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Domestic burns prevention and first aid awareness in and around Jamshedpur, India: strategies and impact
Burns 26 (2000) 605±608
www.elsevier.com/locate/burns
Domestic burns prevention and ®rst aid awareness in and around Jamshedpur, India: strategies and impact A. Ghosh a,*, R. Bharat b a
No. 16, New T.C. Colony, Road no. 2, Kadma, Jamshedpur ± 831001, India b Tata Main Hospital, Jamshedpur, India Accepted 7 January 2000
Abstract This article highlights the strategy for awareness creation regarding burns prevention and ®rst aid and its impact in and around the steel-producing city of Jamshedpur, India. This is a joint venture of the Burns Centre and the Medico Social Welfare Unit of the Tata Main Hospital, Jamshedpur in collaboration with the Social Service Division of Tata Steel and city schools. The ®rst phase of 5 years has been devoted to general awareness building in the population through two main programmes, namely ``Community Awareness Programmes'' for the target group of ladies and teenage girls and ``School Education Programmes'' for the target group of school children of Standard 8 in the steel-producing city. These programmes include audio-visual presentations as well as face to face interactions regarding structure and arrangements in the kitchen, ¯oor level cooking, clothing while cooking, careful use of electrical appliances, pressure stoves, etc. The discussions also include suicidal and homicidal burns prevention strategies. Various competitions for the target group provide feedback on programmes. The growing awareness about burns prevention among school children and community members, and steady increase in the number of patients who use water as ®rst aid, speak about the success of the strategies. 7 2000 Published by Elsevier Science Ltd. Keywords: Burns prevention; First aid; Awareness
1. Introduction Burns continue to constitute a common problem in a developing country like India. The incidence is very high, believed to be second only to road trac accidents. The personal tragedies involved in serious burns accidents need no elaboration. Non±fatal injuries result in lost time in school or work and immense emotional distress, while loss or permanent disability of a previously healthy family member can have a devastating impact on the whole family. The social cost of injury is therefore high [1]. The problem of burns injury in the Indian subcontinent is becoming more obvious with each report published. In Mumbai, * Corresponding author. 0305-4179/00/$20.00 7 2000 Published by Elsevier Science Ltd. PII: S 0 3 0 5 - 4 1 7 9 ( 0 0 ) 0 0 0 2 1 - 8
in 1980, there were 1412 deaths from burns in a population of 8,227,000, a mortality rate of 17.16 per 100,000, while in Poona in the same year the rate was 34.5 per 100,000 (Keswani, 1986) [2]. In Jamshedpur, during 1997±98, the mortality rate due to burns is believed to be about 28.57 per 100,000. There is, clearly, a dire need to prevent such large numbers of deaths, specially since most of these deaths are preventable. It is unfortunate, however, that very few eorts in the ®eld of burns prevention are visible in India. At the Medical Division of Tata Steel for the last 5 years there have been sustained eorts for domestic burns prevention and spreading ®rst aid awareness. The prime objective of this article is to share the strategies and impact of the project taken up at the Tata Main Hospital, Jamshedpur, India.
606
A. Ghosh, R. Bharat / Burns 26 (2000) 605±608
2. Background Built in the memory of the loved ones who perished in the ®re tragedy during the Founder Day procession on 3rd March 1989, the Burn Centre of the Tata Main Hospital, from its inception in August 1992, aims at providing comprehensive care to burns patients. In 1993, the Medico Social Welfare Unit of the Tata Main Hospital undertook an in-house survey. The ®ndings of this unpublished survey were presented at the Clinical Society meeting at the Tata Main Hospital in order to provide an insight into the medico-social background of the patients admitted to the burns centre. It was observed that 68.5% of the burns injuries had occurred due to wrong practices in kitchen or the structure of the kitchen by accident. Seventeen percent were suicidal and 14% were industrial burn injuries. It was also very clear from the ®ndings that the majority of the patients suering from domestic burns were either women or teenage girls whose clothes caught ®re while working in the kitchen. This ®nding shares similar observation by Jayraman et al. where it is stated that ``the typical Indian burns patient is a young woman in her twenties whose sari has caught ®re while she crouched cooking on a ¯oor level kerosene stove. It was observed that only 22.8% of the patients had used or were given water as ®rst aid for burns. The remainder of the respondents had either used no ®rst aid or had used inappropriate ®rst aid such as raw eggs, ink, Murgi tel (oil extract from the skin of a chicken), toothpaste, mashed potato, oily substances, etc, thus infecting or complicating the wound. Twenty percent had not used any ®rst aid at all. The survey ®ndings reinforced the already established need for prevention of domestic burns as well as creating awareness regarding correct ®rst aid for burns. It has been amply highlighted that prevention takes time, energy and money but ultimately it is the solution to the world's burns problem [3]. Thus began the joint eorts of the Medico Social Welfare Unit and the Burn Centre to promote domestic burns prevention and to raise awareness of the importance of correct ®rst aid. 3. Methods and materials Keeping in mind that eective primary prevention of injuries depends on a sound knowledge of the most important risk factors, especially of those that are open to manipulation by means of health education [4], the strategies for a burns prevention programme were planned. It was decided that the ®rst phase of 5 years would be the base of the long term intervention plans. During the ®rst 5 years,
the awareness building eorts would aim to create a conducive atmosphere as well as to raise the general awareness for prevention among the target groups of women and teenage girls in the communities and children in the city schools, whether the nature of injury was accidental, suicidal or homicidal, and whether it happened in an urban or rural area. Education is a slow process. However, it is a most eective way of changing personal practices particularly when involving a wide range and variety of causes as in burn injuries [4]. Once a general awareness is created, then the speci®c goals could be set up in the second phase of the next 5 years of the project. Resources including money, manpower and materials were mobilised within the existing set up as much as possible. A brainstorming session as well as discussions on the observations of the Burn Centre and the Medico Social Welfare Cell sta provided a direction to planning the appropriate methods of reaching out to the target groups. The personnel infrastructure available at Tata Steel was of great help. The Social Service Division of Tata Steel has various departments. The Tata Steel Rural Development Society caters for the welfare needs of the rural population around the city of Jamshedpur. Community Development and Social Welfare looks after the welfare of the employees and their family members in the township of Jamshedpur. The tribal and Harijan Welfare Cell focuses on the welfare needs of the Tribal and Harijan population in the surrounding area of Jamshedpur, who consist of employees as well of non employees of the steel industry taking bene®t of the medical services. All these departments operate through various centres and sub centres through which one can reach the grass root level. The eorts in collaboration with these departments to reach out to the target groups of women and children were termed ``Community Awareness Programmes for Burns Prevention and First Aid''. Inclusion of safety awareness in health education courses for children aged around 10±12 years in certain Bombay schools has proved eective [2]. The target group of Standard 8 school students in the age range of 12±14 years in the steel- producing city was identi®ed for awareness creation in collaboration with the various schools in the city. The reason for focusing on this particular group was that they are free enough to attend the programmes and spread the message, as well as old enough to have a say as change agents in creating awareness. These activities were termed as ``School Education Programmes for Burns Prevention and First Aid.'' Once the target groups were determined, the collaborating agencies i.e. the Social Service Division of Tata Steel and the various schools authorities from
A. Ghosh, R. Bharat / Burns 26 (2000) 605±608
Jamshedpur, were oriented to the basic objectives of the project and consultations were sought to outline the programme details. A team of two people, one a medical ocer from the Burn Centre and one a medico social welfare ocer, visited various urban, rural, and tribal community centres as well as Standard 8 students of various schools in and around Jamshedpur. Although each awareness programme was tailored to suit the level and the needs of that particular audience, certain materials and methods were used as basic tools. Among the basic tools were audio visual cassettes prepared by the Loss Prevention Association of India, Mumbai, as and when appropriate. One video cassette was a cartoon ®lm conveying do's and don'ts about burns prevention, which was very popular among school children. The other video cassettes depicted, through various case studies, the misconceptions prevalent in India and the need for correct ®rst aid for burns. The posters and charts produced by the Burns Association of India, Mumbai, which showed many of the common modes of accidental burn injuries in India and the precautions required to avoid such incidences were useful in explaining correct and safe practices at home. At the Tata Main Hospital, pamphlets based on relevant experiences were prepared, especially for this purpose and these were suitable for local beliefs and needs. Most interesting was the face-to-face interaction with the potential victims from the communities. These interactions brought forward the real-life misconceptions such as ``blisters are life threatening'' or ``pouring water on burns may lead to the death of the burns patient'', etc. It was an eye opener to everyone associated with this project. Although it might seem easier to teach people to act safely in an unsafe environment, it may not necessarily work that way. It is wiser to put the energy into making a safer environment [3]. The main issues highlighted during these sessions were ¯oor level cooking, type of clothing worn while cooking, kitchen arrangements, wrong practices in handling pressure stoves, chulhas (cooking device using coal), electric appliances, ®replaces and related problems. Existing beliefs regarding burns prevention and ®rst aid, the consequences of ®re tragedies including the high cost of treatment involved, the stigma attached to dis®gurement, the dif®culties faced by dis®gured people in social rehabilitation, etc. were also discussed. People were encouraged to come up with suggestions and modi®cations to suit their home environment. The burns survivors (the former patients of the Burns Centre), who accompanied the team whenever possible, played a role in having the desired impact on the audience as they shared their personal experiences and appealed for prevention. At the end of these sessions, skit competitions were announced for people who participated in awareness
607
programmes. For school children, drawing and slogan competitions were announced for all those who participated in awareness sessions. The competitions were held about a month after the announcements and prizes were distributed at a special function which has been organised at the Tata Main Hospital annually for the last 5 years. 4. Results and discussion The programmes began in 1993±94. In the 1st year, only two rural centres and ®ve schools could be visited. However, over the years the responses have been encouraging. To the present date, cumulative ®gures for coverage of the target group of school children is over 4800 and for ladies and teenage girls it is over 5200. Since the programme insists that all participants must try to spread the message among families and neighbourhood, the reach of the programmes becomes wider. It can be roughly estimated that up to the present date about 10,000 people have been covered under the programmes, and even if each one of these has spread the message to a minimum of ®ve people around them, about 50,000 people have bene®ted from the programme in and around Jamshedpur, the population of which was about ®ve lakhs (500,000) at the 1991 census. The impact of the programmes can be observed through the outcome of the various drawing, slogan and skit competitions. These performances also provide a feedback as to how far the programmes have been successful in meeting the objective, and what modi®cations and additions are required for making the programmes more eective. There have been a few cases where the people have built a cooking platform after participating in the programmes. One can also witness an increasing number of cases where patients coming to a burns centre have used water as ®rst aid because someone from the neighbourhood who had participated in awareness programmes had suggested doing so. There is a de®nite structure and system that has been built up for these awareness programmes. The ever increasing demand for the programmes, the active participation, the queries and the experiences shared in the programmes are an indication of people's concern regarding the issue of burns prevention and ®rst aid. Burns prevention is not quick, cheap or easy. If it were, the burns problem would have been eliminated long ago [3]. Changes do not happen overnight, especially changes in attitudes and behaviour patterns. A similar project, burn prevention, an educational programme about burn safety, was implemented in the Greater Boston area in 1977±78 [5]. The programme consisted of three components: a media campaign, a school-initiated intervention and a community-initiated inter-
608
A. Ghosh, R. Bharat / Burns 26 (2000) 605±608
vention. An analysis of burn incidence during and after the intervention did not reduce the incidence or severity of burn injury. For the present programme there is no quantitative analysis or evaluation done as yet. Therefore it is dicult to assess the impact in quantitative terms. However, it is felt that for a lasting impact producing social changes these programmes must become part and parcel of community activities. There is a need for constant reinforcement of the message. There is also a need to focus attention from broader issues to speci®c targets. It is not possible to prevent all types of burns simultaneously [3]. In the next phase of the project, therefore, the nature of the programmes would change from ``outreach'' to ``community-based'', with the local community taking responsibility for manpower, material and infrastructure required for the project. It is also planned that a speci®c domestic burn injury (injury due to a pressure stove) should be the focus of attention in a predetermined geographical area. The eorts in this direction have already begun. For school children, making the sessions as part of the extra curricular activities on a regular basis is being planned. It is also planned that at least 5% of the local population would have participated in awareness programmes providing an exposure to correct knowledge of burns prevention and ®rst aid by the end of the second phase. It is hoped that, as a result of the awareness programme, the incidence of domestic burns and also the number of people using inappropriate ®rst aid would decrease.
Coverage in terms of numbers has been satisfactory. Every year Standard 8 students in city schools as well as the teenage girls from various communities are getting educated regarding burns prevention and ®rst aid. Since the programme insists on spreading the message by the participants among their respective families and neighbourhood, the reach of the programmes becomes wider. It can be roughly estimated that about 1/50th of the population of Jamshedpur is covered in these programmes directly or indirectly. The changes suggested by education material such as building platforms for cooking have begun emerging in a sporadic manner. Motivating enough burns survivors to take the lead in the next phase, and making the programmes community-based rather than outreach, is currently going on. Focusing on only one type of extensive burns injury in a predetermined geographic area, by way of sustainable community-based programmes, would be the next goal in the endeavour to prevent burns and ®rst aid. It is an uphill task. To quote Macloughlin, the project team recommends, ``Be prepared for a struggle. But know that burns are preventable and with your help, fewer people will endure the agony of burns'' [3].
Acknowledgements The authors would like to thank Dr G.K. Lath (Medical Services, Tata Steel) and the sta of the Burns Centre, the Tata Main Hospital, for their constant support and encouragement.
5. Conclusion The eorts for creating awareness regarding burns prevention and ®rst aid among the people in and around Jamshedpur have been part of a follow up programme of a scienti®c research-based Medico Social Activity at the Tata Main Hospital. It is perceived as the step by step and long term but de®nite solution to the problem of burns injuries. The infrastructure available through the Social Service Division of Tata Steel has been of great help in getting the awareness message across to the grass root level. The schools in Jamshedpur have been very enthusiastic in their response.
References [1] Judkins K, Pike H. Prevention and rehabilitation: the community faces of burn care. Burns 1998;24(7):594±5. [2] Jayraman V, Mathangi K, Davis MR. Burns in Madras, India: an analysis of 1368 patients in 1 year. Burns 1993;19(4):342±3. [3] Macloughlin E. A simple guide to burns prevention. Burns 1995;21(3):226±9. [4] Barradas R. Use of hospital statistics to plan preventive strategies for burns in developing country. Burns 1995;21(3):191±3. [5] Mackay AM, Rothman KJ, The incidence and severity of burn injuries following Project Burn Prevention, Am. J. Public Health 1982;248±52.
www.elsevier.com/locate/burns
Domestic burns prevention and ®rst aid awareness in and around Jamshedpur, India: strategies and impact A. Ghosh a,*, R. Bharat b a
No. 16, New T.C. Colony, Road no. 2, Kadma, Jamshedpur ± 831001, India b Tata Main Hospital, Jamshedpur, India Accepted 7 January 2000
Abstract This article highlights the strategy for awareness creation regarding burns prevention and ®rst aid and its impact in and around the steel-producing city of Jamshedpur, India. This is a joint venture of the Burns Centre and the Medico Social Welfare Unit of the Tata Main Hospital, Jamshedpur in collaboration with the Social Service Division of Tata Steel and city schools. The ®rst phase of 5 years has been devoted to general awareness building in the population through two main programmes, namely ``Community Awareness Programmes'' for the target group of ladies and teenage girls and ``School Education Programmes'' for the target group of school children of Standard 8 in the steel-producing city. These programmes include audio-visual presentations as well as face to face interactions regarding structure and arrangements in the kitchen, ¯oor level cooking, clothing while cooking, careful use of electrical appliances, pressure stoves, etc. The discussions also include suicidal and homicidal burns prevention strategies. Various competitions for the target group provide feedback on programmes. The growing awareness about burns prevention among school children and community members, and steady increase in the number of patients who use water as ®rst aid, speak about the success of the strategies. 7 2000 Published by Elsevier Science Ltd. Keywords: Burns prevention; First aid; Awareness
1. Introduction Burns continue to constitute a common problem in a developing country like India. The incidence is very high, believed to be second only to road trac accidents. The personal tragedies involved in serious burns accidents need no elaboration. Non±fatal injuries result in lost time in school or work and immense emotional distress, while loss or permanent disability of a previously healthy family member can have a devastating impact on the whole family. The social cost of injury is therefore high [1]. The problem of burns injury in the Indian subcontinent is becoming more obvious with each report published. In Mumbai, * Corresponding author. 0305-4179/00/$20.00 7 2000 Published by Elsevier Science Ltd. PII: S 0 3 0 5 - 4 1 7 9 ( 0 0 ) 0 0 0 2 1 - 8
in 1980, there were 1412 deaths from burns in a population of 8,227,000, a mortality rate of 17.16 per 100,000, while in Poona in the same year the rate was 34.5 per 100,000 (Keswani, 1986) [2]. In Jamshedpur, during 1997±98, the mortality rate due to burns is believed to be about 28.57 per 100,000. There is, clearly, a dire need to prevent such large numbers of deaths, specially since most of these deaths are preventable. It is unfortunate, however, that very few eorts in the ®eld of burns prevention are visible in India. At the Medical Division of Tata Steel for the last 5 years there have been sustained eorts for domestic burns prevention and spreading ®rst aid awareness. The prime objective of this article is to share the strategies and impact of the project taken up at the Tata Main Hospital, Jamshedpur, India.
606
A. Ghosh, R. Bharat / Burns 26 (2000) 605±608
2. Background Built in the memory of the loved ones who perished in the ®re tragedy during the Founder Day procession on 3rd March 1989, the Burn Centre of the Tata Main Hospital, from its inception in August 1992, aims at providing comprehensive care to burns patients. In 1993, the Medico Social Welfare Unit of the Tata Main Hospital undertook an in-house survey. The ®ndings of this unpublished survey were presented at the Clinical Society meeting at the Tata Main Hospital in order to provide an insight into the medico-social background of the patients admitted to the burns centre. It was observed that 68.5% of the burns injuries had occurred due to wrong practices in kitchen or the structure of the kitchen by accident. Seventeen percent were suicidal and 14% were industrial burn injuries. It was also very clear from the ®ndings that the majority of the patients suering from domestic burns were either women or teenage girls whose clothes caught ®re while working in the kitchen. This ®nding shares similar observation by Jayraman et al. where it is stated that ``the typical Indian burns patient is a young woman in her twenties whose sari has caught ®re while she crouched cooking on a ¯oor level kerosene stove. It was observed that only 22.8% of the patients had used or were given water as ®rst aid for burns. The remainder of the respondents had either used no ®rst aid or had used inappropriate ®rst aid such as raw eggs, ink, Murgi tel (oil extract from the skin of a chicken), toothpaste, mashed potato, oily substances, etc, thus infecting or complicating the wound. Twenty percent had not used any ®rst aid at all. The survey ®ndings reinforced the already established need for prevention of domestic burns as well as creating awareness regarding correct ®rst aid for burns. It has been amply highlighted that prevention takes time, energy and money but ultimately it is the solution to the world's burns problem [3]. Thus began the joint eorts of the Medico Social Welfare Unit and the Burn Centre to promote domestic burns prevention and to raise awareness of the importance of correct ®rst aid. 3. Methods and materials Keeping in mind that eective primary prevention of injuries depends on a sound knowledge of the most important risk factors, especially of those that are open to manipulation by means of health education [4], the strategies for a burns prevention programme were planned. It was decided that the ®rst phase of 5 years would be the base of the long term intervention plans. During the ®rst 5 years,
the awareness building eorts would aim to create a conducive atmosphere as well as to raise the general awareness for prevention among the target groups of women and teenage girls in the communities and children in the city schools, whether the nature of injury was accidental, suicidal or homicidal, and whether it happened in an urban or rural area. Education is a slow process. However, it is a most eective way of changing personal practices particularly when involving a wide range and variety of causes as in burn injuries [4]. Once a general awareness is created, then the speci®c goals could be set up in the second phase of the next 5 years of the project. Resources including money, manpower and materials were mobilised within the existing set up as much as possible. A brainstorming session as well as discussions on the observations of the Burn Centre and the Medico Social Welfare Cell sta provided a direction to planning the appropriate methods of reaching out to the target groups. The personnel infrastructure available at Tata Steel was of great help. The Social Service Division of Tata Steel has various departments. The Tata Steel Rural Development Society caters for the welfare needs of the rural population around the city of Jamshedpur. Community Development and Social Welfare looks after the welfare of the employees and their family members in the township of Jamshedpur. The tribal and Harijan Welfare Cell focuses on the welfare needs of the Tribal and Harijan population in the surrounding area of Jamshedpur, who consist of employees as well of non employees of the steel industry taking bene®t of the medical services. All these departments operate through various centres and sub centres through which one can reach the grass root level. The eorts in collaboration with these departments to reach out to the target groups of women and children were termed ``Community Awareness Programmes for Burns Prevention and First Aid''. Inclusion of safety awareness in health education courses for children aged around 10±12 years in certain Bombay schools has proved eective [2]. The target group of Standard 8 school students in the age range of 12±14 years in the steel- producing city was identi®ed for awareness creation in collaboration with the various schools in the city. The reason for focusing on this particular group was that they are free enough to attend the programmes and spread the message, as well as old enough to have a say as change agents in creating awareness. These activities were termed as ``School Education Programmes for Burns Prevention and First Aid.'' Once the target groups were determined, the collaborating agencies i.e. the Social Service Division of Tata Steel and the various schools authorities from
A. Ghosh, R. Bharat / Burns 26 (2000) 605±608
Jamshedpur, were oriented to the basic objectives of the project and consultations were sought to outline the programme details. A team of two people, one a medical ocer from the Burn Centre and one a medico social welfare ocer, visited various urban, rural, and tribal community centres as well as Standard 8 students of various schools in and around Jamshedpur. Although each awareness programme was tailored to suit the level and the needs of that particular audience, certain materials and methods were used as basic tools. Among the basic tools were audio visual cassettes prepared by the Loss Prevention Association of India, Mumbai, as and when appropriate. One video cassette was a cartoon ®lm conveying do's and don'ts about burns prevention, which was very popular among school children. The other video cassettes depicted, through various case studies, the misconceptions prevalent in India and the need for correct ®rst aid for burns. The posters and charts produced by the Burns Association of India, Mumbai, which showed many of the common modes of accidental burn injuries in India and the precautions required to avoid such incidences were useful in explaining correct and safe practices at home. At the Tata Main Hospital, pamphlets based on relevant experiences were prepared, especially for this purpose and these were suitable for local beliefs and needs. Most interesting was the face-to-face interaction with the potential victims from the communities. These interactions brought forward the real-life misconceptions such as ``blisters are life threatening'' or ``pouring water on burns may lead to the death of the burns patient'', etc. It was an eye opener to everyone associated with this project. Although it might seem easier to teach people to act safely in an unsafe environment, it may not necessarily work that way. It is wiser to put the energy into making a safer environment [3]. The main issues highlighted during these sessions were ¯oor level cooking, type of clothing worn while cooking, kitchen arrangements, wrong practices in handling pressure stoves, chulhas (cooking device using coal), electric appliances, ®replaces and related problems. Existing beliefs regarding burns prevention and ®rst aid, the consequences of ®re tragedies including the high cost of treatment involved, the stigma attached to dis®gurement, the dif®culties faced by dis®gured people in social rehabilitation, etc. were also discussed. People were encouraged to come up with suggestions and modi®cations to suit their home environment. The burns survivors (the former patients of the Burns Centre), who accompanied the team whenever possible, played a role in having the desired impact on the audience as they shared their personal experiences and appealed for prevention. At the end of these sessions, skit competitions were announced for people who participated in awareness
607
programmes. For school children, drawing and slogan competitions were announced for all those who participated in awareness sessions. The competitions were held about a month after the announcements and prizes were distributed at a special function which has been organised at the Tata Main Hospital annually for the last 5 years. 4. Results and discussion The programmes began in 1993±94. In the 1st year, only two rural centres and ®ve schools could be visited. However, over the years the responses have been encouraging. To the present date, cumulative ®gures for coverage of the target group of school children is over 4800 and for ladies and teenage girls it is over 5200. Since the programme insists that all participants must try to spread the message among families and neighbourhood, the reach of the programmes becomes wider. It can be roughly estimated that up to the present date about 10,000 people have been covered under the programmes, and even if each one of these has spread the message to a minimum of ®ve people around them, about 50,000 people have bene®ted from the programme in and around Jamshedpur, the population of which was about ®ve lakhs (500,000) at the 1991 census. The impact of the programmes can be observed through the outcome of the various drawing, slogan and skit competitions. These performances also provide a feedback as to how far the programmes have been successful in meeting the objective, and what modi®cations and additions are required for making the programmes more eective. There have been a few cases where the people have built a cooking platform after participating in the programmes. One can also witness an increasing number of cases where patients coming to a burns centre have used water as ®rst aid because someone from the neighbourhood who had participated in awareness programmes had suggested doing so. There is a de®nite structure and system that has been built up for these awareness programmes. The ever increasing demand for the programmes, the active participation, the queries and the experiences shared in the programmes are an indication of people's concern regarding the issue of burns prevention and ®rst aid. Burns prevention is not quick, cheap or easy. If it were, the burns problem would have been eliminated long ago [3]. Changes do not happen overnight, especially changes in attitudes and behaviour patterns. A similar project, burn prevention, an educational programme about burn safety, was implemented in the Greater Boston area in 1977±78 [5]. The programme consisted of three components: a media campaign, a school-initiated intervention and a community-initiated inter-
608
A. Ghosh, R. Bharat / Burns 26 (2000) 605±608
vention. An analysis of burn incidence during and after the intervention did not reduce the incidence or severity of burn injury. For the present programme there is no quantitative analysis or evaluation done as yet. Therefore it is dicult to assess the impact in quantitative terms. However, it is felt that for a lasting impact producing social changes these programmes must become part and parcel of community activities. There is a need for constant reinforcement of the message. There is also a need to focus attention from broader issues to speci®c targets. It is not possible to prevent all types of burns simultaneously [3]. In the next phase of the project, therefore, the nature of the programmes would change from ``outreach'' to ``community-based'', with the local community taking responsibility for manpower, material and infrastructure required for the project. It is also planned that a speci®c domestic burn injury (injury due to a pressure stove) should be the focus of attention in a predetermined geographical area. The eorts in this direction have already begun. For school children, making the sessions as part of the extra curricular activities on a regular basis is being planned. It is also planned that at least 5% of the local population would have participated in awareness programmes providing an exposure to correct knowledge of burns prevention and ®rst aid by the end of the second phase. It is hoped that, as a result of the awareness programme, the incidence of domestic burns and also the number of people using inappropriate ®rst aid would decrease.
Coverage in terms of numbers has been satisfactory. Every year Standard 8 students in city schools as well as the teenage girls from various communities are getting educated regarding burns prevention and ®rst aid. Since the programme insists on spreading the message by the participants among their respective families and neighbourhood, the reach of the programmes becomes wider. It can be roughly estimated that about 1/50th of the population of Jamshedpur is covered in these programmes directly or indirectly. The changes suggested by education material such as building platforms for cooking have begun emerging in a sporadic manner. Motivating enough burns survivors to take the lead in the next phase, and making the programmes community-based rather than outreach, is currently going on. Focusing on only one type of extensive burns injury in a predetermined geographic area, by way of sustainable community-based programmes, would be the next goal in the endeavour to prevent burns and ®rst aid. It is an uphill task. To quote Macloughlin, the project team recommends, ``Be prepared for a struggle. But know that burns are preventable and with your help, fewer people will endure the agony of burns'' [3].
Acknowledgements The authors would like to thank Dr G.K. Lath (Medical Services, Tata Steel) and the sta of the Burns Centre, the Tata Main Hospital, for their constant support and encouragement.
5. Conclusion The eorts for creating awareness regarding burns prevention and ®rst aid among the people in and around Jamshedpur have been part of a follow up programme of a scienti®c research-based Medico Social Activity at the Tata Main Hospital. It is perceived as the step by step and long term but de®nite solution to the problem of burns injuries. The infrastructure available through the Social Service Division of Tata Steel has been of great help in getting the awareness message across to the grass root level. The schools in Jamshedpur have been very enthusiastic in their response.
References [1] Judkins K, Pike H. Prevention and rehabilitation: the community faces of burn care. Burns 1998;24(7):594±5. [2] Jayraman V, Mathangi K, Davis MR. Burns in Madras, India: an analysis of 1368 patients in 1 year. Burns 1993;19(4):342±3. [3] Macloughlin E. A simple guide to burns prevention. Burns 1995;21(3):226±9. [4] Barradas R. Use of hospital statistics to plan preventive strategies for burns in developing country. Burns 1995;21(3):191±3. [5] Mackay AM, Rothman KJ, The incidence and severity of burn injuries following Project Burn Prevention, Am. J. Public Health 1982;248±52.