Before, During and After (BDA) are the three stages in the life of a burn victim.  We learn about burn victims when they present themselves in a hospital through an accident caused due to fire burns.  Questions that usually follow include why it happened, under what situation would they have to take the extreme step of taking away life, what could be done to prevent it from happening, how often is it an accident, can we rescue/save them, do they want to be rescued, can we bring them back to fully functioning health, what are the steps involved in this journey to recovery and how can the journey of one be a lesson for others before they become victims.  What would drive a person to such despair, what is the role of education, the ability to reason out the situation, the support system that they have versus need in order to think before acting.

As I traverse the cities of India speaking with physicians, caregivers, friends, and family, asking them to share their experience and involvement, I learn that burn victims have a conflicted path in life.  The intention of this blog is to make the implicit explicit.  How to write about the 7+ Million people, 70% of them women spread across India’s breadth and width who suffer from burn wounds and the possible causes which happen, I realize that people want this to be a well-kept secret and refuse to talk about it.

The ‘During’ phase of understanding burn wound pass through the physician, the patient, and Non-Government Organizations.  The physicians do not want to talk about it since this is a Medical Legal Case. The patients do not want to talk about it since they are either utterly ashamed about the position they are in and the burn injury they committed or that was committed unto them.  Many of them are poor and uneducated and do not have the money or the support of family and friends since the care is long and arduous with many complications. The Non-Government Organizations do not want to speak about the patients to whom they provide care due to patient confidentiality issues. Yet they all want to do more as the sheer volume of the problem increases over time.

According to WHO and government of India statistics from 2012, there are 7 Million burn wound cases annually in India and 140,000 of them die each year.  All these are preventable deaths.  This represents close to 75% of all burn victims in the world. On the encouragement of a couple of retired doctors and with the blessing of a health minister, we have started to request institutions to share the data with us in an effort to research this question. The process of working with the establishment (Government, Hospitals, NGOs) is to secure the data to understand the underlying causes and study the profile of the patients so we can try to discover proficient burn management and burn guidelines, and also integrate optimal burn awareness. Here we focus on prevalence, causes, Total Body Surface Area (TBSA) burned, the degree of the burn (first, second and third), the vulnerable parts of the body, potential causes for the accident, demographic mix of the patients and their socio-economic background, and the time of year and location of the accident all provide an eye-opening intelligence into burn incidences. Things like infection, nutrition needs, and the cost of treatment are all non-trivial and working against the burn patient.

The condition of the patient, severity of the burn and the amount of time exposed before they arrive for care have an impact on survival rates.  All this can be done without compromise of the concerns for secrecy and the source of the information. The focus is on reconstructing the patient’s environment and capturing the needs of the patient and their caregiver, the impact on the family and disruption it causes and the time spent in the hospital using Predictive Analytics.

The path ‘After’ the burn incident is long and slow and lasts a lifetime. The psychological and mental aspects such as the fear of the fire and any associated source of the burn wound, the fit into their current family and to society as a whole is a battle.  They are doing this with little support from the social fabric and little potential for gainful employment.  Even skin grafts and setting up skin banks and encouraging people to donate their skin when they decease are not a part of the culture.  While the potential exists, efforts to set up such efforts by select medical establishments have many failures.  Technical challenges in preserving the harvested skin are not trivial.

The patient’s life of challenge has just begun. Societal norms require physical rehabilitation and trained resources are hard to come.  A few NGOs provide this support for patients once they leave the hospital and create a community for them to do things with other people and do things that normal people take for granted and do every day.

We end with the beginning, the activities that lead up to ‘before’ the burn accident. There are many activities which are a part of the norm in the west. We try to mimic without the restraints and the control on the body to stop and lead normal lives.  As a result, there is excessive alcohol.  Abuse of substances also results in long-term damage to mental development.  Many others have been abused as children in schools or homes.  While this is slowly changing, empowerment of women is still at a low among the poor and underprivileged.  Very few avenues exist for them to seek help when they are in hostile environments and they are pushed to the limit to consider taking their own lives.  Many times, the men in their lives provide the last push or the light that set them burning.  This sudden explosive act leads them down the dark alley called burn wound and a life of toil compounding what they have to contend with in the first place.

Two active women in Bangalore– Brinda and the ever present Prasanna have been working tirelessly on women empowerment as part of their NGO and with support from their partners, working in their local environment to strengthen the mind and body of people and ensure we can work on preventing future incidences with the means of burn awareness and knowledge on immediate first aid for burns and treatments for burns. They’re also involved in the support of the burn patients during and after the incidence.

Money, resources, and methods exist to tame this wild beast.  All that’s required is to start with building a bottom-up society.

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