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by Fathima Razik Cader

(cont'd from July 23)

"With a winning attitude and 100% commitment to excellence in care, we will endeavour to turn every burn disaster into a triumph of survival and every burn survivor's life into one of hope and promise". The mission statement clearly displayed in the office of Dr. Chandani Perera, Consultant Plastic Surgeon, Burns Unit at the National Hospital of Sri Lanka. But to get in touch with Dr. Perera was quite something else. Repeated efforts, however, proved fruitful and when this writer finally caught up with her, she was gracious enough to spare some of her valuable time to impart some interesting information.

Although the Burns Unit has only sixteen beds, Dr. Perera and her team are literally performing their duties with aplomb! On an average, there are two major burn cases admitted everyday in addition to other burn injuries. "The majority of the victims are females (around 70%) and are between 15-60 years. This means that such victims come within the childbearing age group.

Whilst most cases are accidental, the rest are suicidal or homicidal" says Dr. Perera. "Those that are attempted suicides are called 'deliberate self-harm' - a psychiatric term and such victims do so in a moment of anger or desperation to frighten someone but end up causing immense harm to themselves", adds Dr. Perera. Men on the other hand, when drunk, stumble onto oil lamps or a hearth and burn themselves. As far as suicides go the females outnumber the males.

Dr. Chandani Perera and her team of medical officers (seven in all) along with the support staff comprising nurses, attendants, physiotherapists and occupational therapists, study the victims over a period of time. These studies (of the injuries and their extent) result in set patterns that emerge and this helps the medical team to treat the patients not only physically but address their emotional problems as well and thereby bring about a complete healing process of both the body and mind.

Whilst healing the body can take years depending on the extent of the burn, the mind set of the victims, with a positive attitude, helps in no small measure to come to terms with the trauma suffered. Thus the healing process is on track. Notwithstanding all of this, the question that arises is 'What has society done to help such people?' Because costs estimated to treat a burn victim could go up to millions of rupees and the state health sector cannot afford it. It would be worthwhile highlighting the woefully inadequate facilities at the Burns Unit with the hope that some readers might step forward with some tangible assistance. Dr. Chandani Perera has an ambitious programme - to find financial resources for a well-equipped and spacious building to house the Burns Unit.

Laudable indeed!

Whilst this article is being written, there are eight patients with acute burns in the Burns Unit and not one of them is an accidental burn.

They are self-inflicted (suicidal) or caused by someone (homicidal). Whilst these are females, the male victims are those who have sustained injuries in their places of work caused by chemicals or electricity. What is strange is that all the females talk of a bottle lamp falling on them. In reply to a query in this regard, Dr. Perera says, "there is no propensity for a lamp to fall only on females. The fact is that someone in anger threw the bottle lamp at the victim". Surgeons in the general surgical wards also treat burns. But these wards are over-crowded and the surgeons are also over-worked. So burns patients do not get optimal treatment.

Treating a burn victim is also a specialized field that requires not only medical treatment but also much more along with it in terms of teaching a patient patience, for it takes a long time before wounds heal. In the case of acute burns, the face, neck and hands invariably get burnt because most victims try to protect their face with their hands (especially when a lamp or acid is hurled at them) resulting in the upper parts of the body being injured. The socio-economic background of the victim also helps to determine how best to treat the patient.

For example, it might be important to treat the hands first - starting with the fingers and then the elbow before going on to straighten the mouth. This helps many victims to begin to use their hands during the healing process in order to earn some money or attend to household chores.

Considering the ground situation as far as burns and the victims are concerned, with more than ten thousand cases being treated annually, one of the most effective ways of reducing the number of cases is through prevention - a point that Dr. Chandani Perera lays much emphasis on. She also says that since the year 2000, she has started collecting and collating data and this will help tremendously towards planning prevention campaigns scientifically and logically.

A positive start which one hopes will lead to a significant reduction in the number of victims who suffer a lifetime of trauma once burnt.

Also of importance is adequate trained and skilled manpower to treat victims. Such training takes time and only those with a commitment and dedication will fit the bill. It is heartening to note that medical personnel from the Batticaloe hospital have undergone training and currently, physiotherapists and occupational therapists from Jaffna are also in Colombo undergoing training.

Questioned on some of the preventive measures that should be adopted, Dr. Chandani Perera said that for example, to reduce the number if homicides, legislation should be brought in with regard to the sale of acids so that only genuine users will have access to chemicals in relation to the nature of their business. Supermarkets have shelves full of detergents that contain acids and alkali and such products should have labels indicating details of contents. "This should be mandatory", says Dr. Perera. Also of concern is the fact that most victims come from homes where the mother is away in the Middle East and the girls in their teens become victims at the hands of the male family members. Once the mother leaves the family, the entire family structure comes apart and this issue should be addressed speedily, avers Dr. Perera.

It is the valued opinion of medical professionals that health care is of utmost importance in order to reduce the number of citizens in Sri Lanka who fall ill or are victims of trauma. This will help the state to cope with the number of patients effectively in the state hospitals and thereby, bring down the high costs of medical care and medication.

In conclusion, a question posed to our readers - "How many (individuals or organizations) are willing to lead by example, in assisting medical officers like Dr.Chandani Perera and the numerous others serving in the state health sector, to help alleviate and ameliorate the suffering of specifically the poor segment of Sri Lanka's society, irrespective of caste, creed or religion? We will wait with hope, to hear from you.

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