- Email: [email protected]
Holistic burn care: Survival and beyond
JBUR 5210 No. of Pages 2
burns xxx (2017) xxx –xxx
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Holistic burn care: Survival and beyond
$
Sir, Recent advances in understanding and treatment of burns have enabled us to save more and more patients with burn [1]. Traditionally, the discussion in academic circles has been about the advances in acute burn care, how much fluid to give, what kinds of dressings, role of antibiotics etc. India is at a crossroads. On the one hand, though we are striving to increase our burn survival rate, focusing beyond survival, providing optimal quality of life to the patients has become one of the priorities of modern burn care [2]. As the health care system in our country surges ahead, both these need to happen simultaneously. Survivors of burns are variously disadvantaged. They are physically scarred, financially drained, psychologically affected, vocationally challenged and socially ostracized. All Burn units need to realize that our work as burn care providers does not end with saving lives. Holistic Burn Care (HBC) should address all of these issues for proper reintegration of the patient back into the society. The aim of this paper is to discuss our experience of providing HBC to burn patients and to create awareness about what is available for burn survivors, as also to arouse sensitivity in the fellow burn care surgeons regarding the same. Supportive strategies for holistic burn care have financial, vocational and psychosocial aspects. Patients of burn may have many underlying psychosocial issues which need to be evaluated and addressed. The environs of the home, availability of space and scope for continued exercise, support of family members and neighbors, all these are evaluated by the occupational and physiotherapists if required on home visits to identify underlying social problems and find solutions. While the patients are still admitted in the wards, initially they are visited by psychiatrists. Later they are visited by the counselors of SNEHA, an a nongovernmental organization (NGO) which works for women rights and women safety. SNEHA (Society for Nutrition, Education and Health Action), is a nongovernmental organization working in the field of maternal and newborn health, prevention of violence against women, child health and adolescent sexual health. In burns, this organization is associated with three burn units in the city, including ours. They provide general counseling to the patients and family members. When required, they provide legal assistance, shelter facilities and even vocational advice to $
burn survivors commensurate with their education and deformities. They have an in house OPD at our hospital, visit the burn ward twice weekly and also keep follow up of the patients with post discharge home visits and organize support group meetings along with other activities. Mumbai based CEHAT (Centre for Enquiry into Health and Allied Themes) and Chennai based PCVC (International Foundation for Crime Prevention and Victim Care) are other organizations working in the field of women violence which our burn patients are a victim of, not very infrequently. The point to be stressed here is that association of the burn unit with some such organization goes a long way in assisting the burn survivors get their rights and settle down in society in a safe and dignified manner. Burn management is expensive. Cost of multiple surgeries, dressings, higher antibiotics, splints and later travel for therapy, and follow-up leads to many financial problems for most of the patients undergoing treatment for a long time while the earning member of the family has also been affected and is kept away from work [3,4]. To help these patients, the medical social workers play a pivotal role by subsidizing and by arranging for donations from multitude of trusts scattered across the city. A number of NGOs also support the burn patients, providing them with financial assistance. Such organizations are present in most cities and we, as burn care providers should be proactive in utilizing their help and referring our patients to them early. Provision of low cost customized thermoplastic splints goes a long way in reducing the cost of treatment in these patients. Made by our occupational therapy department, these splints are available at subsidized rates. An inexpensive activity board placed in the burn ward encourages the patients to perform range of motion exercises with minimum of inputs. Activities like biting into an uncut apple or guava helps in prevention of microstomia. Such exercise along with well motivated therapists form the basis of functional rehabilitation in our wards. Often times burn survivors may develop contractures as an undesirable sequel and these may require multiple surgeries. Burn survivors and their families, already drained financially by protracted treatment and therapy sessions find it difficult to continue with treatment of these post burn contractures (PBC).
Work should be attributed to: Seth G S Medical College and KEM Hospital, Mumbai, India. Please cite this article in press as: V. Puri, et al., Holistic burn care: Survival and beyond, Burns (2017), http://dx.doi.org/10.1016/j. burns.2017.02.019
JBUR 5210 No. of Pages 2
2
burns xxx (2017) xxx –xxx
To help such patients, organizations like Resurge International provide all surgery and splints etc. free of cost to these patients. 30 patients of PBC were operated in 2016 in our department under this programe. Such initiatives definitely go a long way in subsidizing care in post burn contracture patients [5]. Children with post burn deformities often feel desolated, suffer from poor self esteem and face difficulties with reintegration into society. Burn Survivor Camps have been shown to improve the psychosocial outcome of pediatric burn survivors [6,7]. India’s only pediatric burn survivor camp, Camp Karma attempted reintegration of burn survivors back into the society. 21 children participated in the 2013 camp, 20 in 2015 and 26 in 2016. The campers participated in various physical, social and recreational activities like rock climbing, cooking, role play and dancing amongst many others. For the burn survivors to regain confidence and accept their scars, group activities and competitions played a major role and gave them a sense of achievement and worth [8,9]. Thus, burn is a major physical and psychological injury for the patients. In addition to medical and surgical management, financial support, vocational and psychosocial rehabilitation go a long way in achieving self sufficiency and social reintegration, and therefore are an essential part of providing holistic burn care. We as burn surgeons need to provide holistic care of a burn patient starting from life saving measures in the acute phase, extending to the phase after discharge wherein the patients need specialized care for better integration into society. This cannot be done by any one of us alone. Each one of us involved in the care of burn patients should strive to build a team and encourage participation of society in the form of NGOs etc. in order to fulfill the commitment of returning the burn survivors back to their lives.
REFERENCES
[1] Ryan CM, Schoenfeld DA, Thorpe WP, Sheridan RL, Cassem EH, Tompkins RG. Objective estimates of the probability of death from burn injuries. N Engl J Med 1998;338:362–6. [2] Moi AL, Gjengedal E. Life after burn injury: striving for regained freedom. Qual Health Res 2008;18(December (12)):1621–30. [3] Deshpande ON, Puri V, Vora SS, Shende NN, Choudhary SC. Socio-economic burden of burns: how do families cope. Indian J Burns 2012;20:48–52. [4] Shrotriya R. Working in a burn ward: a resident’s view point. Burns 2016;42(November (7)):1367–8. [5] Sabapathy SR, Bajantri B, Bharathi RR, Ramkumar S, Shanmugakrishnan RR. “Hope after fire”: a free reconstructive surgery project for burn survivors: making it possible and the lessons learned. Indian J Burns 2015;23:3–8. [6] Bakker A, Van der Heijden PG, Van Son MJ, Van de Schoot R, Van Loey NE. Impact of pediatric burn camps on participants’ self esteem and body image: an empirical study. Burns 2011;37 (December (8)):1317–25. [7] Maslow GR, Lobato D. Summer camps for children with burn injuries: a literature review. J Burn Care Res 2010;31(September– October (5)):740–9. [8] Puri V. Be the change. Indian J Burns 2015;23:1–2. [9] Venkateshwaran N, Puri V. Israel burn camp visit: Reflections and reactions. Indian J Burns 2012;20:3–4.
Vinita Puri Raghav Shrotriya* Venkateswaran N. Nikhil Ghubade Department of Plastic Surgery, KEM Hospital, Mumbai, India * Corresponding author at: Department of Plastic Surgery, 2nd floor, Gynec Block, KEM Hospital Campus, Parel, Mumbai 400012, India. E-mail address: [email protected] (R. Shrotriya).
Disclosure This paper was presented at NABICON 2017, the 25th Annual conference of the National Academy of Burns, India at New Delhi.
Available online xxx http://dx.doi.org/10.1016/j.burns.2017.02.019 © 2017 Elsevier Ltd and ISBI. All rights reserved.
Please cite this article in press as: V. Puri, et al., Holistic burn care: Survival and beyond, Burns (2017), http://dx.doi.org/10.1016/j. burns.2017.02.019
burns xxx (2017) xxx –xxx
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Holistic burn care: Survival and beyond
$
Sir, Recent advances in understanding and treatment of burns have enabled us to save more and more patients with burn [1]. Traditionally, the discussion in academic circles has been about the advances in acute burn care, how much fluid to give, what kinds of dressings, role of antibiotics etc. India is at a crossroads. On the one hand, though we are striving to increase our burn survival rate, focusing beyond survival, providing optimal quality of life to the patients has become one of the priorities of modern burn care [2]. As the health care system in our country surges ahead, both these need to happen simultaneously. Survivors of burns are variously disadvantaged. They are physically scarred, financially drained, psychologically affected, vocationally challenged and socially ostracized. All Burn units need to realize that our work as burn care providers does not end with saving lives. Holistic Burn Care (HBC) should address all of these issues for proper reintegration of the patient back into the society. The aim of this paper is to discuss our experience of providing HBC to burn patients and to create awareness about what is available for burn survivors, as also to arouse sensitivity in the fellow burn care surgeons regarding the same. Supportive strategies for holistic burn care have financial, vocational and psychosocial aspects. Patients of burn may have many underlying psychosocial issues which need to be evaluated and addressed. The environs of the home, availability of space and scope for continued exercise, support of family members and neighbors, all these are evaluated by the occupational and physiotherapists if required on home visits to identify underlying social problems and find solutions. While the patients are still admitted in the wards, initially they are visited by psychiatrists. Later they are visited by the counselors of SNEHA, an a nongovernmental organization (NGO) which works for women rights and women safety. SNEHA (Society for Nutrition, Education and Health Action), is a nongovernmental organization working in the field of maternal and newborn health, prevention of violence against women, child health and adolescent sexual health. In burns, this organization is associated with three burn units in the city, including ours. They provide general counseling to the patients and family members. When required, they provide legal assistance, shelter facilities and even vocational advice to $
burn survivors commensurate with their education and deformities. They have an in house OPD at our hospital, visit the burn ward twice weekly and also keep follow up of the patients with post discharge home visits and organize support group meetings along with other activities. Mumbai based CEHAT (Centre for Enquiry into Health and Allied Themes) and Chennai based PCVC (International Foundation for Crime Prevention and Victim Care) are other organizations working in the field of women violence which our burn patients are a victim of, not very infrequently. The point to be stressed here is that association of the burn unit with some such organization goes a long way in assisting the burn survivors get their rights and settle down in society in a safe and dignified manner. Burn management is expensive. Cost of multiple surgeries, dressings, higher antibiotics, splints and later travel for therapy, and follow-up leads to many financial problems for most of the patients undergoing treatment for a long time while the earning member of the family has also been affected and is kept away from work [3,4]. To help these patients, the medical social workers play a pivotal role by subsidizing and by arranging for donations from multitude of trusts scattered across the city. A number of NGOs also support the burn patients, providing them with financial assistance. Such organizations are present in most cities and we, as burn care providers should be proactive in utilizing their help and referring our patients to them early. Provision of low cost customized thermoplastic splints goes a long way in reducing the cost of treatment in these patients. Made by our occupational therapy department, these splints are available at subsidized rates. An inexpensive activity board placed in the burn ward encourages the patients to perform range of motion exercises with minimum of inputs. Activities like biting into an uncut apple or guava helps in prevention of microstomia. Such exercise along with well motivated therapists form the basis of functional rehabilitation in our wards. Often times burn survivors may develop contractures as an undesirable sequel and these may require multiple surgeries. Burn survivors and their families, already drained financially by protracted treatment and therapy sessions find it difficult to continue with treatment of these post burn contractures (PBC).
Work should be attributed to: Seth G S Medical College and KEM Hospital, Mumbai, India. Please cite this article in press as: V. Puri, et al., Holistic burn care: Survival and beyond, Burns (2017), http://dx.doi.org/10.1016/j. burns.2017.02.019
JBUR 5210 No. of Pages 2
2
burns xxx (2017) xxx –xxx
To help such patients, organizations like Resurge International provide all surgery and splints etc. free of cost to these patients. 30 patients of PBC were operated in 2016 in our department under this programe. Such initiatives definitely go a long way in subsidizing care in post burn contracture patients [5]. Children with post burn deformities often feel desolated, suffer from poor self esteem and face difficulties with reintegration into society. Burn Survivor Camps have been shown to improve the psychosocial outcome of pediatric burn survivors [6,7]. India’s only pediatric burn survivor camp, Camp Karma attempted reintegration of burn survivors back into the society. 21 children participated in the 2013 camp, 20 in 2015 and 26 in 2016. The campers participated in various physical, social and recreational activities like rock climbing, cooking, role play and dancing amongst many others. For the burn survivors to regain confidence and accept their scars, group activities and competitions played a major role and gave them a sense of achievement and worth [8,9]. Thus, burn is a major physical and psychological injury for the patients. In addition to medical and surgical management, financial support, vocational and psychosocial rehabilitation go a long way in achieving self sufficiency and social reintegration, and therefore are an essential part of providing holistic burn care. We as burn surgeons need to provide holistic care of a burn patient starting from life saving measures in the acute phase, extending to the phase after discharge wherein the patients need specialized care for better integration into society. This cannot be done by any one of us alone. Each one of us involved in the care of burn patients should strive to build a team and encourage participation of society in the form of NGOs etc. in order to fulfill the commitment of returning the burn survivors back to their lives.
REFERENCES
[1] Ryan CM, Schoenfeld DA, Thorpe WP, Sheridan RL, Cassem EH, Tompkins RG. Objective estimates of the probability of death from burn injuries. N Engl J Med 1998;338:362–6. [2] Moi AL, Gjengedal E. Life after burn injury: striving for regained freedom. Qual Health Res 2008;18(December (12)):1621–30. [3] Deshpande ON, Puri V, Vora SS, Shende NN, Choudhary SC. Socio-economic burden of burns: how do families cope. Indian J Burns 2012;20:48–52. [4] Shrotriya R. Working in a burn ward: a resident’s view point. Burns 2016;42(November (7)):1367–8. [5] Sabapathy SR, Bajantri B, Bharathi RR, Ramkumar S, Shanmugakrishnan RR. “Hope after fire”: a free reconstructive surgery project for burn survivors: making it possible and the lessons learned. Indian J Burns 2015;23:3–8. [6] Bakker A, Van der Heijden PG, Van Son MJ, Van de Schoot R, Van Loey NE. Impact of pediatric burn camps on participants’ self esteem and body image: an empirical study. Burns 2011;37 (December (8)):1317–25. [7] Maslow GR, Lobato D. Summer camps for children with burn injuries: a literature review. J Burn Care Res 2010;31(September– October (5)):740–9. [8] Puri V. Be the change. Indian J Burns 2015;23:1–2. [9] Venkateshwaran N, Puri V. Israel burn camp visit: Reflections and reactions. Indian J Burns 2012;20:3–4.
Vinita Puri Raghav Shrotriya* Venkateswaran N. Nikhil Ghubade Department of Plastic Surgery, KEM Hospital, Mumbai, India * Corresponding author at: Department of Plastic Surgery, 2nd floor, Gynec Block, KEM Hospital Campus, Parel, Mumbai 400012, India. E-mail address: [email protected] (R. Shrotriya).
Disclosure This paper was presented at NABICON 2017, the 25th Annual conference of the National Academy of Burns, India at New Delhi.
Available online xxx http://dx.doi.org/10.1016/j.burns.2017.02.019 © 2017 Elsevier Ltd and ISBI. All rights reserved.
Please cite this article in press as: V. Puri, et al., Holistic burn care: Survival and beyond, Burns (2017), http://dx.doi.org/10.1016/j. burns.2017.02.019