India registers about 7,00,000 to 8,00,000 burn admissions annually. The high incidence makes burns an endemic health hazard. The absolute number of survivors is so high that it is a serious task to rehabilitate and integrate the burn victims into society. With an increasing number of burn victims destined to live with reduced physical and mental abilities, it is important to outline key indicators for quick integration into society post-injury.
Findings of study
Our research team in Delhi used the burn specific health scale-brief, or BSHS-B, which is a universally accepted tool to measure Quality of Life (QoL) of burn patients, to outline key indicators and how patients fared on them here. We found that work, economic impact, psychological disorders, post-burn itch and skin hypersensitivity were the major concerns of burn patients, and thus need to be addressed specifically in India. Further, poor scores for female subjects in the domain of body image were reported in our study. This was similar to the findings in developed countries, which had earlier noted that female subjects face more psychological problems adjusting to burns. Our research also underlined a direct correlation between the QoL and inability to resume work. In our study, 70% of the patients were unable to resume work, which further reflected a poor QoL.
It is important for burn specialists and patients to understand these indicators because most patients survive burns. In fact, it is the QoL that is cause for concern. There is a need to understand the key indicators of the QoL and develop a treatment plan that helps a patient resume normal life as quickly as possible. Rehabilitation and social integration are crucial in improving the QoL of a burn survivor, and burn care providers should focus on this aspect.
In India, the National Programme for Prevention and Management on Burn Injuries can play a crucial role in creating awareness on the QoL of burn survivors. The programme has three components: preventive programme; burn injury management programme, and burn injury rehabilitation programme. Our findings are crucial in improving the last two components of the programme. There is a need to focus on women burn patients as well as on the economic impact of burn injuries, which is largely due to a survivor’s inability to resume work.
Recognising burn-nursing
During the 12th Five Year Plan, the programme was expanded to cover 67 medical colleges and 19 district hospitals for the establishment of burn units across the country in a phased manner. General surgeons working in district hospitals form the nucleus of the burn care service and decide on referral procedures. They need to be trained and involved in creating awareness on burn injuries and management. Teaching programmes should be carried out, and perhaps a qualification in burn management could be introduced to meet the requirement for burn specialists. There is a need to understand that the Western model of burn care will not be suitable for India, and, therefore, cost effective treatment modalities and improved referral mechanisms need to be worked out. There is a need to develop regional centres of excellence which could augment the capabilities of existing district centres through better coordination between the two. Nurses can play a crucial role in burn management and rehabilitation. There is a need to make burn-nursing a recognised concept/specialisation in India. Nursing supported by family care could go a long way in rehabilitating burn survivors and providing them the confidence to start all over again.
We need to learn from other countries as well. The International Society for Burn Injuries has played a pivotal role in establishing the need for a team of professionals of different specialities such as surgeons, anaesthetists, bacteriologists, critical care physicians, nurses, dietitians, physiotherapists and clinical psychologists as well as bringing these specialists under one umbrella. It is important that we approach burn treatment as a multifaceted process in India too.
Dr. Rajeev B. Ahuja is Senior Consultant, plastic and cosmetic surgery, Sir Gangaram Hospital, Delhi
