Posted by Aram Harrow, as told to him by Dr. Aditya Sharma
Two months ago, a four-year old girl accidentally knocked over a pot of hot oil, which left her with burns on her face and scalp. The story of her treatment illustrates both the urgent need for accessible healthcare that Nyaya Health addresses, and the limitations of our current clinic.
The patient arrived at the clinic an hour after being burned. At that point her injury seemed mild, with only a small amount of swelling, blisters and raw skin, so she was treated with topical antibiotics, a sterile dressing and oral painkillers. However, the next day she returned in much worse condition – her eyes were swollen shut, the blistering had turned into open wounds and she could barely move her lips to eat. Since then, her mother has brought her in daily to have her bandages changed.
Urmila Basnet, one of our nurse midwives, changes the patient's bandages during a follow-up visit two months after the initial injury.
In many ways, this patient is lucky to be alive. Her burns came close to blocking her nose and cutting off her breathing. She also narrowly escaped infection – had she been unable to get to our clinic for either immediate treatment or continuous follow-up, she would have been at much higher risk of developing life-threatening infections. Fortunately, she is now only a few weeks away from a full recovery.
On the other hand, the best treatment our clinic could offer still had important shortcomings. The key concerns with burns of this type are infection, wound healing, and pain control. All of these would have been better handled if she had been treated as an inpatient, or better yet, in a sterile burn center. Indeed, after her initial treatment at the clinic, we referred her to the nearest feasible hospital for such inpatient care (a 12-hour bus ride away). However, her lack of family near this distant hospital made the trip infeasible. This patient’s case is a good example of why we chose to locate the Nyaya Health clinic in the district of Achham, and not in a less remote area where other NGOs or health posts already operate.
To put her treatment in context, if this patient were an American – even uninsured or on Medicaid – she would have likely stayed for weeks in a specialized burn center, where she would have had skin grafting performed by a plastic surgeon. The average hospital bill for a burn victim in the US is $48,000, a figure that is not far from the total Nyaya expenditures over the past eight months.
We are excited about the greater level of inpatient care and services, such as blood transfusions, that we will be able to provide once we open Bayalpata Hospital this summer. For those patients who live far away, the inpatient ward will also ease the burden of the otherwise extensive and repeated travel for follow-up visits. While we will not be hiring a plastic surgeon, we expect that these added services will help efficiently alleviate the preventable mortality and morbidity associated with such burn injuries.