Inside the burns ward

THE more than 40 beds in the female burns ward of the Victoria Government Hospital are always occupied. There is a typical occupancy profile in this ward. The women who come here are mostly young, married, from lower middle-class or poor economic backgro unds. Most of them are victims of the most vicious forms of marital violence. It is here that we get a searing picture of the horror and violence of a death by burning. The wards are as busy as a railway platform, and indeed as unclean. Patients' relativ es, policemen, harried doctors and overworked nurses walk freely in and out of the ward. There seems little chance of keeping out the infection that can prove deadly to a severely burnt victim fighting for her life. "In the late 1970s, when my associatio n with this ward first started, four or five burns cases a week was considered very high," recalls Dr. Gurumurthy, Head of Department of Plastic Surgery and Burns. "Today we have six to seven patients coming in every day."

"Will these marks go? Will I get better," whimpers Shabrin Begam, 20, a second-year PUC student, her bloated and peeling face wincing under the effort of speaking. She has just given a clear statement, in the presence of the doctor and the investigating officer, of the circumstances which led to her husband setting her on fire. She has suffered 90 per cent burns and, although she does not know it, there is little chance that she will live more than a couple of days.

"I'm hurting, help me," implores Lalitha to a passing nurse, a few beds away. She holds out her arms from which hang strips of burnt skin. Lalitha says she set herself on fire out of "despair", but declines to give the reasons for it.

In yet another bed lies Selvi, 18, her upper torso and face charred. Her husband, who is no more than a boy himself, hangs uncertainly around, his attention more on the police than on his dying wife. "What, changed her statement again?" sniggers the port ly investigating officer, preparing to take her declaration, the third since she was admitted. "First she says it was an accident, then that she was forced to do it to herself, and now that her mother-in-law did it to her. Why don't these people make up their minds?" he grumbles as he enters the ward again. Selvi worked in an agarbathi factory; her husband, Anwar, is a construction worker.

"There is a high mortality rate in our burns ward," explains Dr. Gurumurthy. "While other hospitals can treat cases that have up to 50 per cent burns, all cases above 80 per cent are sent to us." Good nursing is critical to the survival and recovery of a burns patient with over 50 per cent burns. "All patients with burns up to 50 per cent should survive, and above that some should survive. Nurses must monitor burns cases 24 hours a day. Ideally there should be one nurse per bed," he says. At the Victori a Hospital, there are just three doctors with five house-surgeons to assist them, and only three nurses for an eight-hour shift.

There have been many changes for the better in recent times in the quality of treatment, nursing care and cleanliness in the Victoria Hospital burns ward. The credit for this goes partly to Vimochana, which initiated a campaign in September 1997 to draw attention to the general state of the burns wards. There were complaints of negligence and rampant corruption, while the general levels of cleanliness were very poor. Following Vimochana's campaign, which included a hunger strike in front of the hospital in April 1998, there were also demands, in both Houses of the Legislature, for an inquiry into the state of the wards. Not only did this result in a dramatic improvement in conditions within the wards but an entirely new burns ward was constructed on an other floor at a cost of Rs.18 lakhs. The cost of air-conditioning the new unit has been underwritten by Infosys, the Bangalore-based software company.

Vimochana also got permission to have two volunteers posted in the wards. They keep detailed registers on individual cases, counsel victims and families on legal procedures, talk to victims and try to elicit their real stories, monitor under what section s the police book cases, and act as friends to traumatised victims and families.