The young woman was in appalling pain when she was brought into the hospital. Searing burns to three quarters of her body made her cry out loud. The look in her eyes told surgeon Wijaya Godakumbura that she knew her life was over.
For a night and a day, Dr Godakumbura and the casualty staff at his hospital, 100km from Colombo, did what they could to save her and to ease her torment. But she died, and the baby in her womb died with her.
Godakumbura was exhausted. An experienced and compassionate surgeon, he had witnessed many similar struggles, often with tragic outcomes. Yet this one, in 1992, moved him deeply.
"Too many," he thought. "I am seeing too many of these terrible burn cases. What can be done about them?"
He decided to follow up the case, to find out how it had happened — and the answer shocked him. A home-made lamp had overturned and the blazing fuel had soaked the young woman’s clothing. This tiny incident robbed her and her unborn baby of their lives. In the weeks that followed, he noted that accidents with similar lamps were producing many burn victims in the area.
In Sri Lanka, such household accidents are commonplace. About 1.5 million homes do not have electricity, and home-made lamps are used often — to light the stove, to illuminate the living area, for children to study by. About a third of all domestic burn cases in Sri Lanka are caused by unsafe lamps.
Yet, because of this one young woman, a campaign to bring safe lamps to dark homes has gathered pace and the risk has been reduced.
The Danger of Apathy
Lamp burns, Godakumbura realised, are generally a result of poverty. Only the very poor use makeshift lamps. And because they are very poor, the problem has attracted little attention or concern. Lamp burns are also a women’s issue — most victims are female and nearly a third are children.
Godakumbura also realized that the problem was easily preventable. However, he underestimated one thing: apathy.
After treating more burn victims at his hospital, he asked them to bring in their lamps and he immediately saw the cause. Most were ordinary, household bottles with a small tin sheet resting on top and a metal tube for the wick. If the bottle tipped and rolled, the fuel and the wick-carrier — that holds the flame — fell out, often starting a fire. A child reaching out, a playful pet, a mere bump against a table, could extinguish a life.
The more he explored the issue, the more it horrified him. He discovered that the flashpoint of spilt kerosene was lower than many people believed — and the danger far higher. He found that when kerosene soaks into clothing, the material acts like a wick, turning the victim into a blazing torch that may take 10 or 15 minutes to extinguish. He found that people knew little or nothing of how to aid the sufferer and limit the extent of the injuries. He knew, from clinical experience, that once the burns affect more than 60 per cent of the body, the outcome is usually fatal.
"I invited the public to design a safe, cheap lamp," he says. "Many people submitted ideas, but most were complex or costly. In the end I decided the best design was based on a simple Marmite bottle — small and squat, with two flat sides — equipped with a safe metal screw cap to hold the wick. That way, the bottle was more stable. The fuel does not spill if the bottle overturns. It cannot roll. And it is strong enough not to break if dropped."
In 1992, with the approval of the Sri Lanka Medical Association, the College of Surgeons and the National Society for Prevention of Injuries, Godakumbura launched a personal campaign to make and distribute thousands of safe lamps. He found a factory prepared to manufacture the lamps at low cost from recycled glass, launched a media publicity drive, orchestrated public education about safety and first aid for burns, and tried to raise funds to mass-produce the lamps. He began the Herculean task of forming a distribution network that would reach over 1.5 million households without electricity, spread over Sri Lanka’s 65,000 square kilometres.
He ran into a brick wall. Everyone applauded the idea, and everyone praised his commitment. Yet few offered to help. "All the attention went towards disease prevention!" he says.
Godakumbura was perplexed. Sri Lanka had on average three deaths from lamp burns every week, and hundreds were horribly disfigured, their lives ruined by a preventable accident. Figures are still high though exact statistics are not available. "Many are blinded," he says. "They are badly deformed. Some cannot close their mouths because the lips are gone. Some lose all 10 fingers. Young women cannot find a husband afterwards. Wives burnt in household accidents are sometimes driven from their home. The suffering is so great that, it sometimes seems to me, those who die are the lucky ones." With no help coming his way, he began to wonder whether he should give up on prevention and stick to being a surgeon, repairing the injuries.
Then, in 1993, the Canadian High Commission in Sri Lanka heard about his work and sent him US$20,000. The famous science-fiction novelist Sir Arthur C. Clarke, a resident of Sri Lanka, read about Godakumbura’s work in a newspaper and sent a personal donation.
A Major Breakthrough
These gifts and the encouragement they brought were sufficient to keep the Safe Bottle Lamp project in operation, and it has continued, hand to mouth, ever since. In 1998, Godakumbura won a Rolex Award, an event he regards as his most vital break. It ensured the survival of the project by providing substantial funding, international publicity and a higher public profile.
Even with the Award, funding remained a major challenge. But resources trickled in. The Sri Lanka President’s Fund provided $4,000, while the Sri Lankan Health Ministry, a major bank and the Lindbergh Foundation in the U.S. donated $5,000 each. Many others gave smaller donations. Safe-lamp production and sales — at prices below the cost of manufacture — climbed steadily. By late 2004, over 550,000 safe lamps had been distributed to an estimated 275,000 homes. With an average of four members in each household, more than a million people are now less at risk from lamp-burn injuries.
Flyers about safety in the home accompany the lamps, along with advice on how to extinguish the flames and administer first aid to patients. "It is essential to keep the patient soaking in cool water for at least 25 minutes after the flames are extinguished, because the heat from the burnt flesh will continue to make the injuries worse unless they are cooled," Godakumbura explains.
Despite the lack of firm statistics, Godakumbura and his colleagues have a clear impression that the number of lamp cases arriving at their hospital is diminishing as the number of safe lamps distributed climbs.
His waking nightmare is that while a million people are now safe from lamp burns, six million more in homes without power remain at risk. Also, even in homes with electricity, people use unsafe lamps in the kitchen when cooking is done with firewood, and for illumination during power failures.
A Major Problem
During recent years he has made presentations on his work at several international burns congresses where he has met delegates from other countries whose citizens face similar dangers. In Africa, doctors from Mozambique and Malawi report similar concerns. It is likely that problems of this kind are faced by poor households throughout the developing world, where two billion people have no electricity. Yet, among so many other problems, this one goes largely unrecognised.
Godakumbura’s frustration lies in the fact that catastrophic burns are not seen as a major health issue. The focus is almost always on disease prevention, rather than injury prevention. Burns are accidents which, by definition, should not happen. Yet they do. Worldwide, more children die from accidents than any other cause, and burns and scalds are among the principal causes. Godakumbura has found that health authorities, governments, aid agencies, corporations and even medical experts discount the problem.
"Where is the sense in preventing disease if we do not also seek to prevent injury that is equally destructive of people’s lives?" he asks. "It is widely accepted that when certain agents cause disease or injury, the elimination of these agents also eliminates the harm they do. The most effective way to eradicate malaria is to prevent the breeding of the mosquitoes that carry it. The same applies to lamp burns and the unsafe lamps that cause them — but people do not seem to see it."
At times, the tide of unconcern seems to rise too high. "I write constantly to companies, agencies and organisations, seeking funds — but of every 20 letters I send, I get a maximum of three replies," he says, incredulous that so many can be so uncaring. It would cost less than $700,000 to put two safe lamps in every Sri Lankan home without electricity. This would prevent about 140 deaths a year, and save thousands from disfigurement.
Raising Global Awareness
Yet Wijaya Godakumbura is a most determined man. "I will keep going with my crusade, another ten years or more if I have to," he states, adding that on top of his demanding surgical duties he puts in at least 150 hours a month, generally alone, on the safe bottle lamp project.
"A year or so after I began, I truly felt like giving up. Then the Canadian Embassy and Arthur C. Clarke came to my rescue. After that I received the Rolex Award, and that was a tremendous boost. In 2003, I received $5,000 from the Lindbergh Foundation. A government agency has agreed to help market them. It all helps. It is encouraging — but so many people remain at risk, and the burn cases continue to come in, as we have been able to replace only 18 per cent of the unsafe lamps with our safe ones."
"In 2003, we managed to make and distribute about 65,000 safe lamps," he says, adding that he estimates the 2004 figure at close to 100,000. "But it should be much more. I’d like it to be twice that."
As a result of Godakumbura’s work, the International Society for Burn Injuries has decided to produce a handbook on the prevention and treatment of kerosene injuries, which it intends to submit as a "best practice" manual for the World Health Organisation. In late 2004, the two organisations were seeking funds to raise global awareness of the need to prevent burn injuries.
Like nursing pioneer Florence Nightingale, whose lamp brought comfort to the sick and dying in her hospital, Wijaya Godakumbura’s project is casting a hopeful ray in poor homes.
Published in 2005