ZAREENA Bibi, a mother of four, sits in the waiting area of the Jinnah Hospital’s burns centre in Lahore beside her sister-in-law and husband. There are banners in and around the centre expressing solidarity with the victims of the Bahawalpur tragedy.

The grief is palpable and overwhelming. It is also clear that the burns unit has the unfortunate task of replying to queries from distraught families who know that the chances of survival of their loved ones are slim.

The tragedy, which occurred in the early hours of Sunday morning after an oil tanker carrying thousands of litres of fuel careened off a highway into cotton fields outside a village near Ahmedpur Sharqia, has so far claimed about 180 lives.

“I didn’t know that there had been an accident involving an oil tanker and that people were collecting fuel...I saw a lot of people walking towards the fields after saying their Fajr prayers, but all I knew was that my youngest child had gone out to play with his friends,” recalls Zareena.

Moments later she heard a deafening explosion. Zareena recalls how she saw her seven-year-old son Usman running towards her while covered in flames. She describes in gruesome detail how his clothes, body, face and hair were on fire.

As she recounts her son’s ordeal, an eight-year-old victim is wheeled out of the burns ward and is reunited with his parents on Thursday. The first victim of the tragedy to be discharged from a hospital, Yousaf is garlanded with sweets and bouquets of flowers. The sight is one Zareena wishes for her son.

On Eid day, Prof Dr Moazzam Tarar, medical superintendent of the Jinnah Hospital’s burns centre, and Allama Iqbal Medical College (AIMC) Principal Prof Muhammad Rashid Zia were at Lahore airport waiting for C-130 helicopters that were flying in patients from Multan.

“As the patients were being shifted from helicopters to ambulances, I was checking their vitals, oxygen levels and temperature. Since there had been deaths while patients were being taken to hospitals in Multan and Bahawalpur, we had to be absolutely sure that there were no deaths during the patients’ movement in Lahore,” says the AIMC principal.

The crisis of burns victims, one which doesn’t get adequate coverage in media, is that it is a life-long trauma.

“Even if we discharge burns patients after doing the best we can for them, they remain mentally, physically and emotionally scarred...the ordeal they have undergone is one of the worst imaginable,” says a doctor.

Lifelong complications

Other doctors at the hospital explain that there can be lifelong complications resulting from muscle contractures, carbon monoxide inhalation and organ burns, not to mention the psychological impact of permanent scarring or mutilated features.

“We had to make sure that the patients and their attendants were given the best facilities possible,” Dr Zia explains.

For the first 24 hours, patients are given fluids and electrolytes and the challenge is to make the ordeal as painless as possible.

According to Dr Zia, if the skin, the first protective barrier of the body, gets peeled away due to burns, the immediate challenge is that of managing the body temperature and ensuring that there is no bacterial infection in the exposed muscles and organs.

Similarly, modern advancements in technology now allow doctors to place certain dressings on burns. This allows the skin underneath to heal without developing major complications.

Dr Tarar reveals that a 15x20cm patch of dressing costs up to Rs4,000 and is placed on second-degree burns. This helps the patient bide time while the skin underneath heals on its own; the dressing eventually peels away.

Due to the heat loss and demands of tissue regeneration, the patients are fed a high-protein diet.

“The Bahawalpur victims are being given a soft diet based on milk and minced meat...they were asked about their taste preferences and their diet was tailored accordingly,” Dr Zia explained.

Zareena confirms that the attendants, too, were asked about their dietary likes and dislikes.

One of the most important aspects of the treatment, says Dr Tarar, is the psychosocial therapy the patients and their attendants are receiving. The hospital has grief counsellors and therapists who talk to patients about the psychological aspects of their injury and the treatment needed.

The burns centre has requested a non-profit organisation in the USAto provide skin allograft for the Bahawalpur victims and hopes to receive it soon.

Skin allograft involves skin grafts from a cadaver, according to Dr Tarar. It is harvested, like any other organ, soon after a person dies and is preserved either cryogenically (below -30 degrees Celsius) or in glycerol.

“We have an MoU with the Euro Skin Bank, a non-profit organisation based in the Netherlands,” he says. They have offered to help the burns centre set up its own skin bank here.

Dr Tarar hopes that the initiative would help bring down the cost of importing skin allograft and could help save lives.

Grafting skin onto a burn is one of the most vital links in the treatment chain, he says. A skin graft can act as a temporary cover or it can be placed upon a mesh of the patient’s own skin to strengthen and protect it while it heals.

However, the wounds go deep, says the AIMC principal. “They are wounds of the soul.”

Published in Dawn, June 30th, 2017