Kyle Carpenter Awarded Fulbright on Burn Research
Kyle Carpenter, MD, received a 2018 Fulbright Scholar Award to join AMPATH’s surgery team and develop western Kenya’s first registry of burn patients. Dr. Carpenter is surgical resident at the Indiana University School of Medicine and Global Surgery Research Scholar. He is conducting research and engaging in care from June 2018 – June 2019 at Moi Teaching and Referral Hospital and throughout Kenya.
Morning rounds can be somewhat mundane as a surgery resident in the burn unit, but this specific day stood out in late January as the director of the burn unit at Eskenazi Hospital in Indianapolis informed us of a special transfer from Johannesburg, South Africa. I was intrigued due to my passion for global surgery, but as the story unfolded it highlighted the amazing fortitude of this specific patient and emphasized the need for improved surgical care in Kenya. He was a Kenyan-born British bush pilot who worked for a conservation group, patrolling for elephant poachers in Tsavo national park. On duty one morning early January, a strong wind overturned his plane, causing it to crash and catch on fire. He suffered severe burns from the fire and there was no one nearby. Despite his injuries, he self-extricated from the wreckage and trekked five miles, despite the potential dangers of nearby wild animals, until he was met by another human. From there he was transported by air to a hospital in Nairobi. However, due to limited infrastructure to manage his critical condition from the severe burns, the patient was transferred to Johannesburg. Yet again, he was now being transferred to our care.
While his bravery and courage are commendable, the reality is that most patients in western Kenya do not have access to the resources or connections that made it possible for our patient to receive care in South Africa and at Indiana University. My career goal is to improve access to surgical care in underserved parts of the world, such as western Kenya.
This patient was not my first exposure to the difficulties of providing care for victims of burn injuries in Kenya. As a fourth-year medical student, I had the opportunity to participate in a month-long rotation on the pediatric surgery service at African Inland Church Kijabe Hospital in Kenya, a small missionary hospital that serves as a private referral hospital for its region. There, I learned first-hand the frequency and significance of these injuries and the challenges faced by surgeons caring for burn patients in a resource-limited setting. These challenges, along with the rest of my experiences in Kijabe, solidified my passion for a career in global surgery.
I have been pursuing a career in global health since medical school. I was quickly attracted to my school’s robust global health programs. I completed a track of global health electives throughout my four years. Through the National School of Tropical Medicine, I earned a Diploma in Tropical Medicine. The focus of my capstone project was on the burden of road traffic injuries in low- and middle-income countries (LMICs). Choosing to complete an Ethics track of electives as well, I focused my ethics research on global surgery. I devised an ethical framework for measuring competent surgical performance. This tool can be used to determine whether surgeons working in humanitarian and/or global health settings may ethically perform procedures outside the scope of their formal training. Since starting my surgical residency at Indiana University, I have participated in an interdisciplinary global health residency forum along with residents from several different medical specialties. I now have the fortune of serving as my department’s first global surgery research scholar. These experiences have prepared me to meet the challenges of a career in academic global surgery.
Implementation of a Burn Registry
In general, the objective of my Fulbright Scholar experience and study is to better understand the burden of burn injuries in western Kenya as well as the implementation of a validated burn registry at Moi Teaching and Referral Hospital, the national referral hospital in western Kenya.
Burn injuries in Sub-Saharan Africa account for significant morbidity and mortality. The World Health Organization (WHO) estimates that the worldwide annual death toll due to burns is over 265,000, with burns in LMICs accounting for over 95% of all annual burn deaths.8 An estimated 43,000 people die of burns in Africa every year. In Kenya, burn injuries are associated with significantly higher rates of mortality when compared to other traumatic injuries and they are the leading cause of traumatic injury in patients under the age of 5.9-11This is consistent with other data in Africa, where children die three times as often from burns compared to the world. 12-16
There is a shortage of burn care providers in Sub-Saharan Africa, and in Kenya specifically.17,18 Many countries have one or two burn specialists, if any. These providers tend to be located at national referral hospitals in urban centers. Most patients in rural areas of these countries have no access to specialized burn care.18 Even in countries with such resources, burn care is complicated.
This two-phase study will develop a burn registry using validated methods and assess the feasibility of implementing the system into the national referral hospital in Western Kenya that care for patients injured by burns. The study design plans include:
Hospital burn workflow and needs assessment
Development of a burn registry data collection form
Retrospective review of burn patient charts, and
Cross-validation of burn data collection form
The data and subsequent analysis of this study provide the foundation for the first successful full-scale burn registry in Kenya utilizing the WHO Global Burn Registry model. In reviewing challenges in implementation, improvements to be made, and other issues that arise, our study team could develop a revised large-scale model that is best tailored to the national burn care needs in Kenya. Resultant guidelines for quality data collection, standardized burn care processes, and national oversight for development of burn prevention strategies has the potential to reduce the morbidity and mortality of burn injuries within Kenya. Lessons learned can help guide similar global health efforts in LMICs around the world.
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