted on the programme in Egypt, but it took another 20 months or so to start the training. This included waiting for Rafah crossing into Egypt to open, in addition to waiting for security permits, so it took me a lot of time to actually start the programme

What have you learnt over the past two years?

I spent the first two years in the general surgery department. Here I developed my knowledge and clinical experience including dealing with patients in the Burns Unit and the Emergency Room, conducting minor surgical procedures and using various surgical instruments, and correct patient recordkeeping. Having the opportunity to work with a variety of patients gave me helpful experience of surgical interventions for different patients in orthopaedic and general surgery departments.

I am very proud of passing the first two years of the burns and plastic surgery programme, receiving the third highest mark in Egypt.

How has your training adapted since the outbreak of COVID-19?

After COVID-19 hit Egypt like all other countries across the world, the Egyptian Ministry of Health was forced to postpone all elective surgeries and close of a lot of outpatient clinics. Many hospitals also focus on COVID-19 response. This was the case in the hospital I am working in, which is why I became more dependant on online educational resources, such as webinars, attending online lectures, and reading books. I also had to postpone my Membership of the Royal College of Surgeons (MRCS) examination. As there have been no elective surgeries for the past six months, all of my training has been in emergency rooms. Post-surgical follow-up for patients has also been disrupted.

What will the next four years of your training involve?

There are six areas in the burns and plastic surgery residency programme. The first is the two years of general plastic and reconstructive surgery concepts such as skin grafts and skin flaps; dealing with complications such as contractures; correct dressing of burns wounds; and other general concepts of plastic, reconstructive and burns surgery. The second part focuses on upper limb injuries including hands, bone, tendon, and nerve surgery. The third part focuses on lower limb injuries including gunshot injuries, grafting, and doing skin flaps for lower injuries. The fourth area is head and neck surgery, including maxillofacial, cleft lip and palate, and paediatric surgeries. The final two areas of the programme are about aesthetic medicine. I will be focusing on the first four main branches of the programme.

How will your training help patients in Gaza?

After I finish the programme, I hope that I will be able to help and treat Palestinian patients who experience complications from serious burns injuries, and help support the high number of patients who suffered from limb injuries, particularly lower limb amputations and comminated fractures. This will enhance the medical services offered to Palestinian patients in Gaza especially those with burns, lower and upper limbs injuries.

What are your hopes for the future?

My wish and priority is to finalise my speciality in order to help support Palestinian patients in Gaza in treating their problems and suffering from burns injuries. I hope that I can contribute, even a little bit to improving the medical care services in hospitals in Gaza, and to transfer my knowledge and experience in plastic surgery to my colleagues in Gaza.

Many thanks to the MAP team for sponsoring me in this scholarship.

If you would like to support MAP’s burns care work in Palestine, please donate today.

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