Burns victims risk lives in general ward

By ANGELA GREGORY

From behind his horrifically scarred face, Maka Fa'aoa's shining eyes and flash of white teeth reveal a brave boy facing a daunting future.

Maka toppled head first into a bonfire at his Henderson home last year, leaving him with deep burns to 67 per cent of his body.

The 9-year-old underwent 11 operations lasting up to 14 hours in his first 28 days in intensive care at Middlemore Hospital.

The stoic Tongan boy, repeatedly described as lovely by the hospital staff, then had a further five operations and reconstructive surgery as burn surgeons battled to restore his face.

The surgeons say their work was all the more difficult because of the inadequate facilities they work in.

Dr Michael Muller and Dr Stephen Mills, co-directors of the Middlemore burns service, say their job would have been much easier had Maka been treated in a dedicated burns unit.

Instead, they must continue to treat such complex burns cases within the confines of a general plastic surgery ward.

Dr Muller said he was not interested in extending his two-year contract, which runs out in January.

"I feel I am getting poor results, which I am not used to getting. I am not going to stay."

Last year, Maka made the difficult transition back to school, and has now enjoyed his 10th birthday party.

His mother, Lata Tamoua, cannot speak too highly of the Middlemore burns service staff.

"He is a real chatterbox there and knows all the nurses' names," she said. "They have done a brilliant job."

Dr Muller and Dr Mills are also pleased with Maka's progress, but they despair at the conditions they had to work under.

Dr Muller, president of the Australia-New Zealand Burns Association, said New Zealand burns victims were poorly served and some had died because of inadequate facilities.

The lack of a specialised national burns facility was appalling and went against world trends, he said.

Dr Muller, an Australian general surgeon contracted to Middlemore Hospital, said other Western countries had long ago established separate burns units.

"The system of burns care in New Zealand was rejected in most other places around the world years ago. I think burned Kiwis have had a very poor deal for quite a long time."

A major concern was the risk of spreading infections, which slowed a patient's recovery and could be fatal.

At present a serious infection has spread among three burns patients in separate rooms on the plastic surgery ward at Middlemore.

The multi-resistant infection, known as MRSA (methicillin-resistant staphylococcus aureus), took just 10 days to move along three rooms and has already led to a deterioration in the skin grafts of one patient.

Dr Muller said his treatment last year of Maka had been hampered by the difficult working conditions.

He was also frustrated at the lack of support staff available - such as no speech therapists despite burns victims often needing help in learning how to swallow again.

"And because there is no one central unit in New Zealand we don't get the chance to practise enough," he said. "Treating a severely burned child is like trying to land a space shuttle ."

Dr Mills said infections leading to organ failure accounted for most burn deaths where the patient survived the initial trauma and first week of intensive care.

It was critical that patients were isolated in separate rooms.

After an infection, rooms should ideally be kept empty for up to a month to get rid of the germs.

"You can't run these wards like a hotel with 90 per cent occupancy, but we do."

Dr Mills said the best estimate from the Ministry of Health indicated late 2004 as the earliest a specialised unit could be hoped for.

The ministry's deputy director-general clinical services, Dr Colin Feek, said the need for a national burns unit was recognised.

The ministry planned to give Counties-Manukau Health extra money to establish a unit, but no time had been set.

nzherald.co.nz/hospitals