1) The majority of burns in East African children are unintentional scalds at home in children aged 0-3. Harmful first aid by parents increases need for surgery. 2) A theatre outreach program educated over 10,000 villagers through community leaders on burn prevention and first aid. 3) This culturally-sensitive strategy was well-received and hypothesized to decrease burn injuries and surgical interventions.

1. Utilizing Local Theatre to Reduce the Surgical Burden of Childhood Burns in East Africa
JJ Gallagher, MD, FACS*, KB Mitchell, MD*,
A Kuijs, OT§
, U Nkumbi, RN§
*Weill Cornell Medical College, New York, NY §
Sekou Toure Regional Referral Hospital, Mwanza, Tanzania
The majority of burns (70%) presenting to our East Afri-
can pediatric burn unit are unintentional scalds occur-
ring among children aged 0-3 in the home. (Figure 1)
Harmful first aid administered by parents includes flour,
egg, urine, toothpaste, and rabbit fur (Figure 2); chil-
dren treated this way present with deep burns that are
likely to necessitate surgical closure.
Our rural, tribal population maintains a strong oral tradition with limited understanding of written
material. We established a unique system of theatre outreach to disseminate information re-
garding burn injury. It was hypothesized that this culturally-sensitive prevention strategy would
decrease the surgical burden of burns in our region.
We initiated a six-month pilot period of four seminars targeting 100 villages in the 9,467 square
kilometer referral area for our burn unit. The outreach sought through local theatre to educate
villagers on burn prevention and appropriate first aid.
We conducted seminars in different districts for community leaders including health profession-
als, nursery school teachers, primary school teachers, religious leaders and local outreach
groups. Resource persons from the local fire department, police, social welfare office, as well as
caregivers of former burn patients were invited in the seminars to share experiences, give testi-
monials and underline the importance of protecting children from being burn.
We provided community leaders with pictorially-oriented posters (Figure 3) and brochures to be
distributed in their communities.
We invited the media and gave local radio and television interviews.
Figure 1: Unsafe cooking situation with unattended
playing child
Figure 2: Burn
victim treated
with rabbit fur
before coming
to the hospital
Figure 3: Poster in Kiswahili language. Translation: “Protect children from being burned” and
“Keep them away from dangerous heat sources”.
 430 seminar participants from various districts learned strategies for burn prevention.
 They received 1,600 posters and 8,000 brochures to distribute (Figure 4), reaching an audi-
ence of over 10,000 villagers. Through song, drama and dance the theatre depicted danger-
ous fire and hot water situations, and illustrated appropriate burn first aid. {Figure 5).
 Over 2,000 caregivers in the pediatric ward were educated about preventing the child from
being burned and are encouraged to educate relatives and neighbors. (Figure 6)
 Murals in the pediatric ward depict prevention measures and appropriate first aid for burns
(Figure 7)
 Local radio, television and newspapers reported about the outreach activities.
Figure 5: Drama showing parents bringing their child
with burns to the local healer applying harmful com-
modities. The child ends up with disabling contrac-
tures.
Figure 4: Boy in the village with
brochure
Community education using local theatre has received excellent reception by the local rural
community and warrants further exploration as a unique vehicle for primary burn prevention in
an oral tradition East African culture. (Figure 8) We hypothesize that this ultimately would de-
crease burn injury and decrease the rate of referrals requiring surgical intervention.
Figure 6 Education to caregivers in the hospital Figure 7 Murals in the pediatric ward
1.Mitchell KB, Giiti G, Gallagher JJ. Survey of Care and Evaluation of East African Burn Unit Feasibility: An Ac-
ademic Burn Center Exchange. JBCR. 2013;34:78-81.
2.Chalya PL, Mabula JB, Dass RM, Giiti G, Chandika AB Kanumba ES et al. Pattern of childhood burn injuries
and their management outcome at Bugando Medical Centre in Northwestern Tanzania. BMC Res Notes
2011;485.
3.Outwater AH, Ismail H, Mgalilwa L, Temu MJ, Mbembati NA. Burns in Tanzania: morbidity, mortality, causes,
and risk factors: a review. Int J Burn Trauma. 2013;3(1):18-29.
4.Roman IM, Lewis ER, Kigwangalia HA, Wilson ML. Child burn injury in Dar es Salaam, Tanzania: results from
a community survey. Int J Inj Contr Saf Promot. 2012;19(2):135-9
5.Kuijs A. Monthly statistics of pediatric burn unit Sekou Toure Regional Referral Hospital, Mwanza, Tanzania,
2013-2015.
Applicability of Research to Practice: Development of burn prevention strategies in oral tradition cultures.
External Funding: ELMA Grant #F13F003, Weill Cornell Medical Center, New York Firefighters Burn Center
Foundation
Figure 8 Traditional music and dance to mobilize people in the village
Age Age Age Age Age Age
Admissions Scald Flame 0-1 1-2 2-3 3-4 4-5 >5
2013 Apr 4 4 - 1 2 - 1 - -
May 8 5 3 - 6 1 1 - -
Jun 8 5 3 - 3 6 - - -
Jul 21 14 7 3 11 2 2 - 2
Aug 12 10 - 2 9 1 - - -
Sep 12 10 - 4 2 2 1 3
Oct 12 11 1 3 5 4
Nov 14 14 - - 8 3 - 1 2
Dec 7 7 - 2 4 - - - 1
2014 Jan 17 15 2 3 6 4 2 0 2
Feb 15 13 2 6 4 2 0 0 3
Mar 13 13 0 4 4 2 1 1 1
Apr 10 7 3 2 7 0 1 0 0
May 19 18 1 6 7 2 2 3 0
Jun 35 30 2 11 15 3 3 1 2
Jul 21 17 3 6 10 2 2 0 4
Aug 17 15 2 4 4 4 3 0 2
Sep 22 20 2 2 7 3 3 0 7
Oct 20 19 1 2 8 7 1 1 1
Nov 28 23 3 8 4 8 2 1 5
Dec 34 29 5 10 9 7 3 2 3
2015 Jan 28 25 1 8 11 7 1 0 1
Feb 24 19 1 6 7 7 1 0 3
Mar 24 24 0 7 6 5 4 1 1
Apr 32 28 4 3 9 8 2 2 8
TOTAL 457 395 46 103 168 90 36 13 51
86% 10% 23% 37% 20% 8% 3% 11%
Admissions Scald Flame 0-1 1-2 2-3 3-4 4-5 >5
Table 1: Statistics
from our burn unit