Do we have enough burn care facilities?

Burn treatment is currently hogging attention amid the ongoing arson-ridden blockade in Bangladesh even though the National Institute of Burn and Plastic Surgery says they had only 17 arson-related patients on Monday.

Nurul Islam Hasibbdnews24.com
Published : 19 Jan 2015, 05:11 PM
Updated : 19 Jan 2015, 06:56 PM

But overall number of burn patients admitted there is almost twice the capacity of the 300-bed institute, located next to the Dhaka Medical College and Hospital.

It seems this is the only place in Bangladesh to treat burn injuries.

But this is not the case, according to government records, though doctors say the treatment facilities should be extended to the Upazila level.

According to hospital records, more than 650,000 people suffer burns every year and of them, over 6,000 die on the spot.

But the treatment facilities offered by the government are still restricted to the medical college hospitals with only 14 such hospitals across Bangladesh having burn and plastic surgery departments.

“This is far too inadequate to cope with the large number of patients,” said Prof Md Abul Kalam, Project Director at the Institute of Burn and Plastic Surgery.

“Of them, Dinajpur, Bogra and Mymensingh currently do not have qualified doctors to offer treatment,” he told bdnews24.com on Monday.

“Many die while being transferred to the burn-care facilities,” he said.

A growing menace

The National Institute treated 23,508 indoor and outdoor patients in 2010, while the number was 39,000 in 2012 and over 49,000 last year.

Burn injuries seem to peak in Bangladesh between December and March.

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Prof Kalam said lack of awareness, improper handling of electrical equipment and shoddy wiring are pushing up the number of burn victims.
Acts of arson during general strikes and blockades also added to the tally.
Hospital data show flames and scalds cause the maximum casualties, followed by electric burns.
Chemical burns are also a major cause of injuries and deaths.
“Ninety percent of burn patients are victims of carelessness at home or workplace,” Prof Kalam said.
He said many of the electric burn cases could be attributed to mobile phones.
“People speak on the phone while charging it, leading to accidents.”
In some places, high-voltage power lines pass above houses or dense residential localities. This also contributes to electric-burn cases.
“We have only hospital-based figures. There are unreported burn patents being treated outside hospitals.
“The number is growing by the day with rapid urbanisation,” Prof Kalam said, “but we don’t see any awareness campaign for burns.”

Facility, manpower shortage

Apart from general burns, trauma as well as cancer patients and children born with deformities need the help of plastic surgeons.

The government had transformed the earlier burns unit into a national institute through an executive order in November 2013.

The final approval remained pending at the Ministry of Public Administration.

“Without the final approval, we cannot run as a proper institute,” Project Director Kalam said. “We will be able to offer post-graduate courses only after the final approval.”

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He said despite having a separate department, Dinajpur, Bogra and Mymensingh, hospitals cannot offer the services due to lack of manpower.
The other facilities at Sir Salimullah Medical College and Hospital, Pangu Hospital, National Institute of Cancer Research in Dhaka, Chittagong, Comilla, Rajshahi, Faridpur, Barisal, Sylhet, and Rangpur, are “understaffed”.
“Most of them have only an assistant professor,” Prof Kalam said. Currently, only Bangabandhu Sheikh Mujib Medical University offers post-graduate courses on burns and plastic surgery.
“If this trend continues, it will take 100 years to get the requisite manpower,” he said. “So we need to start courses urgently at our institute.”
“We have only 52 post-graduate doctors who have completed FCPS or MD.” 
Future plan
The government has drawn up a plan to extend the services to the Upazilas soon, which Prof Kalam said Prime Minister Sheikh Hasina already approved.
Under it, all government and private medical college and hospitals must have a burns and plastic surgery department.
Specialised institutes, district hospitals, and Upazila health complexes will also have such facilities.
At least 1591 trained doctors will be needed to execute the plan.
The number of nurses and paramedics needed would be twice that of doctors.
“If we can run burns and plastic surgery facilities at the periphery level, then people will not need to come to the centre,” he said.
“The demand is high, but we don’t have adequate facilities. Many injured die while being transferred to Dhaka or other medical college hospitals.
“We need to expand at the periphery level. It does not need sophisticated equipment. It needs knowledge.”
He said the first 24 hours were ‘crucial’ for a burn patient.