355
burns 40 (2014) 354–363
comparison with group 2 (new BICU) in which the most common cause was hot fluid’’ was due to a major factor which explains as follows. In the earlier study by Agbenorku et al. (2010) focus was on four fire disasters that occurred within the middle belt of Ghana (where Kumasi is located) from 2007 to 2008 which were petrol related fires; victims of these petrol related fires formed the group one patients within the period May 2007 till April 2009 who were managed in the group 1 (old BICU) whereas patients in group two (new BICU, from May 2009 to April 2011) were mostly general burns victims of which scalds dominated as the major aetiology of the admissions [1]. It is also true that flame burns especially in closed space may be associated with respiratory injury that would often increase the mortality rate. Although, the two groups had different aetiology of burn in the study, the comparative analysis revealed no significant difference for aetiology (Table 4). The interpretation of the analysis means, the variation in cause of burn in both groups does not have any effect in the comparism, in other words, aetiology of burn is not a factor to be considered in terms of comparism in both new and old groups. Additionally, it is also important to note that clinical research and studies have gone beyond the era where higher percentages were seen as the majority, hence will have an impact or effect on the study. Clinical analysis with specific applications under set confidence intervals are needed to be conclusive in ones results reportage.
Part 2 Burn resuscitation in the study had been explained in details in the ‘‘Summary of Protocol’’ section, where resuscitation was achieved within the shortest possible period. Also, the ‘‘Surgery’’ sub-section had explained various durations of surgery in the study. Hence, burns resuscitation may not be compromised.
Part 3 Usage of Vaseline gauze was done in addition to antibiotics (Tablets and Infusions); also wound swabs for culture and sensitivity were taken and the antibiotic regime changed or continued accordingly. This would prevent (not totally, though) sepsis in even deep burn patients (Laboratory investigations and Wound dressing Sections).
reference
[1] Agbenorku P, Akpaloo J, Farhat BF, Hoyte-Williams PE, Yorke J, Agbenorku M, et al. Burn disasters in the middle belt of Ghana from 2007 to 2008 and their consequences. Burns 2010;36:1309–15.
Pius Agbenorku Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
E-mail address: [email protected] (P. Agbenorku) 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.09.001
Letter to the Editor Self-immolation – A protest against unfair practices in family/society?
We read with interest a recently published article entitled ‘‘Why it is so important to prevent self-immolation around the globe?’’ [1]. Self-immolation has a far reaching medical and social outcome and there is certainly a need for a social campaign worldwide to prevent these deaths. In this correspondence we wish to highlight certain details relating to the two types of self-immolations discussed by Rezaeian [1]. Availability, accessibility, popularity, and social acceptability are the major factors in the choice of methods of suicide, and preference of self-immolation as a method of suicide among females is well known [2,3]. Self-immolation among young married females has been a cause of concern in Indian sub-continent and ‘Dowry’ is one well recognized cause for suicides and parasuicides among young, married women in India [4]. A protest on the other hand, is an expression of dissent or disapproval of certain policies or situations. The protests likewise can involve any method. Just like a suicide chooses a certain method to commit suicide, the protesters opt for a particular method to show their dissent. The author [1] states that among the two types, the first type of self-immolation receives vast coverage by the mass media, and this vast coverage may possibly bring about some desired changes. On the other hand, second type of selfimmolation hardly receives any mass media coverage, and is not successful to change the unfair family situation. However, we would like to point out that self-immolation as a method of protest may attract vast media coverage but whether the same is likely to bring desired changes is uncertain. Similarly, just because individual cases of self-burning in the second type of self-immolation do not receive much coverage in media, it does not bring about changes in the unfair family situation may not hold true. India alone has seen the majority of the worldwide protests involving self-immolation during 1963–2002 [5]. None of these events, however, had a favourable outcome in terms of the reason for protest. On the other hand, newer laws have been enacted in India time and again to curb the problem of dowry deaths for which self-burning is recognized as the most common cause. In this regard, The Dowry Prohibition Act was enacted in 1961, which was followed by insertion of more stringent criminal laws by amendments in the Indian Penal code (IPC). Section 498A was inserted into the
356
burns 40 (2014) 354–363
Indian Penal Code in 1983 and Section 304B of the Indian Penal Code in 1986. Section 498A of IPC describes punishment for ‘Husband or relative of husband of a woman subjecting her to cruelty.’ For the purpose of this section, ‘‘cruelty’’ refers to any willful conduct which is of such a nature as is likely to drive the woman to commit suicide or to cause grave injury or danger to life, limb or health whether mental or physical of the woman. Section 304B of IPC deals with Dowry deaths and states that ‘Where the death of a woman is caused by any burns or bodily injury or occurs otherwise than under normal circumstances within seven years of her marriage and it is shown that soon before her death she was subjected to cruelty or harassment by her husband or any relative of her husband for, or in connection with, any demand for dowry, such death shall be called ‘‘dowry death’’ and such husband or relative shall be deemed to have caused her death’. It needs to be highlighted here that this section explicitly recognizes the deaths caused by any burns in women. As per Section 304 (B) of IPC, there is a provision of imprisonment for a term which shall not be less than seven years but which may extend to imprisonment for life. Protection of Women from Domestic Violence Act of 2005 is the latest legislation in this regard. This Act also provides protection for any form of domestic violence arising for any unlawful demand for dowry. Predisposing factors behind suicides can be multi-factorial and sometimes difficult to analyze per se, and mere presumption that any act of self-immolation by a young married female is a form of protest may be unwarranted. Possibility of considering an act of self-burning as a protest against current unfair situation in the family/society in general thus, needs to be explored and justified.
Conflict of interest None to declare.
references
[1] Rezaeian M. Why it is so important to prevent selfimmolation around the globe? Burns 2013;39:1322–3. [2] Kanchan T, Menon A, Menezes RG. Methods of choice in completed suicides: gender differences and review of literature. J Forensic Sci 2009;54(4):938–42. [3] Kumar TS, Kanchan T, Yoganarasimha K, Kumar GP. Profile of unnatural deaths in Manipal, Southern India 1994–2004. J Clin Forensic Med 2006;13(3):117–20. [4] Menezes RG, Kanchan T, Pillay VV, Lobo SW, Subba SH. Selfinflicted burns. Burns 2008;34(3):427. [5] Biggs M. Dying without killing: self-immolations, 1963–2002. In: Gambetta D, editor. Making sense of suicide missions. Oxford: Oxford University Press; 2005. Available from: http:// users.ox.ac.uk/sfos0060/immolation.pdf [accessed 20.08.13].
Tanuj Kanchan* Department of Forensic Medicine and Toxicology, Kasturba Medical College, Mangalore (Affiliated to Manipal University), India *Tel.: +91 824 2444590x5565/9448252394; fax: +91 824 2428183
E-mail addresses: [email protected] [email protected] [email protected] (T. Kanchan) Accepted 22 August 2013 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.08.040
Reply Social campaigns are needed to stop any forms of self-immolation Sir In my recent article [1], I tried to explain why it is so important to stop self-immolation around the globe. In that article and based on the current literature [2–5], I have distinguished between two common types of suicide. The first one usually occurs in middle-aged males in protest against an unfair situation in their society. The second type usually happens in young married women in protest against the unfair situation in their family. Again, based on the current literature [6], I have also added that the first type of self-immolation frequently attracts mass media far more than the second type and for this reason it might be able to trigger civil unrests. However, Kanchan [7] has raised two questions regarding my article. Firstly he believes that in the second type: ‘‘selfimmolation as a method of protest may attract vast media coverage but whether the same is likely to bring desired changes is uncertain.’’ Secondly he emphasizes that ‘‘just because individual cases of self-burning in the second type of self-immolation do not receive much coverage in media, it does not bring about changes in the unfair family situation may not hold true.’’ And for supporting his ideas he has referred to dowry deaths in India and has pointed out that ‘‘newer laws have been enacted in India time and again to curb the problem of dowry deaths for which self-burning is recognized as the most common cause.’’ I would like to thank Kanchan for his questions and in what follows I will try to answer them. In response to the first question, I would like to only refer to one of the most resent famous first type case of selfimmolation i.e. Mohamed Bouazizi a Tunisian street vendor who set himself on fire in 2010 in protest against the unfair socio-economic situation. His suicide has a great impact on Tunisians’ revolution and he was considered as a hero in the Arab world. A square in Paris and the main square in Tunis were named after him and in the year 2011 the Time magazine named him as person of the year [8]. As far as I am aware no cases of the second type self-immolation has received such mass media coverage and brought such desired changes. In response to the second question and as Kanchan has referred to dowry deaths in India and newer laws in order to restrain them I will only focus on such deaths. Evidence
burns 40 (2014) 354–363
comparison with group 2 (new BICU) in which the most common cause was hot fluid’’ was due to a major factor which explains as follows. In the earlier study by Agbenorku et al. (2010) focus was on four fire disasters that occurred within the middle belt of Ghana (where Kumasi is located) from 2007 to 2008 which were petrol related fires; victims of these petrol related fires formed the group one patients within the period May 2007 till April 2009 who were managed in the group 1 (old BICU) whereas patients in group two (new BICU, from May 2009 to April 2011) were mostly general burns victims of which scalds dominated as the major aetiology of the admissions [1]. It is also true that flame burns especially in closed space may be associated with respiratory injury that would often increase the mortality rate. Although, the two groups had different aetiology of burn in the study, the comparative analysis revealed no significant difference for aetiology (Table 4). The interpretation of the analysis means, the variation in cause of burn in both groups does not have any effect in the comparism, in other words, aetiology of burn is not a factor to be considered in terms of comparism in both new and old groups. Additionally, it is also important to note that clinical research and studies have gone beyond the era where higher percentages were seen as the majority, hence will have an impact or effect on the study. Clinical analysis with specific applications under set confidence intervals are needed to be conclusive in ones results reportage.
Part 2 Burn resuscitation in the study had been explained in details in the ‘‘Summary of Protocol’’ section, where resuscitation was achieved within the shortest possible period. Also, the ‘‘Surgery’’ sub-section had explained various durations of surgery in the study. Hence, burns resuscitation may not be compromised.
Part 3 Usage of Vaseline gauze was done in addition to antibiotics (Tablets and Infusions); also wound swabs for culture and sensitivity were taken and the antibiotic regime changed or continued accordingly. This would prevent (not totally, though) sepsis in even deep burn patients (Laboratory investigations and Wound dressing Sections).
reference
[1] Agbenorku P, Akpaloo J, Farhat BF, Hoyte-Williams PE, Yorke J, Agbenorku M, et al. Burn disasters in the middle belt of Ghana from 2007 to 2008 and their consequences. Burns 2010;36:1309–15.
Pius Agbenorku Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
E-mail address: [email protected] (P. Agbenorku) 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.09.001
Letter to the Editor Self-immolation – A protest against unfair practices in family/society?
We read with interest a recently published article entitled ‘‘Why it is so important to prevent self-immolation around the globe?’’ [1]. Self-immolation has a far reaching medical and social outcome and there is certainly a need for a social campaign worldwide to prevent these deaths. In this correspondence we wish to highlight certain details relating to the two types of self-immolations discussed by Rezaeian [1]. Availability, accessibility, popularity, and social acceptability are the major factors in the choice of methods of suicide, and preference of self-immolation as a method of suicide among females is well known [2,3]. Self-immolation among young married females has been a cause of concern in Indian sub-continent and ‘Dowry’ is one well recognized cause for suicides and parasuicides among young, married women in India [4]. A protest on the other hand, is an expression of dissent or disapproval of certain policies or situations. The protests likewise can involve any method. Just like a suicide chooses a certain method to commit suicide, the protesters opt for a particular method to show their dissent. The author [1] states that among the two types, the first type of self-immolation receives vast coverage by the mass media, and this vast coverage may possibly bring about some desired changes. On the other hand, second type of selfimmolation hardly receives any mass media coverage, and is not successful to change the unfair family situation. However, we would like to point out that self-immolation as a method of protest may attract vast media coverage but whether the same is likely to bring desired changes is uncertain. Similarly, just because individual cases of self-burning in the second type of self-immolation do not receive much coverage in media, it does not bring about changes in the unfair family situation may not hold true. India alone has seen the majority of the worldwide protests involving self-immolation during 1963–2002 [5]. None of these events, however, had a favourable outcome in terms of the reason for protest. On the other hand, newer laws have been enacted in India time and again to curb the problem of dowry deaths for which self-burning is recognized as the most common cause. In this regard, The Dowry Prohibition Act was enacted in 1961, which was followed by insertion of more stringent criminal laws by amendments in the Indian Penal code (IPC). Section 498A was inserted into the
356
burns 40 (2014) 354–363
Indian Penal Code in 1983 and Section 304B of the Indian Penal Code in 1986. Section 498A of IPC describes punishment for ‘Husband or relative of husband of a woman subjecting her to cruelty.’ For the purpose of this section, ‘‘cruelty’’ refers to any willful conduct which is of such a nature as is likely to drive the woman to commit suicide or to cause grave injury or danger to life, limb or health whether mental or physical of the woman. Section 304B of IPC deals with Dowry deaths and states that ‘Where the death of a woman is caused by any burns or bodily injury or occurs otherwise than under normal circumstances within seven years of her marriage and it is shown that soon before her death she was subjected to cruelty or harassment by her husband or any relative of her husband for, or in connection with, any demand for dowry, such death shall be called ‘‘dowry death’’ and such husband or relative shall be deemed to have caused her death’. It needs to be highlighted here that this section explicitly recognizes the deaths caused by any burns in women. As per Section 304 (B) of IPC, there is a provision of imprisonment for a term which shall not be less than seven years but which may extend to imprisonment for life. Protection of Women from Domestic Violence Act of 2005 is the latest legislation in this regard. This Act also provides protection for any form of domestic violence arising for any unlawful demand for dowry. Predisposing factors behind suicides can be multi-factorial and sometimes difficult to analyze per se, and mere presumption that any act of self-immolation by a young married female is a form of protest may be unwarranted. Possibility of considering an act of self-burning as a protest against current unfair situation in the family/society in general thus, needs to be explored and justified.
Conflict of interest None to declare.
references
[1] Rezaeian M. Why it is so important to prevent selfimmolation around the globe? Burns 2013;39:1322–3. [2] Kanchan T, Menon A, Menezes RG. Methods of choice in completed suicides: gender differences and review of literature. J Forensic Sci 2009;54(4):938–42. [3] Kumar TS, Kanchan T, Yoganarasimha K, Kumar GP. Profile of unnatural deaths in Manipal, Southern India 1994–2004. J Clin Forensic Med 2006;13(3):117–20. [4] Menezes RG, Kanchan T, Pillay VV, Lobo SW, Subba SH. Selfinflicted burns. Burns 2008;34(3):427. [5] Biggs M. Dying without killing: self-immolations, 1963–2002. In: Gambetta D, editor. Making sense of suicide missions. Oxford: Oxford University Press; 2005. Available from: http:// users.ox.ac.uk/sfos0060/immolation.pdf [accessed 20.08.13].
Tanuj Kanchan* Department of Forensic Medicine and Toxicology, Kasturba Medical College, Mangalore (Affiliated to Manipal University), India *Tel.: +91 824 2444590x5565/9448252394; fax: +91 824 2428183
E-mail addresses: [email protected] [email protected] [email protected] (T. Kanchan) Accepted 22 August 2013 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.08.040
Reply Social campaigns are needed to stop any forms of self-immolation Sir In my recent article [1], I tried to explain why it is so important to stop self-immolation around the globe. In that article and based on the current literature [2–5], I have distinguished between two common types of suicide. The first one usually occurs in middle-aged males in protest against an unfair situation in their society. The second type usually happens in young married women in protest against the unfair situation in their family. Again, based on the current literature [6], I have also added that the first type of self-immolation frequently attracts mass media far more than the second type and for this reason it might be able to trigger civil unrests. However, Kanchan [7] has raised two questions regarding my article. Firstly he believes that in the second type: ‘‘selfimmolation as a method of protest may attract vast media coverage but whether the same is likely to bring desired changes is uncertain.’’ Secondly he emphasizes that ‘‘just because individual cases of self-burning in the second type of self-immolation do not receive much coverage in media, it does not bring about changes in the unfair family situation may not hold true.’’ And for supporting his ideas he has referred to dowry deaths in India and has pointed out that ‘‘newer laws have been enacted in India time and again to curb the problem of dowry deaths for which self-burning is recognized as the most common cause.’’ I would like to thank Kanchan for his questions and in what follows I will try to answer them. In response to the first question, I would like to only refer to one of the most resent famous first type case of selfimmolation i.e. Mohamed Bouazizi a Tunisian street vendor who set himself on fire in 2010 in protest against the unfair socio-economic situation. His suicide has a great impact on Tunisians’ revolution and he was considered as a hero in the Arab world. A square in Paris and the main square in Tunis were named after him and in the year 2011 the Time magazine named him as person of the year [8]. As far as I am aware no cases of the second type self-immolation has received such mass media coverage and brought such desired changes. In response to the second question and as Kanchan has referred to dowry deaths in India and newer laws in order to restrain them I will only focus on such deaths. Evidence
