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Now, you've probably heard many times about the serious impact that diseases like malaria, tuberculosis or HIV/AIDS have on the world, especially in natural disasters, as we've been talking about. But what you may not know about is the serious health crisis represented by burns. According to the World Health Organization, more children die in fires every year than from malaria and tuberculosis, and as many women suffer a severe or disabling burn as are diagnosed with HIV/AIDS. And although burnings occur throughout the world, more than half of all reported incidents happen in Southeast Asia. Here to talk about this is Dr. Chandini Perera. She is one of only six plastic surgeons practicing in Sri Lanka. She's been visiting the U.S. to draw attention to the issue and she spoke with us from San Francisco. Welcome, thank you for speaking with us.

Dr. CHANDINI PERERA: (Plastic Surgeon, Sri Lanka) Thank you for having me. I'm really glad to be here.

MARTIN: Well, doctor, first of all, can I just ask, how did you get interested in plastic surgery?

Dr. PERERA: I've always been interested in surgery but particularly in reconstructive surgery, in that you take something that's deformed or crippled or defaced, and you're able to make it better. Sometimes not beautiful, but better, so that that person becomes functional.

MARTIN: Were you aware during your training, or is it something that's just obvious and understood where you practice, that burns are such a big part of the health problem? Because I have to say, this was very surprising to me.

Dr. PERERA: No. This is the sad fact. Because burns affects the low socioeconomic group and in particular, women and young children, and the disease is very prolonged and painful, and there is a period where rehabilitation really plays a huge part in burns. You can treat a burn, but what most people don't know is that if you don't rehabilitate them properly, they will contract. And then they become disabled and disfigured.

So among surgeons, it's kind of an ego thing, you know? You can't really make a burn beautiful. It is the beauty of the person who survives that actually comes out. And in that sense, a lot of people don't like to do it.

MARTIN: We mentioned earlier that according to these World Health Organization statistics, nearly four million women fall victim to a severe burn from fire every year, which is about the same number of people who are diagnosed with HIV/AIDS. And it's the only injury that happens more to women than men. Why?

Dr. PERERA: Yes, it is. It is very closely tied to poverty and, as I see it in my country, domestic violence, abuse and neglect. And so it's the women who have to cope with this in South Asia and Southeast Asia.

MARTIN: So are these accidents, or are these crimes?

Dr. PERERA: In some countries, they're accidents because women are the ones who live in this one-roomed dwelling that has to serve as the sleeping place as well as the cooking place. And in my country, it's actually a lot of the severe burns are due to domestic violence.

MARTIN: And what is that? Are you saying that violent or abusive spouses deliberately burn these women?

Dr. PERERA: Yes. Yes. You know, a woman is, like, having huge difficulties in coping, and there's emotional abuse, physical abuse. And then it's like some pressure-cooker effect, you know? And there's nothing else. Why do they choose fire? Because that's the only thing they've got. They're living in this one room. They're doing the cooking with open fires. And very much a part of being pushed on to the fire or someone saying that's enough, I'm going to just set myself on fire. It's a kind of attention seeking. I know it's a terrible way to do it, but that's what they do.

MARTIN: So it's both women being abused, it's sometimes - it's an act of suicide, an act of desperation, and sometime it's an accident.

Dr. PERERA: Accident, yes.

MARTIN: You direct the Surgical Outreach Program for Interplast. That's a humanitarian organization...

Dr. PERERA: That's right.

MARTIN: That tries to provide reconstructive surgery for people with disabling burns. First of all, I'd like to hear about what kind of treatment one needs for severe burns. How long could it take to recover from a severe burn?

Dr. PERERA: OK. So let's take a 20 percent burn. We consider 20 percent as a very severe burn because you can - in the first 24 hours, you can go into shock. And so they need to be admitted and resuscitated. You have to have very aggressive, prolonged rehabilitation. So the whole thing would take something like six weeks just to stay in hospital. But the rehabilitation and the physiotherapy and the therapy could take as long as 24 months, 18 months, anywhere close to that to get a good outcome. And this is what is mostly neglected.

MARTIN: What happens to these women after they've suffered these burns?

Dr. PERERA: Very often, due to neglect and poor access to treatment, they will end up with a contraction. So for example, if you burned your right hand, right elbow and your neck, your neck would get stuck to your chin, your right hand would be like in a fist position and flexed, and your elbow would be stuck to your arm. And that means you can't feed yourself or wash yourself. Also, if you're a mother, you can't take care of your children. And you can't earn income. And then you become a huge disability to the family because there's this whole social outcast business about disfigured people.

MARTIN: I wanted to ask you about that. Is there a stigma attached to being severely disfigured, even if it's due to an accident?

Dr. PERERA: Very much so. For example, in my country, if a woman was pregnant, they would not look upon a woman who was disfigured in case had an ugly baby.

MARTIN: And a child, I assume, a child who had been disfigured would have a very hard time at having a marriage.

Dr. PERERA: A child, too. Yes. A young girl would not be able to get married, exactly. Or a child would not be able to get into school for a simple reason like, in South Asia, to enter school you need to wear shoes. So if you have a little contraction of your toes and you can't get your feet into a pair of shoes, that means that child will actually not be able to get into school.

MARTIN: I'm wondering why it is that we here in this country know so little about this.

Dr. PERERA: You know, if you're stigmatized and you're an outcast, then you live in this unseen world. And I think it's even less likely that people in the developed world would know about it. But that is precisely the reason why we need to start caring for them. Because I think, like AIDS, it's only when you started care of these people that you actually got to know the data.

So it's such a huge problem that in our countries, it's almost like people are overwhelmed and they've given up. They don't know what to do. So one of the first steps is to create awareness, to let people know this is actually happening. And it's even more than AIDS and malaria in South Asia and Southeast Asia. And it is affecting women and children.

MARTIN: And I know that your job is to, finally - and you've been very generous with your time - but I know that after a certain point, when you spend so much time patching people up, at some point your thoughts must turn to prevention. You know, what would stop this? What would stop so much of this from happening? Do you have some thoughts about that?

Dr. PERERA: You know, when I first started it, I was overwhelmed myself. And I used to think it would be like emptying the sea with a bucket. You know, where do you start? But then when you really treat them right, and these women go back into the community and are empowered, and they come back to me and say to me, you know, now I'm working. I think that's when the awareness is going to grow.

And how can you help? I think by helping to train people in our countries to be more responsive to burns, by training therapists and doctors in trying to treat these people right.

MARTIN: Dr. Chandini Perera is one of six plastic surgeons practicing in Sri Lanka. She heads the country's burn care facility there. She is traveling in the U.S. on a training to raise awareness about the impact of severe burns as a health crisis. She joined us from member station KQED in San Francisco. Doctor, thank you so much for speaking with us.

Dr. PERERA: Oh, thank you so much for having me on.

MARTIN: To see photos of Dr. Perera and her patients and learn more about Interplast, the organization that's - are trying to support burn care victims in developing countries, please visit our Web site, npr.org/tellmemore.

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