Burns in the developing world and burn disasters
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7463.447 (Published 19 August 2004) Cite this as: BMJ 2004;329:447All rapid responses
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Burns in the Developing World and Burn Disasters. BMJ 21/8/04
at p447.
In this article no mention is made of the role that the first aid
worker could play, and the updating of his/her knowledge on the use of
plastic film as a covering for minor burns etc as described in one of the
earlier articles from the ‘ABC of Burns’.
Coming also from a developing country, knowledge of First Aid for
first aid workers particularly women and school children is very
important, and our auxiliaries, would I’m sure be glad that the Red
Cross/Red Crescent and St Johns Ambulance Brigade include this teaching in
their handbooks and lectures. Clear plastic film is also far more readily
available than a piece of clean white cloth.
Alison M. Brydone, MB.Ch.B. (London)
Specialist in Community Health
Parirenyatwa Hospital, Harare, Zimbabwe
Competing interests:
None declared
Competing interests: No competing interests
The Editor, BMJ
We found the article on burns in the developing world and burn disasters
management by Ahuja et al1 very interesting. In our experience while
working in a tertiary health instituition in Nigeria, additional
demographic factors associated with high risk of burns injury include
perennial fuel scarcity, adulterated kerosene, erratic power supply and
local traditional practices such as hot water bath for mothers immediately
after childbirth and the treatment of convulsions in children with fire.
As a result of fuel shortage, petrol is stored in homes; commercial
vehicle drivers whose livelihood is threatened by the shortage carry
containers filled with petrol in their overcrowded vehicles. This is
ordinarily hazardous and more so in a road crash.
While most burns injuries occur in the home, burns following road
traffic injuries are on the increase from empirical observations. These
patients suffer significant inhalation injuries in association with other
injuries.There are no facilities for measuring carboxyhaemoglobin. Often,
mass casualties involving these cases overwhelm hospital staffs that are
thin on the ground. Delays in hospital attendance in an environment where
pre-hospital management by trained personnel is non existent pose
formidable challenge for the management of the airways and fluids
especially in those with moderate to severe burns. The vulnerable groups
are women and children.
Airway management in some cases entails tracheostomy. Aggressive
fluid resuscitation strategies with Parkland's formula in combination with
wound debridement are measures that help in management. Physiotherapy
commenced early significantly reduces the deformities and scarring. Often
the relatives of the patients are taught what to do and they readily
assist in this regard.
Given the limited resources and lack of personnel in the developing
countries, the focus should be on the prevention of burns by advocating
for a change from harmful local cultural practices. This needs to be done
with care and sensitivity. The radio is a medium through which this change
can be advocated effectively given its outreach. Tips on prevention and
first-aid treatment can be aired in the local language. The incorporation
of such tips in school lessons will create awareness among children who
are vulnerable. Market days provide opportunities for public enlightenment
and education at village market squares. Antenatal talks are commonly held
for pregnant women in developing countries. It will be worthwhile to
incorporate safety tips and first-aid lessons on dealing with burns in
this. This is beneficial to the women who apart from being themselves
vulnerable are the ones who look after children in most developing
countries. Collaborative initiatives that help train staff in burns
management will go a long way to improve outcome for burns patient.
Measures such as electrification to reduce dependence on candles and
kerosene2 as advocated by the World Health Organisation (WHO)will require
sustained pressure on governments that have the resources to re-order
their priorities.
References
1. Ahuja RB, Bhattacharya S. burns in the developing world and burn
disasters BMJ 2004;329:447-9
2. http://www.who.int/violence_injury_prevention/unintent ional_injuries/burns/burns2/en/print.html
Accessed 21/08/04
Competing interests:
We both worked previously at Jos University Teaching Hospital Jos Nigeria
Competing interests: No competing interests
Your article has highlighted the problems in developing countries
faced verywell.
I think implementing changes at Primary Care Centres with aim of
Prevention is much easier than making changes to Law or any measure
involving Government which every Indian knows.
Domestic violence and Child abuse are not uncommon causes of Burns in
India.
The media (TV,Radio, Newspapers and Magazines )should play a very
important role as they are the only ways of reaching Common Man.
There are many points in your article which could go to make handouts
and keep it in Hospital OPD,Reception containig firstaid measures,contact
details, preventive measures etc. This practice is very uncommon in most
of the Hospitals in India.
Out of interest I am keen to know what measures have been implemented
in your Hospital or your area.
Competing interests:
None declared
Competing interests: No competing interests
The thermal burns in young women in India specially in Hindi
heartland(J&K,Punjab,UP,Bihar,Madhya Pradesh and Rajsthan)is
frequently blamed on faulty kerosene stove and vengeful mother-in-law.But
someone who works in a burn department notices that if carefully study the
pattern of wound and circumstances,it is always not the true story.In my
job as M.Ch.trainee for Plastic and Burn Unit in Patna Medical College I
found that cheap synthetic cloths made of Polyester has a big role in
burns.These polyester cloths are cheap and last longer and are easy to
clean.Women who wear a petticoat(Usually of cotton)underneath thier saree
get less burn on thighs and legs and more on abdomen and chest and
face.Polyester melts and clings to body and burns very fast.So it doesn't
give much time for putting off the fire.
The kerosene stove is not all that unsafe.And if you study the
mechanism of hot kerosene vapour spray,it is directed upwards at high
presuure while some one lighting it sits beside the stove.The likelyhood
of burn should be face rather trunk in such situation.Bursting of stove is
a myth spread by interested parties in dowry disputes.
A cheap way prevention would be educating people against hazards of
polyester clothing and use of fire resistant blanket in case of accidents.
Competing interests:
None declared
Competing interests: No competing interests
Lamps, acid and deliberate self harm: significant causes of burns in the developing world
Ahuja et al(1) acknowledged the epidemiological differences of burns
in the developing world and the radically different approach to their
management. As a volunteer with a plastic surgery charity working in a
rural part of southern Sri Lanka, where a large proportion of the workload
involved managing the sequelae of burns such as contractures and
hypertrophic scarring, I encountered peculiarities of burn epidemiology
which are worthy of mention.
From personal experience, up to 40% of burns resulted from accidents
involving kerosene bottle lamps. In Sri Lanka where more than half of all
households have no electricity, homemade lamps are used for lighting. Made
using empty bottles with a wick fastened to a metal disc, these lamps are
unstable and easily knocked over, spilling the highly flammable kerosene,
with disastrous consequences. Children and young women are often the
casualties. While there have been great advances in the treatment of
burns, there are few reports of successful prevention campaigns. However,
one such project has justifiably received international acclaim(2).
Founded by a Sri Lankan general surgeon, Dr Wijaya Godakumbura, who
developed the award winning Safe Bottle Lamp; a safe yet inexpensive
alternative to the homemade bottle lamp; the main advantage of this lamp
lies in its design for stability - short with a heavy base made of
virtually unbreakable glass and two flat surfaces so that it would not
roll if knocked over. A screw-on metal lid prevented oil leaks while
allowing the bottle to be refilled with ease. Replacing homemade lamps
with the safer version will have a significant effect on the incidence of
burns.
Chemical burns from acid throwing is a relatively new phenomenon,
constituting some 9% of burns treated(3). Young girls between the ages of
15 and 25 are often victimised, with the face and genitalia commonly
targeted. The incidence of acid burns is rising among rural communities,
facilitated by the easy availability of acid, which is used widely in the
jewellery, car battery manufacturing and leather industries. Prevention of
these injuries requires understanding of the social factors underlying
such assaults. Opinion remains divided whether public educational programs
will reduce or increase the incidence of assaults.
Although self-burning is an uncommon method of deliberate self harm,
published data suggests that as much as 25% of all burn admissions in Sri
Lanka are self-inflicted(4). Women between the ages of 15-34 without prior
psychiatric history are most likely to contemplate self-burning. Most
victims have no real desire to die and their actions are impulsive and
brought about by poor problem-solving skills or a lack of family support.
Unfortunately, self-inflicted burns tend to be more extensive and have a
14 times higher mortality rate than accidental burns owing to the use of
accelerants. Mobile clinics run by the Médecins Sans Frontières target
young women in rural areas, presenting them with real life scenarios of
burn victims together with pictures of horrific scars. Aspects of problem-
solving are also brought up. It is hoped that the impact of this programme
can deter people from self-inflicted burns.
References
1. Ahuja RB, Bhattacharya S. Burns in the developing world and burn
disasters. BMJ 2004; 329: 447-9
2. Wijaya Godakumbura. Science and Medicine section, Laureate 1998,
Rolex Award for Enterprise. www.rolexawards.com
3. Faga A, Scevola D, Messetti MG, Scevola S. Sulphuric acid burned
women in Bangladesh: a social and medical problem. Burns 2000; 26:701-9
4. Laloë V, Ganesan M. Self-immolation a common suicidal behaviour in
eastern Sri Lanka. Burns 2002; 28: 475-80
Competing interests:
None declared
Competing interests: No competing interests