Burn cases are the second most common incidents in Nepal after road accidents, causing people to lose their lives, limbs, and dreams. According to recent research by the World Health Organisation, over 55,000 burn injuries and 2,100 deaths are reported annually in Nepal. Despite the severity indicated by these numbers, there is a general lack of awareness and skills among people on how to prevent burns or respond effectively when they occur in daily life. Experts suggest that quick thinking and simple preventive measures can significantly impact a survivor’s outcome.
Although many burn incidents occur, only 10% of cases require critical and surgical care. Hence, a timely response can indeed make a significant difference for other 90% of cases. As responsible citizens, it is essential to have basic knowledge about burn incidents – their prevention and remedial measures – to minimize their occurrence and severity.
While burns and fire do not discriminate across age, gender or region, however societal attitudes, gender roles, perceptions of injuries and scars, and disparities in access to healthcare significantly shape both the occurrence of such incidents and the recovery journeys of burn survivors. It is not only important to prevent such incidents but also to treat survivors, both those with visible and invisible scars, with dignity, compassion and support. This would ensure that their rehabilitation journey is less painful than the incident itself.
In this feature, I explore burn-related challenges, perceptions and aspirations by speaking to three individuals connected to the topic: Akrisha Khadka, a burn survivor; Ujjwal Bikram Thapa, an activist and philanthropist for burn survivors; and Dr. Shankar Man Rai, a cleft and burn specialist at Kirtipur Burn Hospital. The intention of this article is to raise awareness about burn incidents and inspire a shift in societal attitudes towards burn survivors.
Aakrisha Khadka
a teenager, a student and a burn survivor
Aakrisha is an 18-year-old pursuing her bachelor’s degree while working at Himalayan Java after college. Her warm smile can instantly brighten anyone’s day. At first glance, she seems like a regular teenager, but behind that smile is a story of resilience and hope, one that might inspire others facing similar challenges.
Aakrisha is a burn survivor. Like many survivors, she often reflects on the “ifs and buts” surrounding the incident. She wonders if she had stayed with her mother and sister an extra day or gone straight to class after ironing her clothes, things might have been different. On the day of the incident, she even chose a different seat in the school canteen instead of her usual one. That small decision changed everything. While walking toward the unfamiliar seat, she accidentally touched an old rusted water dispenser. Boiling water spilled onto her legs, causing deep burn injuries. She recalls, “If I hadn’t used my hand to shield myself, the water would have fallen on my face. Instead, it went to my legs.”
She showed her scars. While the scars themselves don’t bother her as much, the keloids—excessive scar tissue—make her feel disheartened. Despite this, she still dreams of becoming a volleyball player, though she knows the dream feels distant now. Her other aspiration, to join the army like her father, might never come true.
Aakrisha recounts the struggles she has faced since the incident. She still needs to manage and keep the wounds properly moisturized and clean; otherwise, they start to itch, cause pain, and leave her feeling tired. On the day of incident, there was no one at her school who knew how to respond to burn injuries. “If someone had poured cold water on my burns right away, my injuries wouldn’t have been this severe,” she says. A kind person rushed to help her and burned his own hands in the process, but when she was taken to the first hospital, they refused to treat her because they didn’t handle burn cases. She was transferred to the burn hospital but the journey was fraught with difficulties: the ambulance driver didn’t know the way and traffic jams delayed her care. Even in the hospital, she feels better physiotherapy could have helped her recover more effectively.
The financial burden of her treatment was another challenge. Her father, recently retired, had just left for foreign employment and her mother struggled to cover the medical expenses. The family had to take out loans which her family is still repaying. Though her family has been supportive, Aakrisha senses their unspoken regret about the money spent on her treatment which saddens her. Adding to her disappointment, her school showed no interest in supporting her, and she had no access to external aid. She wishes there were institutions that could help burn survivors like her with the cost of treatment.
She recalls her initial days in the hospital: “The first thought I had was that I could never become an army officer anymore. It was a deeply depressing time. But seeing other patients at the hospital, I realized I wasn’t alone in this journey.”
It was during her time at the hospital that she met Ujjwal Bikram Thapa. His positive energy reignited the hope she thought she had lost. Learning about her passion for volleyball, Ujjwal introduced her to few national players and helped her secure training and a job at Himalayan Java through his network.
Aakrisha dislikes pity and fake concern from people. She says, “I don’t mind questions about my injuries as long as they come from a place of genuine compassion and a belief that I still have a meaningful life, which I do.”
For Aakrisha, Himalayan Java Coffee has been a lifeline. The support and understanding she has received there have been crucial in her recovery. Through her work, she has learned new skills and has been interacting with people, earning some money, and has regained some normalcy in her life. The team at the Java has been supportive, giving her help when needed but also trusting her to fulfill her responsibilities which has helped rebuild her confidence.
To other burn survivors, Aakrisha shares an encouraging message: “Live life to the fullest. Move forward and keep believing in yourself. Don’t let one incident define the rest of your life.” She smiles and says, “I am trying to do the same.”
Ujjwal Bikram Thapa
Activist and Philanthropist
The day we met, Ujjwal Bikram Thapa had good news to share: a policy concerning burn survivors had just been approved on the day we met. After years of relentless advocacy, he informed me that the Government of Nepal had allocated Rs 13 crore specifically for the treatment of burn survivors from the poorest families. If implemented properly, Ujjwal feels this policy will ease his burden significantly. He emphasized the importance of aligning activism with government support, stating, “Without making the government your ally, you can’t achieve sustainable change.”
In addition to financial aid, Ujjwal has been pushing for reconstructive surgeries for burn survivors to be treated on par with acid attack survivors under government schemes. He explained that deep burn injuries require lifelong care, as there is no definitive “moving on” for survivors; instead, they must navigate life with scars – both physical and emotional.
Known for his instrumental role in acid attack-related reforms including compensation policies and regulations on acid sales, Ujjwal feels the issue of burn survivors is unjustly overshadowed. He pointed out that burns are one of the leading causes of disability in Nepal, yet public and media attention remain limited. “Burn injuries are a major reason why people become handicapped in this country, but not many are aware of it,” he said.
Having worked closely with numerous burn survivors, Ujjwal remarked, “A common thread among them is that none of them thought it would happen to them. All of them believed it was something that happened to others.” Stressing the unpredictability of burn incidents, he highlighted the importance of public education about preventive measures and first-aid response. He shared an essential tip: “The first instinct for many is to rush to the hospital, but the best immediate action is to pour cold running water over the burn for 15-20 minutes. It can significantly reduce the severity of the injury.”
Ujjwal outlined several simple yet critical preventive measures: being cautious around open flames, avoiding flammable clothing near stoves, and supervising children and pets near heaters or cooking areas. He also advised opening windows to disperse gas leaks, checking electrical wiring under carpets, and parents and teachers ensuring schools and hostels conduct regular fire drills. He urges everyone to remain vigilant, especially when using modern conveniences like electric heaters or charging electronic vehicles, as these can sometimes pose hidden risks.
Highlighting ways individuals can contribute: Ujjwal suggested donating winter clothes to burn hospitals, especially during colder months when burn incidents surge. He also mentioned that even donating used toys of children can provide comfort to young burn survivors, aiding their recovery process. “It’s a small effort that can make a big difference,” he added.
Burn incidents have a profound impact on young people, Ujjwal observed. “Infants adapt more easily, and elderly patients often succumb to their injuries. But young adults – the ones who are just building their lives – face shattered dreams and immense challenges in acceptance.” Women, in particular, face societal hurdles as scars often bring stigma and isolation. Ujjwal added, “Every visible or invisible scar reminds them of the incident and how they are perceived. The media and society’s obsession with physical appearance make recovery even harder for women. Men, on the other hand, tend to recover and reintegrate more easily, as they’re not judged as harshly.” However, women, in particular, show remarkable resilience for survival, often driven by the sense of responsibility toward their families.
He also noted differences between urban and rural survivors, observing that urban residents often have a lower threshold for pain, while rural survivors endure their injuries with remarkable resilience. Ujjwal expressed hope that provincial hospitals will soon establish burn units or at least have five beds for burn survivors, ensuring that basic treatment is available locally. This would reduce the need for survivors to travel to Kathmandu, easing the burden on both patients and families. Even if they do need to travel, transitions would be smoother for survivors.
As we wrapped our conversation, Ujjwal emphasized the importance of spreading knowledge about burn prevention and response and he reiterated that a lack of knowledge exacerbates burn injuries and their aftermath. He called on media houses to play a more active role in raising awareness, especially during winter, when incidents peak. “The government and media need to be equally responsible for all burn cases including accidental ones, not just sensationalized acid attacks. Survivors, no matter how they were burned, deserve dignity, support, and attention from all stakeholders,” he said firmly.
Dr Shankar Man Rai
A cleft and burn specialist
Dr Raju Bhandari
Specialising in surgical and critical burn care
Dr Shankar Man Rai, honored with various international awards, including the Unsung Heroes of Compassion Award in 2009 and having served the country for more than three decades, still believes there is more to learn and improve in the field of burns and burn-related injuries. As he deepened his understanding of burns and their complexities, he realised that while most burn cases are not lethal, the ones that are require specialized care and support; something Nepal still lacks due to several reasons.
Dr Shankar pointed out some key challenges such as a lack of trained human resources, specialised doctors for critical burn care, updated technology, including skin grafting materials essential for treating deep burn injuries. He admitted that his team has been so focused on clinical treatments that they have not spent enough energy or resources raising awareness about donations to Kirtipur Hospital’s endowment fund or promoting pledges for skin donation at their skin bank.
“While physical recovery is crucial, burns are a multidisciplinary issue that requires a comprehensive approach to support survivors,” Dr Shankar asserted. He explained that their hospital focuses on both physical and psychological recovery, but he feels society does not yet value psychological treatment. “Even educated people tend to dismiss the importance of psychological care,” he added. He also highlighted the lack of proper rehabilitation systems in Nepal, with little attention given to survivors’ social reintegration. He believes burn survivors need avenues to develop social and vocational skills, which are still missing in their recovery journey.
I met Dr Shankar at the Nepal Cleft and Burn Center section dedicated for burn survivors in the hospital where he introduced me to his colleague, Dr Raju Bhandari. Dr Raju is the only doctor in Nepal specialising in surgical and critical burn care. Dr Shankar reflected on the early days of the burn center in the hospital in 2014, admitting he had naively assumed that one operating room and two ICU rooms would suffice. “We realised it wasn’t that there weren’t many burn survivors, but that they had nowhere to go for treatment,” he said.
While many burn incidents can be avoided, Dr Shankar also addressed the societal and economic factors behind burn incidents. Many cases involve young children or rural women, reflecting deeper social issues. “In many households, small children are left unsupervised, and we have this culture of leaving a five-year-old to care for a toddler while parents have to work for their sustenance. Similarly, rural women using firewood for heating often get caught in accidents due to their attire and inability to respond quickly,” he explained. He also pointed out that while acid attacks receive significant attention, burn incidents caused by other means do not garner the same focus.
Dr Raju added to the discussion by emphasising the importance of clear communication with families. He recounted cases where children ended up in the ICU due to burns caused by traditional remedies like steam inhalation for bronchitis and the importance of having fire exits in all of our apartments and buildings which still don’t exist in our buildings.
Despite these challenges, Dr Shankar is optimistic. “In 2014, when we started, we struggled to save patients with full-thickness burns. Over the years, our survival rates have improved to 50%, but we still have a long way to go,” he noted. He dreams of matching the 90% survival rate seen in developed countries. Acknowledging the high cost of burn treatment and the financial struggles of most survivors, he expressed hope for the future: “We are building a new facility, incorporating advanced technology, and collaborating with foreign experts. I am hopeful that one day, with enough support, we can provide free treatment for all burn survivors.”
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