Burn injuries: Not a national priority

In 2006, Radha Shrestha and her mother suffered severe third-degree burns when a gas cylinder exploded in their one-bedroom home. Their treatment began only on the third day when they were shifted to Sushma Koirala Memorial Hospital (SKMH) in Sankhu. Shrestha’s mother passed away and she was discharged after 39 days. 

Doctors attending to them said her mother’s death could have been prevented had she received immediate medical attention. Nearly two decades on, the situation remains much the same. Most hospitals in Nepal are still ill-equipped to handle burn cases, causing inevitable delays in case of emergencies. 

Dr Binod Karn, associate professor of plastic surgery at Nepalgunj Medical College, says the government hasn’t given much attention to burn care. A few NGOs and INGOs conduct awareness and training programs and give medical assistance, and that’s about it. 

Burns are the second most common injuries in Nepal. They are the most debilitating too. Treatment often lasts years, with victims requiring multiple surgeries. There are roughly 50,000 injuries and 21,000 deaths due to burns every year. Nepal is ranked number one in the list of countries with the highest rate of mortality by fire-related accidents.

Burn cases are mostly accidental and sometimes even homicidal and suicidal. In winter, most burn cases are 50-plus women who sit with their backs to the fire to keep themselves warm. In summer, electrical burns among metal workers are the most frequent cases. Suicidal and homicidal cases in Nepal are frequently related to dowry. Sometimes, women, frustrated by nagging and abuse, set themselves alight but usually, it’s the in-laws who burn them.

Most burn cases are referred to Kathmandu. Dr Karn says Nepalgunj Medical College can handle cases with 20 percent burn. Anything above that is either referred to Kirtipur Hospital or SKMH in the capital city. Many patients can’t afford the transport cost. Treatment is expensive. The survival rate, he says, is also low. A patient with a 20 to 30 percent burn has only a 20 to 30 percent chance of survival. 

“Burn treatment is complex and most hospitals aren’t equipped for it,” says Dr Karn. There should be a separate hospital or at least a dedicated burn unit in each hospital. The medical staff also needs burn-focused training. He says every province should have at least one proper burn unit or hospital. “We can save many lives if there were at least three burn units in Nepal to begin with—one for provinces one and two; one for three and four; and one for provinces five, six, and seven,” he says. 

Dr Santosh Bikram Bhandari, a burn, plastic, reconstructive, and cosmetic surgeon at SKMH, says the hospital handles over 100 burn cases every month. Though it has a separate burn ward and the government provides an allowance for free burn treatment, they are not enough to cater to all the needs of burn patients. 

Experts say most burn cases emanate from the lower socio-economic strata. The families from these strata cannot afford expensive surgeries that follow an incident. There have been cases of families taking loans or selling their meager assets to fund treatment—driving them deeper into poverty.  

Dr Bhandari says there is a lack of awareness on the management of burn injuries among the public as well as medical personnel. Poverty, he says, is the biggest strain. Many people simply don’t have access to alternatives to firewood. Saris catching fire while cooking is a common occurrence in rural areas. 

“Lack of knowledge on fire safety as well as first aid is appalling. People have wrong concepts about what to do after a burn injury and that often makes it worse,” says Dr Bhandari. 

The government remains oblivious to the sufferings of burn victims. After Nepali Congress leader Chandra Bhandari and his mother were injured in a gas cylinder explosion, burns became a much-discussed topic at ministerial meetings, says Dr Bhandari, with the authorities promising to give everything needed to establish a state-of-the-art burn care unit at SKMH. But the talks, he adds, soon fizzled out and nothing happened. 

Dr Prakash Budathoki, spokesperson for the Ministry of Health and Population, says the government’s priority is communicable diseases and other ailments that regularly claim more lives. But burn cases are also on their radar. They have separated a budget for the burn ward at Bir Hospital. The ministry is also working on a plan to run awareness programs and training in all seven provinces.

Dr Bhandari, however, insists that the government isn’t serious about burns. Despite repeated lobbying for better policies to ease the load of burn treatment, the government has done little. “It’s not difficult to have a separate burn treatment fund if the government is willing,” he says. 

Burns, in Nepal, are usually the result of gas explosions, petroleum-related incidents, and electrical malfunctions or accidents. The government can bring a policy where one rupee extra is charged per cylinder and fuel refill, and 0.1 percent of the total electrical bill is levied on each customer—and all of it goes to building a national burn treatment fund. “The government can easily make burn treatment accessible and save lives if it wants to,” says Dr Bhandari. 

Archana Ranjit, a nursing officer at Tribhuvan University Teaching Hospital, has years of experience working with burn patients. She agrees with Dr Bhandari and says government involvement is crucial in tackling burn cases as they require extensive care and facilities. “When patients are forced to move from one hospital to the next due to the lack of all necessary facilities under one roof, there is a delay in treatment, which is sometimes fatal. In the case of burn injuries, the earlier the victim gets treated, the better the chances of survival and healing after surgery,” says Ranjit.