Burns in the developing world and burn disasters

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