Abstract
ObjectiveTo describe the capacity of the Indian healthcare system in providing appropriate and effective burns treatment and rehabilitation services.ResultsHealth professionals involved in burns treatment or rehabilitation at seven hospitals from four states in India were invited to participate in consultative meetings. Existing treatment and rehabilitation strategies, barriers and enablers to patient flow across the continuum of care and details on inpatient and outpatient rehabilitation were discussed during the meetings. Seventeen health professionals from various clinical backgrounds were involved in the consultation process. Key themes highlighted (a) a lack of awareness on burn first aid at the community level, (b) a lack of human resource to treat burn injuries in hospital settings, (c) a gap in burn care training for medical staff, (d) poor hospital infrastructure and (e) a variation in treatment practices and rehabilitation services available between hospitals. A number of opportunities exist to improve burns treatment and rehabilitation in India. Improvements would most effectively be achieved through promoting multidisciplinary care across a number of facilities and service providers. Further research is required to develop context-specific burn care models, determining how these can be integrated into the Indian healthcare system.
Highlights
Seven million people sustain burns every year in India [1] with over 61,000 deaths attributed to exposure to fire, heat or hot substances in 2015 [2]
As part of this quality improvement project, a number of barriers were identified for the provision of care for burn injuries at primary, district and tertiary health services in India
This study demonstrates how a lack of operational standards for burns care, the varied knowledge and skills of health professionals in providing burns care, together with resource shortages, greatly impacts the quality of care for burns patients
Summary
A total of 17 health professionals were involved in the consultation process including nurses, allied health professionals such as residents, consultants, physiotherapists, social workers, dietician, plastic surgeons and general surgeons (Table 1). Lack of standardization in treatment practices Lack of guidelines for rehabilitation “But madam, we have to provide First Aid, patients can’t do it for themselves.” [Nurse, Public Hospital] “Lack of awareness is a big issue. [Resident, Public Hospital] “It is very late in practice after years of experience that physicians begin to recognise the relevance of mental health in patient treatment.” [Consultant, Charitable Hospital]. Psychologists were generally not included in burn care teams and the physicians interviewed agreed they were often unable to diagnose or assist patients with psychological challenges including post-traumatic stress disorder (PTSD), anxiety and depression. Staff generally understood the need for treatment and care across the various rehabilitation domains (physical, psychological and social and community) but were limited in their capacity and the resources available to them. Commute to the health facility for rehabilitation was observed as a major challenge for treatment compliance
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