Bringing Sedation to Paediatric Burns Care at Tintswalo Hospital
The Hidden Trauma of Burn Care
Burns are a significant cause of injury for children across South Africa, and I saw many of these cases during my time working in Tintswalo Hospital’s casualty department.It’s clear that children need thorough and compassionate treatment—not only to improve physical outcomes but to ensure they feel safe, respected, and cared for during a frightening time.
When I arrived at Tintswalo, I quickly learned that children on the paediatric ward had gone without sedation during burn dressing changes for decades. These dressing changes happen every two days—a painful process that can leave children distressed, fearful, and traumatised.
Sedation helps children tolerate these procedures by placing them in a semi-conscious state, reducing pain and preventing traumatic memories. Without it, children often become distrustful of the medical team, making their ongoing care even harder to deliver.
Barriers to Change
Despite the clear need, no children were receiving sedation. I was told this had been the case for the past 30 years, for many reasons:
- A lack of time, with doctors stretched across multiple wards.
- Limited access to oxygen, monitoring, suction, and emergency equipment.
- Little experience or training in procedural sedation.
- A belief among some staff that sedation added unnecessary work without clear benefit.
When I began offering to carry out sedation myself, I faced all of these challenges. Even when I found the necessary equipment, I struggled to gain buy-in from the nursing team, who viewed it as an extra burden on their already stretched capacity.
A Turning Point in Practice
The real break through came when Dr Mosoane, Head of Surgery, championed the effort. Despite his many responsibilities, he took the time to perform the procedures alongside me. This shifted the mood among the nursing team. Seeing a trusted local leader commit to the practice helped them see its value and got more staff on board.
This was an important lesson for me as a foreign volunteer. Building good relationships is important—but lasting change happens when local professionals lead the way.Their leadership is what ultimately brings the wider team along.
Challenges That Remain
Providing sedation for children with burns at Tintswalo Hospital remains a challenge. Equipment is not always available. There are no formal protocols in place yet. However as a result of these initial efforts now one doctor is currently providing sedation.
These barriers still need to be overcome—perhaps by another willing volunteer—but I’m encouraged that we’ve made a start.
Looking Ahead
Progress is possible, even in resource-limited settings. I hope that future volunteers and local staff continue this work, proving that compassionate, humane care is not a luxury, but something every child deserves.
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Hari Jeyabelen, UK Medical Doctor