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A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India.

Daruwalla N, Belur J, Kumar M, Tiwari V, Sarabahi S, Tilley N, Osrin D - BMC Womens Health (2014)

Bottom Line: Distinguishing between these was difficult because the underlying combination of poverty and cultural precedent was common to all and action was contingent on potentially conflicting narratives.Clinicians adhered to medicolegal procedures, the police carried out their investigative requirements relatively rapidly, but both groups felt vulnerable in the face of the legal process.The contested status of forensic evidence and a reliance on testimony means that only a minority of cases lead to conviction.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Most burns happen in low- and middle-income countries. In India, deaths related to burns are more common in women than in men and occur against a complex background in which the cause - accidental or non-accidental, suicidal or homicidal - is often unclear. Our study aimed to understand the antecedents to burns and the problem of ascribing cause, the sequence of medicolegal events after a woman was admitted to hospital, and potential opportunities for improvement.

Methods: We conducted semi-structured interviews with 33 women admitted to two major burns units, their families, and 26 key informant doctors, nurses, and police officers. We used framework analysis to examine the context in which burns occurred and the sequence of medicolegal action after admission to hospital.

Results: Interviewees described accidents, attempted suicide, and attempted homicide. Distinguishing between these was difficult because the underlying combination of poverty and cultural precedent was common to all and action was contingent on potentially conflicting narratives. Space constraint, problems with cooking equipment, and inflammable clothing increased the risk of accidental burns, but coexisted with household conflict, gender-based violence, and alcohol use. Most burns were initially ascribed to accidents. Clinicians adhered to medicolegal procedures, the police carried out their investigative requirements relatively rapidly, but both groups felt vulnerable in the face of the legal process. Women's understandable reticence to describe burns as non-accidental, the contested nature of statements, their perceived history of changeability, the limited quality and validity of forensic evidence, and the requirement for resilience on the part of clients underlay a general pessimism.

Conclusions: The similarities between accident and intention cluster so tightly as to make them challenging to distinguish, especially given women's understandable reticence to describe burns as non-accidental. The contested status of forensic evidence and a reliance on testimony means that only a minority of cases lead to conviction. The emphasis should be on improving documentation, communication between service providers, and public understanding of the risks of burns.

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Related in: MedlinePlus

Schematic summary of duties of clinicians and police when women are admitted to hospital with burns. Steps beginning with the lodging of a First Information Report depend on an allegation being made.
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Fig1: Schematic summary of duties of clinicians and police when women are admitted to hospital with burns. Steps beginning with the lodging of a First Information Report depend on an allegation being made.

Mentions: Figure 1 summarizes the processes that clinicians and police had to work through in responding to burns admissions. The stages of action were relatively clear from clinicians’ accounts: immediate clinical care, registration, admission to hospital, informing the police, clinical note-taking and medicolegal documentation, forensic pathology, and – later - court proceedings, if initiated. The processes by which these were achieved differed in detail in the two units.Figure 1


A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India.

Daruwalla N, Belur J, Kumar M, Tiwari V, Sarabahi S, Tilley N, Osrin D - BMC Womens Health (2014)

Schematic summary of duties of clinicians and police when women are admitted to hospital with burns. Steps beginning with the lodging of a First Information Report depend on an allegation being made.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4260258&req=5

Fig1: Schematic summary of duties of clinicians and police when women are admitted to hospital with burns. Steps beginning with the lodging of a First Information Report depend on an allegation being made.
Mentions: Figure 1 summarizes the processes that clinicians and police had to work through in responding to burns admissions. The stages of action were relatively clear from clinicians’ accounts: immediate clinical care, registration, admission to hospital, informing the police, clinical note-taking and medicolegal documentation, forensic pathology, and – later - court proceedings, if initiated. The processes by which these were achieved differed in detail in the two units.Figure 1

Bottom Line: Distinguishing between these was difficult because the underlying combination of poverty and cultural precedent was common to all and action was contingent on potentially conflicting narratives.Clinicians adhered to medicolegal procedures, the police carried out their investigative requirements relatively rapidly, but both groups felt vulnerable in the face of the legal process.The contested status of forensic evidence and a reliance on testimony means that only a minority of cases lead to conviction.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Most burns happen in low- and middle-income countries. In India, deaths related to burns are more common in women than in men and occur against a complex background in which the cause - accidental or non-accidental, suicidal or homicidal - is often unclear. Our study aimed to understand the antecedents to burns and the problem of ascribing cause, the sequence of medicolegal events after a woman was admitted to hospital, and potential opportunities for improvement.

Methods: We conducted semi-structured interviews with 33 women admitted to two major burns units, their families, and 26 key informant doctors, nurses, and police officers. We used framework analysis to examine the context in which burns occurred and the sequence of medicolegal action after admission to hospital.

Results: Interviewees described accidents, attempted suicide, and attempted homicide. Distinguishing between these was difficult because the underlying combination of poverty and cultural precedent was common to all and action was contingent on potentially conflicting narratives. Space constraint, problems with cooking equipment, and inflammable clothing increased the risk of accidental burns, but coexisted with household conflict, gender-based violence, and alcohol use. Most burns were initially ascribed to accidents. Clinicians adhered to medicolegal procedures, the police carried out their investigative requirements relatively rapidly, but both groups felt vulnerable in the face of the legal process. Women's understandable reticence to describe burns as non-accidental, the contested nature of statements, their perceived history of changeability, the limited quality and validity of forensic evidence, and the requirement for resilience on the part of clients underlay a general pessimism.

Conclusions: The similarities between accident and intention cluster so tightly as to make them challenging to distinguish, especially given women's understandable reticence to describe burns as non-accidental. The contested status of forensic evidence and a reliance on testimony means that only a minority of cases lead to conviction. The emphasis should be on improving documentation, communication between service providers, and public understanding of the risks of burns.

Show MeSH
Related in: MedlinePlus