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COMMENTARY
Year : 2013  |  Volume : 21  |  Issue : 1  |  Page : 40-41

Rehabilitating the burn patient: An unfulfilled goal


Department of Plastic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication22-Nov-2013

Correspondence Address:
Divya Narain Upadhyaya
B-2/128, Sector - F, Janakipuram, Lucknow - 226 021, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-653X.121880

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How to cite this article:
Upadhyaya DN, Singh AK. Rehabilitating the burn patient: An unfulfilled goal. Indian J Burns 2013;21:40-1

How to cite this URL:
Upadhyaya DN, Singh AK. Rehabilitating the burn patient: An unfulfilled goal. Indian J Burns [serial online] 2013 [cited 2019 Aug 21];21:40-1. Available from: http://www.ijburns.com/text.asp?2013/21/1/40/121880

Burns is a devastating injury with far reaching effects for the patients, their families as well as for the care providers. Approximately, 11 million people suffered burns globally in the year 2004 [1] with the greater part of this burden being borne by the low (per capita income < USD 1,000) and middle income (per capita income USD 1,000-4,000) countries (LMICs). India stands apart in this as a country having the highest incidence of burns [2] as well as having a very high mean total body surface area (TBSA) of burns. [3] Burn patients require aggressive acute medical and surgical care as well as long-term and intensive rehabilitation effort. The world literature is littered with studies debating the economic burden of acute burn care, [4],[5],[6] but hardly any papers discussing the long-term burden of burn rehabilitation. [7] It is heartening to note that the authors have taken up an aspect of burn care hitherto largely neglected by the burn surgeons in the developing world and accorded it its due importance.

The priority of LMICs still remains focused on reduction of mortality figures [2] and unfortunately complete rehabilitation of the burn patient comes way down in the priority list which, given the financial and personnel constraints, is understandable. It is in this backdrop that the authors' efforts to provide a complete rehabilitative care to their patients are laudable.

Burn rehabilitation is a continuum of active therapy that starts from the time of admission of the patient to the burn hospital and not after discharge from it. The division of treatment of burns into an 'acute' or surgical phase and a chronic or rehabilitative phase is artificial and should be discouraged as it relegates the functional, societal, and psychological rehabilitation of the patient to a less important status. With the increase in burn survival rates around the world, due, no doubt to the standardization of burn care in burn centers, the burn care providers are increasingly faced with more and more patients suffering the inevitable sequelae of burns, namely, unstable scars, contractures, hypertrophy/keloids, and numerous psychological and societal disabilities. I concur with the authors that in a healthcare system like ours where costs need to be contained, rehabilitation, defined as return of the patient to the physical, social, and psychological health they enjoyed prior to the burn injury, is often the first victim of underfunding or loss of funding.

The authors' have rightly stressed the fact that rehabilitation is a team process in which results are brought about slowly and with much input from the patient and the rehabilitation team. A typical burn care team should comprise of not only the surgeon and the nursing staff but also the physical therapist, occupational therapist, psychologist, psychiatrist, counselor, and social worker; as the rehabilitation process that begins with the admission of the patient often continues for years after discharge, with the patients sometimes requiring lifelong support from survivor groups and other such support systems. All the members of the burn rehabilitation team have to be involved in patient care from day 1. Wound care, splinting, and anti-contracture positioning should proceed hand-in-hand with psychological counseling. There is ample evidence in the literature that burn injury induces psychological effects, which may vary in type and severity from person to person. Burn survivors suffer from varying degrees of rage, guilt, shame, and depression; which make their complete rehabilitation difficult. Added to this are the debilitating physical deformities and disfigurements, which not only add to the suffering but are also a constant reminder of the initial devastating event that started these patients on this very depressing path. Repetitive surgeries drain the patients' pockets and the struggle of daily living drains them emotionally. Financial help and social support are rarely forthcoming and the patients and their immediate family members are left to fend for themselves. In this scenario, the burn care hospital can play a pivotal role. Most burn care centers will not only help the patients seek financial support but also help them reintegrate into the society by having a social worker delegated to them and introducing them to a survivor group like the authors have done in their center. The burn patients are also often embroiled in difficult lawsuits, which is a further financial and psychological strain on their already rapidly depleting resources. It is not surprising then that many patients lose the will to live and often become suicidal. The surgeon in such cases is often called upon to counsel or arbiter issues beyond his brief making his job more difficult and infinitely more challenging. Hospitals will often have nongovernmental organizations (NGOs) look after such problems of the patients' and help them with familial, legal, and societal issues. Such NGOs and survivor groups often become an extended family of the burn victim and play an inalienable role in the true integration of the patient into the family and society. Burns thus becomes more than just a surgical challenge. Long after all the skin wounds have been resurfaced, begins the actual healing - making the patients accept themselves before helping the society accept them.

 
  References Top

1.Peck MD. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns 2011;37:1087-100.  Back to cited text no. 1
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2.Ahuja RB, Goswami P. Cost of providing inpatient burn care in a tertiary, teaching, hospital of North India. Burns 2013;30:558-64. Available from: http://www.worldmapper.org/display_extra.php?selected=478 [04.10.2013 ].  Back to cited text no. 2
    
3.Ahuja RB, Bhattacharya S. An analysis of 11,196 burn admissions and evaluation of conservative management techniques. Burns 2002;28:555-61.  Back to cited text no. 3
[PUBMED]    
4.Onarheim H, Jensen SA, Rosenberg BE, Guttormsen AB. The epidemiology of patients with burn injuries admitted to Norwegian hospitals in 2007. Burns 2009;35:1142-6.  Back to cited text no. 4
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5.Ahn CS, Maitz PK. The true cost of burn. Burns 2012;38:967-74.  Back to cited text no. 5
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6.Sanchez JL, Pereperez SB, Bastida JL, Martinez MM. Cost-utility analysis applied to treatment of burns patients in a specialized center. Arch Surg 2007;142:50-7.  Back to cited text no. 6
    
7.Mirastschijski U, Sander JT, Weyand B, Rennekampff HO. Rehabilitation of burn patients: An underestimated soci-economic burden. Burns 2013;39:262-8.  Back to cited text no. 7
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