Eur J Plast Surg (2006) 29: 97–98
LETTER TO THE EDITOR
A letter from Malawi
Received: 10 November 2005 / Accepted: 23 February 2006 / Published online: 20 June 2006
# Springer-Verlag 2006
Malawi is a south-eastern African country with a popu-
lation of approximately 11 million. It is one of the ten
poorest countries in the world, but also a country of
stunning natural beauty . Blantyre, a city of 2 million, is
Malawi’s cultural and economic centre, and houses its only
Burn care is provided at Queen Elizabeth Central
Hospital, Blantyre. The burn unit consists of a few
inpatient beds, an outpatient clinic, and an operating
theatre. Since it first started treating patients in 1994, it has
made a significant impact on the treatment of burns in
I observed a number of burn patients during my brief
visit. Most of the burn victims were children and young
people. More than half were children aged 6 and under.
They would accidentally burn themselves with hot water or
an open fire. More than 90% of patients were under the age
of 30. Males were twice as likely to sustain a burn over
females. While 75% of female patients were adults, 75% of
male patients were children.
Most patients were injured accidentally, but occasion-
ally, a non-accidental burn would present. I encountered
only one non-accidental burn patient. One of three patients
as an epileptic who sustained a burn during an epileptic fit
near a petroleum lamp or open fire. Shortage of anti-
epileptic medication caused non-compliance.
Prevalence rates for HIV/AIDS among local population
vary slightly. James et al.  suggested that one in three
aged 15 and above are HIV-positive. None of the patients
encountered were tested for HIV as there were no in-
dications for it.
Malnutrition was a common problem among burn
patients. This is consistent with the finding by Kurth ,
who reported chronic malnutrition rates in Malawi children
of between 36 and 41%.
For second degree burns, the standard treatment for
majority of burns was to de-roof the blisters, silver
sulfadiazine, dressings, and follow-up in the dressing
clinic. Although alternatives such as topical tetracycline
ointment exist, they were not routinely used because they
were not commonly available. They could, however, be
used as cheaper and effective alternatives. For burns that
needed excision and grafting, this was often performed
under Ketamine anaesthesia. Antibiotics were given, and
patient was discharged when feasible with a follow-up in
the dressing clinic.
HIV/AIDS and malnutrition play an important role in the
management of burns in Malawi. From a practical point of
view, these two factors are the two most important
variables in terms of outcomes of management.
The hospital hygiene was generally poor, although the
burn unit was considerably better. The standard equipment
was basic, but the staff compensated for this with their
dedication and enthusiasm. Surgical gloves were routinely
washed and re-used, as were surgical gowns and hats.
Drugs available were limited in type and quantity. Most
patients who needed antibiotics received a combination of
antibiotics, including a Penicillin-based antibiotic.
Expertise was limited. Nurses managed patients in the
dressing clinic competently, but also rotated into operating
theatre and the ward. Recruitment of nurses was difficult as
the government did not pay them much. The Chief Surgeon
often had to top their pay using his own money to retain
G. Virich (*)
University College of London,