BY RACHEL PERLER
This summer, I interned at ANIQUEM (Asociación de Ayuda al Niño Quemado), a Peruvian NGO that is working to change the national approach to burn injuries and their care. The organization was founded in 1999 by a pair of doctors from Lima with the mission to reduce the prevalence of burn accidents in the Peruvian youth population through community education initiatives. Burn injuries are a significant but neglected global health challenge, particularly in low- and middle- income countries where cultural cooking practices and overcrowded dwellings present a high risk of burns. Each year, an estimated 195,000 people die from fire-related injuries alone. Even more die from “scalds, electrical burns, and other forms of burns.” Yet non-fatal burns, which are common and can cause profoundly negative psychosocial effects, have not been well-studied in low and middle-income countries. Existing research shows that severe burn injuries can be devastating — they disproportionately affect poor women and children and often require a long, costly process of physical and psychological recuperation. Lack of proper care following a serious burn injury can have profound physical and psychological effects, including serious physical disfigurements, disabilities, and mental illnesses like depression or PTSD. Furthermore, the stigmatization of burn scars often affects the economic potential of burn victims, who often find it difficult to obtain work even years after recovery because of their physical appearance.
In Peru, there is very little epidemiological data on the prevalence of burns and almost no data at all on the ability of burn victims throughout the country to access and afford appropriate medical care. A clinical guide to burns issued by the Peruvian Ministry of Health uses U.S. burn statistics to outline the prevalence of burn injuries — about 0.8% of the United States population presents burn injuries each year. The guide also acknowledges that the statistics for Peru are “not so precise.” Considering that burns disproportionately affect poor people in low- and middleincome countries, it is likely that the prevalence of burns in Peru, a middle income country in which 25.8 percent of the population lives below the national poverty line, is significantly higher than the given U.S. figure.
ANIQUEM is working to address the complex problem of childhood burns and change the standard of treatment in Peru. Although the NGO has maintained its emphasis on prevention, ANIQUEM shifted its focus in 2002 when it opened a rehabilitation center offering completely free services of “physical therapy, psychosocial rehabilitation, and social reintegration.” At ANIQUEM, children and occasionally adults receive comprehensive care for an average duration of 24 months which focuses on the complete mental, physical, and spiritual recovery of burn patients and their families. Although no comprehensive studies have examined outcomes of ANIQUEM’s care, the organization’s patient records suggest that those who adhere to treatment exhibit marked diminishment in scar complications. Records show that patients who undergo psychological treatment often find success overcoming mental illnesses associated with their burns, and anecdotal evidence suggests that families who use the NGO’s social services feel more prepared to deal with the challenges, physical and psychosocial, that burn patients must face for the rest of their lives.
ANIQUEM’s services are limited by several factors. First, a general lack of data stunts the organization’s progress. Little cost-effectiveness and outcomes data exist to guide ANIQUEM’s community-based burn prevention education workshops. Second, lack of funding curbs the quality and number of treatments available to patients at ANIQUEM. The NGO’s budget is derived almost entirely from donations and fundraisers with very limited federal funding. Yet ANIQUEM is the only organization of its kind in Peru, and its services are in high demand: on average, one new patient is admitted for treatment per day, 90% of whom come from families with a low socioeconomic status, many of whom are indigenous, and many of whom travel hours to reach the center. So far over two thousand patients have been treated at ANIQUEM; the number of Peruvian burn survivors who have not been able to access rehabilitative services for financial or geographic reasons remains unknown.
The World Health Organization estimates that up to 265,000 annual deaths can be attributed to burns, the majority of which occur in low- and middle-income countries. However, the scope of data on the effects of nonfatal burns in low- and middle-income countries is narrow, partially because epidemiologists often lump burns together with a variety of other accidents under the label “injuries.” ANIQUEM’s situation shows that burns are an important standalone global health issue with profound physical, psychological, social, and economic implications. ANIQUEM represents a successful model of a community-based burn rehabilitation and treatment center, but a single center of this kind is not sufficient to serve all of Peru, much less every low and middle-income country in Latin America. Existing health sytems in Latin America must recognize the need to fund extended physical and psychosocial rehabilitation services for burn patients, and centers like ANIQUEM must be created throughout the continent . Furthermore, more research must be done specifically on the demographics and risk factors of burn injuries so that effective treatments and prevention strategies can be devised. So far, we know that burn injuries are closely linked to poverty and that they are preventable. In the future, research should examine how the most effective burn prevention interventions should be devised to serve the populations most at risk, how the lifelong physical and psychosocial consequences of burn injuries might be alleviated, and how the stigmatization of burn injuries might be lessened in Peru and Latin America in general.
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