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Prem Prasad died of hot air and smoke he inhaled during self-immolation: Dr Nakarmi (video interview)

I wish burn patients would be treated free of cost since they are mostly poor
Samridhdha KC

Samridhdha KC

 |  Kathmandu

Thirty-six year-old Prem Prasad Acharya of Ilam set a fire to himself after being doused in petrol in broad daylight in front of federal parliament building in New Baneshwor on Tuesday. Critically injured Acharya, who was rushed to Kritipur Hospital, succumbed to his injuries on Wednesday morning. According to the doctor who attended to his treatment, eighty percent of Acharya’s body had been charred. With this, there have been growing concerns regarding the treatment of burn patients.

Against this backdrop, Nepalkhabar talked to Dr. Kiran Nakarmi, the Head of the Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, on this issue.

How often do injury patients come to this hospital?
Burn injury patients outnumber the cases of outpatient department. According to the statistics maintained by the hospital, around 660 burn injury cases are admitted to the hospital annually. The condition of the burn patients to be admitted is very critical.


What is the percentage of recovery of burn injury patients?
Burn injury cases can be divided into two parts – critical and normal. In average, if more than 15 percent of body parts is burnt, it is called critical. In such a case, vital organs -- heart, lungs, brain and intestines -- are also badly affected apart from the burn area.If burn injury is less than 15 percent, it is called normal. Its affect is limited only to the burn area.  Those who suffer more than 15 percent of the body parts must be hospitalized. Looking at the statistics of 2022, we could not save 24 percent of those who were admitted to the hospital.  In average, the death rate ranges between 20 to 24 percent.

Could you suggest a first-aid for those who suffer burn injuries?
If someone is burning, the fire should be extinguished with a thick blanket, water or a fire extinguisher, at first. Ornaments and clothes worn by the injured should be removed. The burn areas should be cooled with running water. Tap water is suitable for it. But it can be effective within three hours of the incident or before taking the patient to the hospital.  The burn injury should be covered with a plastic and paste should be applied to it. The patient should be given Jeevanjal.

Burn injury treatment is said to be expensive. How is the treatment done to such patients and why the burn treatment so expensive?
The treatment for burn injury is expensive across the globe, not only in Nepal. A lot of equipment and medicine are required for its treatment. Besides, the patient has to remain in bed for months and the bed fee is also expensive. There is only one ICU of burns in Nepal and that is with Kirtipur Hospital. The ICU fee is only Rs 2,500 but the patient will have to pay more when the patient remains here for several days. The other expenses is that the patient has to take high-dose antibiotics which might cost Rs 5,000 to 6,000 in a single day.

The government has introduced a provision of health insurance for the treatment of various diseases. What do you expect from the government regarding treatment services for burn patients?
The government has included treatment of various diseases in health insurance scheme, but burn injury. The cost of complete treatment of burn injury patient will come around Rs 400,000 to 500,000 which a patient cannot afford.  We don’t say that the government should bear all the expenses. What we expect from the government is an infrastructure with sufficient number of beds. A hospital with 100 beds, 50 to 60 beds are occupied by burn patients. The technology is also very costly. Burn injury patients would heave a sigh of relief, if the government made an arrangement for free access to treatment without recommendation or documents through the arrangement of fund at the national or international level. There is no crunch of human resources. But there is a shortage of physical infrastructure and finance. 

Prem Prasad Acharya who self-immolated breathed his last in the course of treatment at this hospital. How was his condition? Some said he passed away while speaking. 
Eighty percent of Acharya’s body had been burnt. This is too critical. The patient of this condition cannot be saved. Besides, he had inhaled hot air and smoke. We even saw patients with 90 percent burn injuries die speaking. This is normal.

What precautions do you suggest to prevent such burn incidents?
Precaution is the best way to control such incidents.  According to the World Health Organization, we can preempt 80 percent burn incidents if we take precautions. Before 45 years ago, burn incidents used to take place even in the developed countries like our country Nepal. Now, 11 million people suffer from burn injuries, of them 95 percent of incidents occur in developing countries. Only five percent of such injuries take place in the developed countries. This was all possible due to preventive measures they adopted.

It is advised not to put on loose and nylon clothes while cooking. Make sure fire is extinguished or regulator of cooking gas cylinder closed after cooking. Similarly, we should not leave patients suffering from epilepsy, children and the elderly near the fire.


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