Scarred fingers move deftly fixing the wick on a freshly made six-inch candle. Callused hands mold hot, molten wax never hesitating as heat ripples through her skin reminding her of the time she burnt. Simran KC, who suffered 45% burn injuries, has made peace with fire.
The doctors who attended to her at Sushma Koirala Memorial Hospital in Sankhu never thought Simran would make it. Four years and multiple surgeries later, Simran now counsels other burn victims when needed, besides working at Burn Violence Survivors (BVS)-Nepal, the NGO that funded her medical expenses, and making candles during her free time.
“The doctors there didn’t recognize me when they saw me a year ago,” says Simran who had set herself on fire following severe depression due to emotional and physical abuse from her husband. A photo of her when she was initially admitted at the hospital hangs on the wall next to the staircase leading up to the wards. You’ll struggle to find similarities between the girl in the picture and the woman now.
Simran has definitely come a long way. She is now able to look you in the eye and talk without wearing a mask to hide her scars. Her disfiguring and disabling scars, though constant reminders of the pain she has had to go through, are no longer a source of shame.
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Burn survivors work with hot wax and fire to craft beautiful candles. The irony isn't lost on them but fire doesn't seem menacing anymore. (Photo Courtesy: BVS-Nepal)
But complete recovery seems elusive and almost impossible, given the fact that despite having healed, her scars burn and ache with slight weather fluctuations, or a wrong turn of the limb. While commuting, Simran can’t hold on to the bus railing for more than a minute or so because searing pain rips through her taut skin.
“For burn survivors, the road to recovery is long. And their bodies will never be the same,” says Dr Binod Karn, Lecturer, Department of Plastic Surgery at Nepalgunj Medical College, explaining how a patient is destined for lengthy hospital stays and even when they are finally discharged need to keep coming back for surgeries, not just for aesthetic purposes but to regain basic movements and functions.
Burn injuries are the second most common injuries in Nepal. There are mostly accidently and sometimes even homicidal and suicidal. In case of accidents, scald burns is the most common type of burns in children, while electrical burns and flame burns are common in men and women respectively. Homicidal or suicidal cases are almost always related to dowry or abuse – mental or physical and often both.
Whatever the case be, the fact of the matter is that burn injuries are perhaps the most painful of all injuries and need to be treated with utmost care and urgency. But management of burn injuries is alarmingly bad in Nepal with zero support from the government. In such a scenario, the situation quickly goes from bad to worse for the victims who are already in excruciating pain and in urgent need of medical attention.
“Private hospital won’t admit patients who have sustained more than 40% burn injuries,” says Rumi Rajbhandari, program coordinator at BVS-Nepal. The hospitals cite lack of equipment and professionals skilled enough to handle such sensitive cases. "Also private hospitals charge a lot and not many can afford expensive medical care,” she adds citing a recent squabble BVS-Nepal had with one of the private hospitals in the capital when they tried to charge a burn victim an exorbitant amount for an ill furnished room and regular medicines.
BVS-Nepal works in collaboration with government run hospitals and because of the bureaucratic system of the country, even this sometimes proves to be quite a chore. Government hospitals outside Kathmandu aren’t sufficiently equipped to handle burn cases, and many patients have to be brought to Kathmandu after receiving emergency treatment at district hospitals.
“I have seen many nurses and even doctors at district hospitals handling burn cases with such negligence that it’s appalling,” says Rajbhandari explaining that she has seen a nurse literally patting the arms of a burn victim and doing next to nothing as if the patient wasn’t in danger.
In the current situation, with the Indian blockage, the scenario has become trickier. Unlike before, BVS-Nepal hasn’t been able to bring many patients to the capital for treatment. Many reconstructive surgeries have also been put on hold.
“After the earthquake, there was quite an upsurge in burn cases. And now the blockade has added to the ineffectiveness in the management of burns,” says Laetitia, who handles accidental burn cases at BVS-Nepal.
According to her, post the earthquake as many people are still living in congested spaces in temporary shelters, burns due to cooking fires are very common. Burns from hot liquid falling on children or children falling in large utensils are also frequent occurrences. Similarly, there’s been an increase in accidental burn cases after the Indian blockage.
According to Laetitia, fuel explosions have escalated in the recent times as people have taken to storing large quantities of kerosene and petrol in their homes. She narrates an incident of a couple in Sarlahi who got burnt and died on spot after the wife’s six year old brother struck a match in the room where they had stored petrol.
“A bus conductor in Nawalparasi was hit on the head with a live electrical wire while he was on the bus roof. His skull was burnt and deformed,” she says adding that he has received a total of six surgeries – five at Kirtipur Model hospital and one at the trauma center in Kathmandu – in the two months since the accident.
There have been plenty other cases where people sitting on roofs of buses have been electrocuted by dangling wires. Other cases include burns from lighting firewood or not stubbing out cooking fires properly especially since more and more people are using firewood in their homes.
When burns are so common and aplenty, you would expect treatment to be easily accessible. But that isn’t the case. Our hospitals simply aren’t well equipped to handle burn cases as a result of which there are constant referrals and shifting of patients from one hospital to another. Till now, Sushma Koirala Memorial Hospital in Sankhu is the only hospital that seems to have a proper system and protocol in place regarding treatment of burn injuries but it also has its own constraints.
“Burn injury is an extensive trauma and the treatment is a never ending process. The victims will need some form of medical care throughout their lives,” says Dr Karn adding a lot depends on the initial care received by the victims but burn injuries are neglected in Nepal.
And indeed the government is making little to no effort in terms of management of burn injuries. According to Mahendra Shrestha, spokesperson at Ministry of Health and Population, the issue hasn’t been on their priority list and there is no concrete plan on how to address this ‘burning’ issue.
“Last year, we provided training on how to handle burn patients to 600 doctors and nurses in major hospitals across Tarai region, but this year we haven’t been able to give continuity to it,” says Shrestha. He also confesses that there is no initiative from the government to provide medical aid to burn victims who can’t afford treatment. However, Shrestha says that the ministry sees the need to address this issue soon.
To add insult to injury, there seems to be a lack of strong laws regarding burn violence. Advocate Sushma Gautam says that over the years there has been little improvement in the legal system. The punishment for acts of violence has gone up to three to eight years from a meager two years but a lot still needs to be done. “The compensation for burn victims is a mere 150 thousand rupees. That is nothing because the treatment is costly,” she explains.
Dr Karn believes that unless and until the government takes action the situation will remain the same regarding both management of burn injuries and legalities. “There needs to be strong initiatives from the government, but this issue has forever been sidelined by the state. However, the government can no longer be apathetic because burn injuries are increasing by the day,” he says adding that a burn ICU was recently set up at Nepalgunj Medical College when patients suffering from all kinds of burns have been coming to the hospital for years now.
With such negligent and slow system in place, can we ever hope for the scenario to change? As Simran crafts beautiful candles, her eyes glued to what she calls ‘ugly’ hands, does she have no other option than to come to terms with the fact that here in the country she calls home scars are forever?
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