Thursday, July 21, 2011


VM, aged 4 years was sitting along with his mother on a late April morning. Although winter was long over, the chill in the air was enough for VM's parents to get a fire going to boil water for bathing. VM still complained that it was cold that his mother wrapped a shawl around her son. His mother was busy with all the morning's cooking and other activities. VM's shrill cries caught her attention - her son had accidently gone too close to the fire where water was kept for boiling. The shawl had caught fire. By the time they could put out the fire, the damage was done.

VM along with his parents and little sister lived quite far away from the main town. There was only a single bus service to the village - and it was quite jampacked that very few of the villagers planned to make a trip to town. VM's father worked in the local Catholic school. In fact, it was the association that NJH has with the Catholic dispensaries through the Global Fund Tuberculosis Programme that helped VM to come to us after being burnt.

After VM got burnt, both the parents did not understand the gravity of the situation. They requested the local nurse in charge at the Catholic dispensary to provide them with some burn balm. The nurse got suspicious and asked that she see the burns. She understood that things were quite bad and VM required urgent treatment. Somehow, she convinced the parents to take VM to a good doctor. The parents took VM to various doctors in the nearby town of Daltonganj. They were refused treatment at all places - everybody advised that he needs to go to a higher centre.

This was when, the nurse calls me and asks whether we could take a look at VM. VM arrived at NJH at around 12 pm, about 7 hours after the incident had occured. It was a terrible sight. The boy had burnt both his arms, front of his chest and neck. In addition to dehydration, compartment syndrome was setting in both the upper limbs. I somehow convinced the parents to allow us to do a fasciotomy of both the limbs.

I knew this was going to be a tough case. The boy was in the ward for about 2 weeks - unfortunately, the parents were not willing for a tangential excision and skin grafting. The wounds started to heal on its own. Then, they wanted to go home - and even intensive counselling did not yield any results.

The family left for home. Somehow, we got in touch with them - again thanks to our network through GF TB work - and counselled the family again on the need for regular treatment. Unfortunately, the scars were causing contractures, which thankfully alerted the family to seek medical care. VM has come back to us last week. Nandamani did some amount of contracture release of his limbs yesterday. Kindly pray that the family will be able to understand and heed our advice on further management.

Once more, we have a family where things could have been prevented at various levels. First of all the burns could have been prevented had the parents been a bit careful. The healing could have been faster and more appealing if they agreed for a tangential excision and skin grafting.

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