INTRODUCTION
Awareness of plastic surgery is lacking among the general public and medical personnel.
The number of plastic surgeons is so small as compared to otherspecialities, that
it is virtually not possible for us to address the entire spectrum of the work and
create an awareness about the speciality. As a result different specialities are exploring
their boundaries to impinge on what we claim to be rightfully ours.
Advocacy for plastic surgery has never been so important. We have to fend for ourselves,
promote ourselves and shape the future of our speciality.
Increasing amounts of funds are being spent on communicable diseases, whereas those
non-communicable diseases, which are preventable like burns or occupational hand injuries,
causing a huge impact on the well-being of the society are neglected. Mass education
to prevent such disasters helps the speciality to get deeper penetration into the
society, which we feel is an essential step to advocacy. Over the years, we have worked
in our own small way towards advocacy and mass education on topics related to us as
plastic surgeons.
This article is an attempt to present our efforts since November 2008. Based on the
experience, we look to improvise the ways to enhance the advocacy and mass education
of plastic surgery speciality.
MATERIALS AND METHODS
Mass education for burn prevention
Pictorial guide for burns prevention
Burn injuries continue to be a major health problem and preventive measures cannot
be overemphasised. We developed a pictorial guide depicting ‘Do's’ and ‘Don'ts’ for
burn prevention. It deals with almost all the types of burns we come across in our
day to day practice such as domestic, electrical, chemical, firecracker, vehicular
and lightening burns. The booklet also gives guidelines to the general public on ‘what
to do’ in case of fire and burns. The booklet is available for free download at: https://www.scribd.com/doc/201477988/Prevent-Burns-Marathi in Marathi and at https://www.scribd.com/doc/201474946/Prevent-Burns-Prevention-is-better-than-cure-In-English in English.
For increased impact, booklets in the Marathi language were distributed in municipal
Marathi schools in Pune.
The funds for the printing of the books were provided by the American Association
of Physicians of Indian Origin and Human Biosciences and distribution was undertaken
by various non-governmental organisations (NGO's).
Training of school teachers and adopt a school policy
We visited various schools and took lectures for school teachers on the importance
of burn prevention. It was also impressed on them that they are the ones who can teach
the children about the basics of burn prevention.
Urban schools were requested to adopt a school each in the rural area and provide
funds for providing booklets to these rural schools. The response was though not so
positive, one of the rural schools at Sakherkherda village in Buldhana district was
provided with booklets in Marathi for burn prevention education.
Use of social media and internet
The booklets on burn prevention were published and made available on the internet
for free download. At the time of submitting the manuscript, there were 676 downloads
of the booklet. An individual from Switzerland – after reading the booklet offered
donations for a project on burn prevention video which was executed with the Film
Technical Institute of India.
Soft copies of booklets were E-mailed to addresses of parents in the databases of
some schools. Although the impact could not be measured, it was a very cost-effective
means of reaching a wide audience.
This information on burns prevention was also put up on the website of centres of
excellence for managing burn patients like The National Burns Centre – Airoli as well
as the National Academy of Burns India.
Elevated kitchen platforms for cooking
Ground level cooking is one of the most common causes of paediatric burns in the country.
In an initiation to prevent this, Jeevan Jyot Charitable Trust, an NGO provided elevated
kitchen platforms to numerous households in urban slums on the outskirts of Pune.
The elevated platforms were made up of three blocks of kadappa, and the cost of each
of the platforms was Rs. 800/- [Figure 1]. Interestingly, the patients were happier because their knee problems were taken
care of, in addition to the objective of burn prevention.
Figure 1: Elevated kitchen platform for cooking
Attempts to incorporate burn prevention education in the school curriculum
We have been in contact with various authorities, including the Ministry of Human
Resource Development (HRD) to incorporate burn prevention education in school curriculum.
However, the results are not yet forthcoming. The HRD ministry appreciated the efforts,
and also replied to our suggestion. They felt that school children are already burdened
with various subjects, and it will not be possible to include additional syllabus
in the curriculum. However, the teachers can be primed to gradually teach these topics
as and when deemed necessary.
Burn prevention activities during Diwali
Every year during Diwali, there is an increase in the incidence of burn injuries.
To promote safe firecracker practices, brochures were made in English and Marathi.
These brochures were distributed at firecracker stalls across Pune. Firecracker vendors
were distributed these brochures and were requested to give a copy to all the customers.
Images, especially related to firecracker injury safety and prevention were displayed
on social networking sites to cater to a wider audience.
Burn prevention education in the wards
The victims who are admitted to the wards are already a proven high-risk group of
individuals. They have in their vicinity all the factors which can cause recurrence
of the accident, which may involve other family members or neighbours. Targeting this
population, posters on burn prevention are displayed in the wards and they are handed
over the burn prevention and burn care brochures during discharge.
Other ways of promoting burn prevention
Other ways like using T-shirts with burn prevention messages, Facebook and Whats app
profiles were also used [Figure 2].
Figure 2: T-shirt with burn prevention message
Burn prevention documentary videos
With the help of Film Technical Institute of India and Jeevan Jyoti Charitable Trust,
we have come up with a video on burn prevention. It is a short documentary intended
to be displayed at railway stations, bus depots and other public places for maximum
impact. The video is also available for free download at https://vimeo.com/110649623.
Patient awareness brochures
Various brochures for patient information and awareness were created.
Brochures are also parked on social media for increased awareness. The various brochures
available are:
-
Arteriovenous (AV) fistula patient information brochure
Marathi - https://www.scribd.com/doc/201484655/AV-fistula-What-the-patient-needs-to-know-In-Marathi.
English - https://www.scribd.com/doc/201479087/AV-Fistula-What-the-Patient-Needs-to-Know-In-English.
-
Cleft lip and palate information brochure
Marathi - https://www.scribd.com/doc/155858290/Cleft-lip-and-Palate-information-brochure.
-
Occupational hand injury prevention brochure
Marathi - https://www.scribd.com/doc/201485510/Occupational-Hand-Injury-Prevention-In-Marathi.
English - https://www.scribd.com/doc/201487337/Occupational-Hand-Injury-Prevention-In-English.
-
Diet brochures to improve nutritional status, especially for burn patients needing
repeated surgeries
Marathi - https://www.scribd.com/doc/295772380/Diet-Charts-for-Plastic-Surgery.
-
Diwali firecracker injury prevention and first aid brochures
Marathi - https://www.scribd.com/doc/179122226/Prevent-Burns-this-Diwali-Marathi-leaflet-pdf. English - https://www.scribd.com/doc/178952910/prevent-burns-in-diwali-english-pdf.
-
Skin donation awareness brochures.
English - https://www.scribd.com/doc/156520214/Skin-Donation-Information-guide.
Changing the name of our speciality
We conducted a study on the awareness of plastic surgery among doctors in Pune, in
2012.[1] We found that the name of our speciality itself is not understood by many. Unlike
other specialties, where the name itself indicates the work being carried out by that
particular speciality, plastic surgery lags behind on this front. We feel an urgent
need to change the name of the speciality from ‘plastic surgery’ to ‘plastic, reconstructive
and aesthetic surgery’ and the name of association from Association of Plastic Surgeons
of India (APSI) to Association of Plastic, Reconstructive and Aesthetic Surgeons of
India.[1]
A similar effort was done by the British Association of Plastic Surgeons, who changed
the name of the organisation to British Association of Plastic, Reconstructive and
Aesthetic Surgeons in July 2006.[2]
Awareness activities for skin donation and skin banking
There is limited knowledge amongst medical students regarding skin donation and skin
banks.[3] The need for concentrated and continuous efforts to create awareness about skin
donation was recognised by Gore and De.[4] However, most of their efforts such as preparation of brochures, posters, flip charts,
articles in print media, television interviews and radio talks were targeted towards
the general public.[4] We felt that apart from creating awareness in the general public, it is more important
to create awareness in our own fraternity. If medicos are aware of skin donation,
they can counsel the relatives of the patient regarding skin donation. That way, we
will be able to tap the potential of deaths in hospital for skin donation.
As per our literature search, skin donation in specific and organ donation, in general,
does not form a part of any of the popular reference books used by the undergraduates.
We approached various authors and publishers requesting them to incorporate these
topics in the reference books.
Telemedicine for advocacy of plastic surgery
Telemedicine is being increasingly used for diagnosis and management, but teleeducation
has not yet gained popularity. We initiated awareness lectures for the medical officers
and the telemedicine support staff at these centres. A document was created with pre-
and post-operative images of the patients we cater to, and was mailed to all the telemedicine
centres. This initiative helped in increasing direct referrals to plastic surgery
through telemedicine.
Undergraduate education in plastic surgery
To bring the brightest and the best students to the plastic surgery fraternity, we
should be able to tap them whereas they are still young. We need to interact with
them more, but unfortunately, undergraduate curriculum has got a very little scope
for plastic surgery topics. Kumar et al.[5] felt that plastic surgery department must be developed in all colleges in India,
and medical students and surgical residents must be rotated for at least a week or
two as part of their training program.
At our unit, we make it a point to devote the first lecture to the spectrum and scope
of plastic surgery with a large number of clinical photographs to promote the interest
of the undergraduates in plastic surgery.
Occupational hand injury prevention activities and awareness
Freshwater deliberated on the likely status of hand injuries in India in 2061.[6] We stressed on the need of hand injury prevention over the next 50 years.[7]
We initiated a minuscule campaign on occupational hand injury prevention by distributing
pamphlets on prevention of occupational hand injury on World Labour Day 2011, the
link to which is provided above. The need of a national occupational hand injury database
was felt like never before. We have also appraised National Institute of Occupational
Health, Indian Council of Medical Research and ministry of labour the need of giving
more importance to occupational hand injuries. We have started our own online registry
and efforts are on to request others to contribute so that we have a large database.
RESULTS
Failures and disappointments
We had our share of failures and disappointments, and they were definitely more than
our successes. Regarding our successes:
-
The burn prevention booklet effort was recognised by the government of Maharashtra.
The support for publication and free distribution of these booklets in the schools
was forthcoming initially. Around 15,000 booklets were distributed free of cost
-
More and more undergraduates have started approaching our department for study topics
related to their short-term studentship programmes
-
The occupational hand injury registry is started, and we will have significant data
regarding epidemiology over the next 5–7 years.
As regards our failures and disappointments:
-
On many instances we used to find crumpled brochures lying outside the outpatient
department. These were the same brochures; we had painstakingly created for education
and awareness of our patients
-
Poor response to E-mail or snail mail from government bodies regarding our initiatives
like the incorporation of burn prevention education in schools, starting an occupational
hand injury registry and lack of time and commitment on our part to repeatedly go
and follow up with the authorities concerned has reduced the pace of these initiatives.
There are intervening spikes of enthusiasm which give some momentum to these projects
occasionally.
DISCUSSION
Individual and group efforts towards mass education and advocacy are fraught with
failures, disappointments.
Sometimes, the work at hand takes a back seat due to other important issues. Then
there is the realisation that in spite of all the efforts being taken and the time
spent on these endeavours, very less is achieved. The input to output ratio is dismal
and leads to frustration at times. There are no incentives. This leads to a diminution
of interest in working towards advocacy of our speciality.
A lot of efforts are being taken throughout India for public awareness and preventive
education in plastic surgery. Undergraduate and post-graduate quizzes are organised;
plastic surgery days and weeks are celebrated. Undergraduate plastic surgery days
are organised at some places. Painting competitions, promotional activities for burn
prevention and skin donation are organised. Participation for various NGO's and the
rotary and other organisations is solicited to promote advocacy and mass education.
Most of the efforts taken in our country are at individual and institute levels. They
are far too sparse, and collective efforts are lacking. Advocacy and lobbying for
plastic surgery at the national level is almost non-existent.
For wider coverage and public awareness, the help of media must be sought. It is necessary
that we as plastic surgeons give ample information to the media regarding the reconstructive
aspects of plastic surgery.[1] Professional communication services can be hired if needed to improvise on communication
and awareness. Celebrities can be requested or hired to focuson the reconstructive
part of plastic surgery.[1] APSI may invite media personnel on an awareness trip to well-established centres
to see a variety of procedures and the necessity of plastic surgeon in trauma centres,
burn care, as reconstructive surgeons in trauma, congenital and oncological surgeries
besides their role as an aesthetic surgeon.[5] We should encourage media personnel to project a real picture to the general public
and publicise the various conditions in which plastic surgeons play a role.[7] Innovative ways of reaching the public must be sought and implemented.[1]
Social media has immense potential and can help to a great extent in projecting our
speciality. These efforts should be made at an association level.
Funds should be earmarked and made available for promoting advocacy and awareness
of plastic surgery by the APSI. This would be very important from the patients point
of view as increased advocacy regarding the spectrum of plasic surgery would increase
direct referrals to plastic surgery and early and better management of patients.
Projects and thesis topics given to our students can have topics related to epidemiology,
mass education and awareness of entities relevant to us as plastic surgeons, and not
merely topics of scientific interest. After all these are the pillars on which the
speciality stands.
