|Year : 2018 | Volume
| Issue : 1 | Page : 3-5
Burns management in India: The way ahead
Arun Kumar Singh
Department of Plastic Surgery, K.G. Medical University, Lucknow, Uttar Pradesh, Association; President-National Academy of Burns; Past President Association of Plastic Surgeons of India, India
|Date of Web Publication||11-Mar-2019|
Prof. Arun Kumar Singh
Department of Plastic Surgery, K G Medical University, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh AK. Burns management in India: The way ahead. Indian J Burns 2018;26:3-5
| Introduction|| |
Burns in this part of the world is a potential public health problem, yet underrecognized. In India, some media reports come up during Diwali festival and disasters, whereas sporadic instances keep happening quite frequently in homes more so in rural areas.
According to estimates of the National Program for Prevention of Burns injuries, 7 million individuals sustain burn injuries each year, of which 0.7 million require hospitalization, 0.25 million get crippled, and 0.14 million succumb [Figure 1] and [Figure 2].
70% of all burn injuries occur in the most productive age group (15–35 years). Four out of five burnt patients are women and children. 80% are due to home-related mishaps.
Among all traumas, burn cases have highest hospital stay period (average 8 weeks). Even a small burn of approximately 10% leads to 3 weeks of loss of work. The cost of treatment is also very high. Minor burn treatment partial thickness or second-degree averages 2000 INR/ percentage burn area Total Burn Surface area (TBSA); however, the same escalates to 6000 INR/percentage in case of major burns.
Average daily cost of bed per day in other cases of trauma is 700 INR for indoor patients. The same for burn patient is ten times more. It is estimated that financial burden per year (direct costs) to the public exchequer is INR 1400 crores. The indirect costs due to wages loss wage of nonworking days, for patients, his relatives, joblessness, etc., is much more.
Most of the burns happen in the lower and lower-middle economic group who are poor and cannot afford treatment. They land into a debt trap.
To be able to meet the millennium Sustainable Development Goals (SDGs) laid by the World Health Organization (WHO), we have to collectively involve all the stakeholders, the public, government (health and other wings like social welfare), and the treating personal.
To be able to bring down the incidence, mortality, and morbidity, fiscal impact related to burns, we have to plan short-term and long-term strategies which must include the following.
| Creating Burn Registry|| |
Burn data records in our country are woefully inadequate, in fact nonexistent. All data mentioned are either estimated or projected. To be able to combat a disease, its causations, prevention, treatment, and rehabilitative measures, we must have reliable hard data regarding the above.
The WHO and the Indian Council of Medical Research are in the process of initiating steps in this direction. No tangible action has come out so far.
The problems of data collection in a country like ours are many:
- Multiplicity of treatment providers – Wide array of persons from plastic surgeons, surgeons, dermatologists, alternative medicine practitioners to Quacks are providing treatment to mild and moderate burns
- Absence of a robust health information system (HIS): Underdeveloped and developing countries often do not have the resources to invest in data collection and analysis.
As a result, policy makers are unable to identify the problems and respond to them with evidence-based solutions and allocate resources effectively. A weak HIS is a major challenge for allocation of resources for burns. Creation of a National Registry is a must. All burns say above 10% must be notified on an online platform. The form must be standard and at the same time simple. The information thus obtained can be used for epidemiological analysis, aggregate reporting, and for research.
| Prevention|| |
The redeeming feature with burns is that the disease is mostly preventable. Many developed actions have been successful in significantly reducing the number of burn cases by adopting suitable strategies. These include, but not limited to creating awareness regarding preventive measures such as avoiding floor level cooking, avoid synthetic clothes while working near fire, and proper (or deterring) use of fire crackers during festivities. Legislation regarding ensuring fire safety measures (including smoke detectors) in individual homes, multistoried building, types of pandals (enclosures), use of fire retardant materials in enclosures, regulation for use of only quality electrical products, etc. The list is long.
With good preventive measures, backed by the administrative will, burn units/centers in the west are closing down for good.
| Inadequate Workforce|| |
The current workforce of burn care surgeons, paramedical staff is grossly inadequate. As such, the patient-to-doctor (and nurse) ratio in this country is skewed [Figure 3]. When it comes to burns, figures are appalling.
We must train doctors (surgeons), nurses, dressers, operation theater technicians, and other paramedical staff in burn care.
We must increase the availability of burn units. A few beds in a separate room is not a burn unit. Some burn units in the country are good and up to mark. Most of the medical colleges even do not have a structured burn unit.
It is, therefore, not surprising that the already existing ones are flooded beyond their capacity, with overcrowding and adversely affecting the outcomes, both in terms of mortality and morbidity.
| Inadequate Rehabilitation|| |
Rehabilitation is an essential part of continuum of care along with prevention, promotion, treatment, and palliation and is an essential part of integrated health services. With early definitive treatment and good physiotherapy, the morbidity can be reduced. In case of burns, once again both are deficient and lacking [Figure 4] and [Figure 5], resulting in a multitude of handicaps in burn patients who ultimately survive. It includes blindness, locomotor problems, inability to use the hands properly, contractures, symptomatic hypertrophic scars, and multiple facial deformities. Besides physical handicaps which may even lead to loss/change of work, psychological problems also dominate. According to WHO3 up to 74% of years lost in disability in 2015 were linked to health condition that could be potentially be helped by rehabilitative measures. They are in the form of depression (even suicidal tendencies) reduction in marital proposals, marital discords, inability to get jobs, etc.
|Figure 4: Availability of occupational therapist in some developing countries|
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|Figure 5: Distribution of Burns related physical Medical & Rehabilitation personal in developing countries|
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Having survived the ordeal they are not conducive to the growth of the society. The role of rehabilitation is immense. These individuals do not have access to assistive technology, occupational therapy, and psychotherapy.
Once again, such support to these individuals is lacking. I have been working to make it inclusive in the Rehabilitation 2030: A call for action project of the WHO, as part of Global Cooperation on Assistive Technology initiative [Figure 6].
To summarise therefore, the current barriers in burn care are:
- A dearth of evidence of problems due to burns
- Under prioritization of burn amongst other competing priorities
- Absence of policies and planning at national and subnational level
- Insufficient number and skill of professionals
- Non existing or inadequate funding
- Absence of burn facilities and equipment
- Lack of integration into health systems.
The way ahead is by advocacy for burns at all levels by creating a strong leadership, and political support by strengthening planning and implementation of preventive programs, by incorporating it in universal health coverage, by developing strong multidisciplinary teams, by expanding finances by tapping nongovernment organizations by building research capacity and establishing partnerships between less advanced and more advanced centers.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1211-59.
World Health Organization. Standards for Prosthetics and Orthotics. Geneva: World Health Organization; 2017.
World Health Organization. WHO Global Disability Action Plan 2014-21: Better Health for all People with Disability. Geneva: World Health Organization report. 2016.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]