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Pediatric burn patients from Vietnamese Camps in Hong Kong from 1989 to 1997
Burns 26 (2000) 271±274
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Pediatric burn patients from Vietnamese Camps in Hong Kong from 1989 to 1997 Eric S.Y. Chan*, Walter W.K. King Division of Head and Neck/Plastic and Burns Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China Accepted 7 July 1999
Abstract Over the 9 years from 1989 to 1997, many children who suered from scald burns in the Vietnamese camps in the New Territories of Hong Kong were treated. The pro®le of these children was examined and analyzed. # 2000 Elsevier Science Ltd and ISBI. All rights reserved. Keywords: Burns; Refugee; Scald; Vietnamese
1. Introduction From 1989 to 1997, many Vietnamese refugees came to Hong Kong by boat from Vietnam for various reasons, including both political and economic hardship. Most of them were kept inside several designated detention centers throughout Hong Kong. During the peak years, there were more than 100,000 Vietnamese scattered throughout the New Territories of Hong Kong. The Whitehead Detention Center, was the largest center with 24,000 residents, located only a few kilometers from the Prince of Wales Hospital. The Vietnamese refugees were all living in the temporary housing in these camps for quite a few years, waiting to be screened for emigration to the USA, Canada or European countries. These screening procedures were tedious and prolonged. During these years, many children were born in the camps and lived in a very limited space where they would sleep, bath and eat. The detention centers were usually divided into sections. Each section could house about 3000 residents
* Corresponding author. Tel.: +852-2-632-2639; fax: +852-2-6325008.
in 8±10 houses. The houses were about the same size and of single story except for one center. The area of each house was about 300 m2 with four rows of beds of treble bunks. There were 10±12 beds in one row. Two persons shared one bunk of the bed. The camp management provided hot meals, hot water, clothing, daily utensils and medical services to the residents. Other services such as education, recreation, well baby service, dental service, vocational training, information and orientation service and supply of provisions, were provided by the non-government organizations under the umbrella of United Nations High Commissioner for Refugees (Fig. 1). Many families have small children and babies. Because of the crowded conditions, quite a few of these children suered from burns injuries in the camps. Most of them suered from scald burns, especially in the wintertime when the parents would use hot water to bath children. Scald burns from the spillage of hot soup and congee over the children were also very common. Many of these patients were sent to our hospital where they were admitted to the Burns Unit for treatment. This study is a pro®le of the pediatric patients that we had treated over the 9 years period from 1989 to 1997.
0305-4179/00/$20.00+0.00 # 2000 Elsevier Science Ltd and ISBI. All rights reserved. PII: S 0 3 0 5 - 4 1 7 9 ( 9 9 ) 0 0 1 3 8 - 2
272
E.S.Y. Chan, W.W.K. King / Burns 26 (2000) 271±274
Fig. 1. A corner of a dentention center house.
2. Methods This retrospective study was carried out on the acute burn pediatric patients under the age of 16 treated at the Prince of Wales Hospital Burns Unit in Hong Kong between the years 1989 to 1997. They were all from the Vietnamese detention centers in Hong Kong. Their charts were reviewed for the sex, age, etiology and extent of burns, days of hospitalization and the number of operations.
down. Only a few patients were admitted to our Burns Unit during these two years (Fig. 2). The majority of the Vietnamese pediatric patients, 171 out of a total of 182, suered from scald injuries. There were seven patients who suered from ¯ame burns and three from electrical burns (Fig. 3). Most of the patients sustained less than 10% of the total sur-
3. Results During the years 1989±1997, there were a total of 182 children, aged below 16 years old, admitted from the Vietnamese detention camps to our Burns Unit. There were 93 males and 89 females. The largest number of admissions was in 1991, with a total of 44. That was the same year when we have the largest number of Vietnamese staying in Hong Kong. During the years 1996±1998, many Vietnamese were returning to their home country with the help of the Hong Kong Government. The detention centers were slowly closing
Fig. 2. Sex distribution in Vietnamese burn children admissions 1989±1997 PWH.
E.S.Y. Chan, W.W.K. King / Burns 26 (2000) 271±274
273
scald 171 flame 7 electrical 3 others 1
7
3
1
171 Fig. 3. Types of burns in Vietnamese children 1989±1997 PWH.
Fig. 5. Number of operations in Vietnamese burn children 1989± 1997 PWH.
face area burned. However, there were 20 patients who had more than 15% total surface area burned (Fig. 4). One hundred ®fty-nine patients out of 182 patients (87%) required no operative procedure for the burn injuries. The wounds were managed conservatively with dressing changes and local wound care. Twentythree patients however required a total of 45 operative procedures for debridement and skin grafting (Fig. 5). Most of the patients were hospitalized for less than three weeks, ranging from one to 20 days (Fig. 6).
of burn admissions from the community and that from the Vietnamese camps is not signi®cant. The majority of the pediatric admissions from the community were also scald injuries from home accidents. The home conditions of this community were better than those of the Vietnamese camps. The similar number of burn injuries re¯ects that a better living conditions does not necessarily translate to a smaller number of burn injuries. Many pediatric burn injuries are preventable if the parents are more informed and better educated about home safety precautions. The living conditions and the social economic status of the family may not be signi®cant contributing factors to the injury. The very crowded living conditions are presumably the basis of many home accidents in addition to the burn injuries mentioned above. Throughout the years and for various reasons, there were a few episodes of riots within the Vietnamese camps. Burns by tear gas used in controlling the riots has been reported [1]. This large number of Vietnamese camp residents in a civilian setting was uncommon and unprecedented. The temporary
4. Discussion There were a total of 182 Vietnamese pediatric admissions to our Burns Unit during this 9-year period, with an average of 20 patients per year. The camp nearest to our hospital housed about 24,000 residents. That translates to 8.425 admissions per 10,000 residents per year. For the same the period of time, the number of pediatric admissions to the Prince of Wales Hospital Burns Unit was 934, an average of 103.8 per year. The population served by this hospital is about 1.2 million. That is 8.65 admissions per 10,000 residents per year. The dierence in the number
Fig. 4. %TSAB in Vietnamese burn children 1989±1997 PWH.
Fig. 6. Days of hospitalization in Vietnamese burn children 1989± 1997 PWH.
274
E.S.Y. Chan, W.W.K. King / Burns 26 (2000) 271±274
housing was built in a hurry throughout the city within a very short time for a large number of refugees with limited funding. The housing was meant for only a short period of time with the idea that these refugees would emigrate to another countries quite rapidly as promised. It turns out that many of these residents did stay in Hong Kong for ®ve or more years. A big health problem was generated in addition to the ®nancial burden for Hong Kong. We all feel sorry for these children's pain and suering. Many of these scald injuries are avoidable. Parental education in regard to home safety precautions here is of paramount importance. These accidents happened in where the Vietnamese people were living in a very crowded space and in where children were left unattended. We may learn from these accidents since many of our Hong Kong citizens live in very crowded apartments. It is quite common that both parents have to work to support the family while the younger children are left home to be taken care of by the older siblings, their elderly grandparents or a housekeeping maid. Many of the accidents are due to negligence or ignorance. Some of the factors are dicult to alter but many can be improved. One of the most common etiologies in scald injuries in the winter is that the mother would like to use hot water to bath the child
in a basin. A typical mother fears that the child would catch a cold or come down with pneumonia if the water is too cold. As a habit she would prefer to put in hot water in the basin before mixing it with cold water to the right temperature. Often times she would be distracted by something else, such as something cooking in the kitchen. She may have the child unattended before she mixes the hot water with enough cold water or the child would turn on the hot water tap after the mother is gone. This habit of adding cold water to the hot water in the basin is actually very common in a traditional Chinese family. This tradition can be changed with education, mostly through school and public multimedia programs in the hope that many of these scald injuries can be prevented [2,3].
References [1] Zekri ABM, King WWK, Yeung R, Taylor WR. Acute mass burns caused by o-chlorobenzylidene malononitrile (CS) tear gas. Burns 1995;21:586±9. [2] Fallat ME, Rengers SJ. The eect of education and safety devices on scald burn prevention. J Trauma 1993;34:560. [3] McLoughlin E. A simple guide to burn prevention. International Society for Burn Injuries in collaboration with World Health Organization. Burns 1995;21:226.
www.elsevier.com/locate/burns
Pediatric burn patients from Vietnamese Camps in Hong Kong from 1989 to 1997 Eric S.Y. Chan*, Walter W.K. King Division of Head and Neck/Plastic and Burns Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China Accepted 7 July 1999
Abstract Over the 9 years from 1989 to 1997, many children who suered from scald burns in the Vietnamese camps in the New Territories of Hong Kong were treated. The pro®le of these children was examined and analyzed. # 2000 Elsevier Science Ltd and ISBI. All rights reserved. Keywords: Burns; Refugee; Scald; Vietnamese
1. Introduction From 1989 to 1997, many Vietnamese refugees came to Hong Kong by boat from Vietnam for various reasons, including both political and economic hardship. Most of them were kept inside several designated detention centers throughout Hong Kong. During the peak years, there were more than 100,000 Vietnamese scattered throughout the New Territories of Hong Kong. The Whitehead Detention Center, was the largest center with 24,000 residents, located only a few kilometers from the Prince of Wales Hospital. The Vietnamese refugees were all living in the temporary housing in these camps for quite a few years, waiting to be screened for emigration to the USA, Canada or European countries. These screening procedures were tedious and prolonged. During these years, many children were born in the camps and lived in a very limited space where they would sleep, bath and eat. The detention centers were usually divided into sections. Each section could house about 3000 residents
* Corresponding author. Tel.: +852-2-632-2639; fax: +852-2-6325008.
in 8±10 houses. The houses were about the same size and of single story except for one center. The area of each house was about 300 m2 with four rows of beds of treble bunks. There were 10±12 beds in one row. Two persons shared one bunk of the bed. The camp management provided hot meals, hot water, clothing, daily utensils and medical services to the residents. Other services such as education, recreation, well baby service, dental service, vocational training, information and orientation service and supply of provisions, were provided by the non-government organizations under the umbrella of United Nations High Commissioner for Refugees (Fig. 1). Many families have small children and babies. Because of the crowded conditions, quite a few of these children suered from burns injuries in the camps. Most of them suered from scald burns, especially in the wintertime when the parents would use hot water to bath children. Scald burns from the spillage of hot soup and congee over the children were also very common. Many of these patients were sent to our hospital where they were admitted to the Burns Unit for treatment. This study is a pro®le of the pediatric patients that we had treated over the 9 years period from 1989 to 1997.
0305-4179/00/$20.00+0.00 # 2000 Elsevier Science Ltd and ISBI. All rights reserved. PII: S 0 3 0 5 - 4 1 7 9 ( 9 9 ) 0 0 1 3 8 - 2
272
E.S.Y. Chan, W.W.K. King / Burns 26 (2000) 271±274
Fig. 1. A corner of a dentention center house.
2. Methods This retrospective study was carried out on the acute burn pediatric patients under the age of 16 treated at the Prince of Wales Hospital Burns Unit in Hong Kong between the years 1989 to 1997. They were all from the Vietnamese detention centers in Hong Kong. Their charts were reviewed for the sex, age, etiology and extent of burns, days of hospitalization and the number of operations.
down. Only a few patients were admitted to our Burns Unit during these two years (Fig. 2). The majority of the Vietnamese pediatric patients, 171 out of a total of 182, suered from scald injuries. There were seven patients who suered from ¯ame burns and three from electrical burns (Fig. 3). Most of the patients sustained less than 10% of the total sur-
3. Results During the years 1989±1997, there were a total of 182 children, aged below 16 years old, admitted from the Vietnamese detention camps to our Burns Unit. There were 93 males and 89 females. The largest number of admissions was in 1991, with a total of 44. That was the same year when we have the largest number of Vietnamese staying in Hong Kong. During the years 1996±1998, many Vietnamese were returning to their home country with the help of the Hong Kong Government. The detention centers were slowly closing
Fig. 2. Sex distribution in Vietnamese burn children admissions 1989±1997 PWH.
E.S.Y. Chan, W.W.K. King / Burns 26 (2000) 271±274
273
scald 171 flame 7 electrical 3 others 1
7
3
1
171 Fig. 3. Types of burns in Vietnamese children 1989±1997 PWH.
Fig. 5. Number of operations in Vietnamese burn children 1989± 1997 PWH.
face area burned. However, there were 20 patients who had more than 15% total surface area burned (Fig. 4). One hundred ®fty-nine patients out of 182 patients (87%) required no operative procedure for the burn injuries. The wounds were managed conservatively with dressing changes and local wound care. Twentythree patients however required a total of 45 operative procedures for debridement and skin grafting (Fig. 5). Most of the patients were hospitalized for less than three weeks, ranging from one to 20 days (Fig. 6).
of burn admissions from the community and that from the Vietnamese camps is not signi®cant. The majority of the pediatric admissions from the community were also scald injuries from home accidents. The home conditions of this community were better than those of the Vietnamese camps. The similar number of burn injuries re¯ects that a better living conditions does not necessarily translate to a smaller number of burn injuries. Many pediatric burn injuries are preventable if the parents are more informed and better educated about home safety precautions. The living conditions and the social economic status of the family may not be signi®cant contributing factors to the injury. The very crowded living conditions are presumably the basis of many home accidents in addition to the burn injuries mentioned above. Throughout the years and for various reasons, there were a few episodes of riots within the Vietnamese camps. Burns by tear gas used in controlling the riots has been reported [1]. This large number of Vietnamese camp residents in a civilian setting was uncommon and unprecedented. The temporary
4. Discussion There were a total of 182 Vietnamese pediatric admissions to our Burns Unit during this 9-year period, with an average of 20 patients per year. The camp nearest to our hospital housed about 24,000 residents. That translates to 8.425 admissions per 10,000 residents per year. For the same the period of time, the number of pediatric admissions to the Prince of Wales Hospital Burns Unit was 934, an average of 103.8 per year. The population served by this hospital is about 1.2 million. That is 8.65 admissions per 10,000 residents per year. The dierence in the number
Fig. 4. %TSAB in Vietnamese burn children 1989±1997 PWH.
Fig. 6. Days of hospitalization in Vietnamese burn children 1989± 1997 PWH.
274
E.S.Y. Chan, W.W.K. King / Burns 26 (2000) 271±274
housing was built in a hurry throughout the city within a very short time for a large number of refugees with limited funding. The housing was meant for only a short period of time with the idea that these refugees would emigrate to another countries quite rapidly as promised. It turns out that many of these residents did stay in Hong Kong for ®ve or more years. A big health problem was generated in addition to the ®nancial burden for Hong Kong. We all feel sorry for these children's pain and suering. Many of these scald injuries are avoidable. Parental education in regard to home safety precautions here is of paramount importance. These accidents happened in where the Vietnamese people were living in a very crowded space and in where children were left unattended. We may learn from these accidents since many of our Hong Kong citizens live in very crowded apartments. It is quite common that both parents have to work to support the family while the younger children are left home to be taken care of by the older siblings, their elderly grandparents or a housekeeping maid. Many of the accidents are due to negligence or ignorance. Some of the factors are dicult to alter but many can be improved. One of the most common etiologies in scald injuries in the winter is that the mother would like to use hot water to bath the child
in a basin. A typical mother fears that the child would catch a cold or come down with pneumonia if the water is too cold. As a habit she would prefer to put in hot water in the basin before mixing it with cold water to the right temperature. Often times she would be distracted by something else, such as something cooking in the kitchen. She may have the child unattended before she mixes the hot water with enough cold water or the child would turn on the hot water tap after the mother is gone. This habit of adding cold water to the hot water in the basin is actually very common in a traditional Chinese family. This tradition can be changed with education, mostly through school and public multimedia programs in the hope that many of these scald injuries can be prevented [2,3].
References [1] Zekri ABM, King WWK, Yeung R, Taylor WR. Acute mass burns caused by o-chlorobenzylidene malononitrile (CS) tear gas. Burns 1995;21:586±9. [2] Fallat ME, Rengers SJ. The eect of education and safety devices on scald burn prevention. J Trauma 1993;34:560. [3] McLoughlin E. A simple guide to burn prevention. International Society for Burn Injuries in collaboration with World Health Organization. Burns 1995;21:226.