Burn unit in tight spot

The DMCH burn unit has had its doors open to all arson victims, but it might have been able to prevent a few deaths if it were not for a lack of space, inadequate equipment and staff negligence.
Shahjahan Mia, 30, a burn victim who died on December 27, had developed a deadly infection in his lungs after breathing fumes, said the burn unit's Resident Surgeon Partha Shankar Pal.
He had only 31 percent burns. By the time he died, the condition of his breathing tract had become so bad that each gulp of air was a stab of pain -- he cried out every time he breathed.  
Similarly, twenty-six-year-old Al-Amin died in the High Dependency Unit on December 18 with only 26 percent burns, mainly because of infection he acquired from other patients very close to him.
Al-Amin may have had a chance at life if the Dhaka Medical College Hospital (DMCH) authorities had kept him in isolation, added Pal.
“The flames had flayed Al-Amin's skin and left him exposed to infection. Yet he had to be kept beside other patients because there were too many of them.”
His infection went out of control to such an extent that he developed a resistance to antibiotics.
Samanto Lal Sen, veteran burn expert at the unit, told The Daily Star that the High Dependency Unit (HDU) needs to be a completely isolated ward.
According to DMCH sources, the wards are forced to let family and caregivers in because there are not enough nurses to take care of so many patients.
"Only three nurses take care of the twenty patients in the HDU and the others who had to be kept in the corridor because the beds were not enough," said Partha Shankar Pal.
Even the ICU has only one ward boy to attend to the patients.
Around 70 staff are yet to be on the payroll since the burn unit is still running as a government project, said Samanto Lal.

"They do not get any wages; they just make do with the tips they get from patients. Therefore, they have no accountability, and I cannot penalise them either if they do not perform their duties."  
Even those who get wages are paid once in three months, he added.
The burn unit is intended for a hundred patients, but it is currently treating over 350. "With so many patients and so little space, it becomes difficult for me to keep the hartal victims in isolation," Samanto observed.
The ICU needs at least fifty beds, whereas it currently has only ten, he said.
The unit had only one bed empty yesterday, meaning that if the condition of two or more patients deteriorates, only one of them can be accommodated.
Many life-saving machines, some of which are needed for giving mechanical ventilation to critically injured patients, are missing in the ICU, where most of the deaths took place.
"The proposed budget for the ICU was Tk 8 crore, but we were given only Tk 1.5 crore. There are at least 14 different types of much-needed equipment that we do not have," said ICU in-charge Shah Alam.
Although the ICU has four ventilators that can give life support to the patients, it lacks monitoring equipment to make them work effectively.