Annals of Burns and Fire Disasters - vol. XVII - n. 3 - September 2004

MASQUERADES: HIGHLY FLAMMABLE. TWO CASE REPORTS OF FLAME BURN INJURIES DUE TO MASQUERADES

Olaitan P.B., Ogbonnaya I.S.

Plastic and Reconstructive Surgery Department, National Orthopaedic Hospital, Enugu, Nigeria

SUMMARY. Masquerades are a common cultural practice in Nigeria, and especially in Eastern Nigeria. Often these masquerades are performed during social functions, burials, house-warming parties, at Christmas and Easter, and indeed during most festivities. However, in relation to such events, some people accidentally suffer flame burns and present to our burns centre. The extensive injuries usually sustained are exemplified in the two cases presented. Education of the people remains a vital way to stop this problem.

Introduction

The masquerade is one of the cultural displays of the Nigerian people, especially of Ibo men in Eastern Nigeria, who put on ceremonial attire whenever there is an important ceremony such as a burial or Easter and Christmas festivities.

The costumes are made either of pieces of clothing sewn together or of dry material covering the whole body from head to toe, with two small openings over the eyes to allow the masquerader to see (Figs. 1-3).

Only men are involved as it is forbidden for women to take part in a masquerade ceremony. The masquerader is said to be a spirit, and he is not expected to respond to any external affliction like ordinary men. This compounds the problem of masquerades, as to pull off the costume is considered a sign of cowardice, even when the person is burning! Men are also initiated into the “masquerade world” in some parts of our environment. At such ceremonies, the activities include wearing masquerade costumes and dancing, when a naked light may accidentally set the costumes ablaze.

Case reports

Case 1

The first patient we present is A.O., a 29-yr-old trader who presented to our centre 24 h after suffering burns. He was being initiated into the “masquerade world’ - while dancing around a lighted candle, his costume accidentally caught fire. He was not culturally allowed to remove the burning costume, as this would have been regarded as cowardice.

A.O. had sustained extensive burns but he was kept in his village with no resuscitation for about 48 h, after which he was brought to our unit. He had been unable to pass urine for 12 h before presentation.

On arrival he was weak, severely dehydrated, pale, and febrile (body temperature, 38.9 oC). The burn wound involved all parts of his body except a patch of skin over the occiput.

A diagnosis was made of 98% mixed-thickness burns with severe dehydration, and resuscitation commenced. The patient died 2 h after presentation.

Case 2

B.D. was a 24-yr-old bus conductor who presented 24 h after he had sustained flame burns. He had been wearing masquerade costume during Christmas celebrations when his costume was set ablaze by one of his colleagues, who threw a sparkler at him. He extinguished the fire by rolling on the floor. He applied raw eggs on the wound before presenting at a private hospital where resuscitation was commenced. He was subsequently referred to our centre about 24 h after the injury.

On examination he was found to be a young man, not pale, but febrile (body temperature, 37.8 °C). He was tachypnoeic (respiration rate, 36 per min), with transmitted sounds in both lungs.

Burn assessment revealed a total body surface area involved of 87%, with mixed-thickness burns sparing some patchy areas of the back and the right upper limb.

Resuscitation was commenced with intravenous fluids, antibiotics, and wound dressing.

The patient developed severe respiratory distress and died two days later.

Discussion and conclusions

Several unusual hazards for burn injury have been described in the literature.1-3 Singh3 described sparklers as a major hazard for burn injuries. He described fireworks as an integral part of festivities in many cultures and their use in United Kingdom celebrations at Halloween and Guy Fawkes Night celebrations. He described a 4-yr-old girl who was burned while holding a sparkler in her left hand which ignited her clothing, causing extensive burn injury, and a 5-yr-old boy whose clothing was set on fire when he was chased by a child of similar age holding a sparkler, sustaining 30% full-thickness burns. He reported that injuries caused by sparklers are “potentially fatal and can leave severe and permanent disfigurement and disability”.

Chondhary and Streets,4 in their paper “Horrors of Halloween”, noted that the eve of All Saints’ Day is celebrated as Halloween night on October 31 every year, when for fun people tell creepy and haunting stories and dress up as ghosts. They described a 19-yr-old teenager wrapped up in toilet paper from head to toe as an “Egyptian mummy”. The costume was accidentally ignited by a candle placed to celebrate Halloween and the young man sustained a 15% burn. They submit that it is very important to be very careful in such moments and that wrapping anyone in an easily flammable material like toilet tissue paper can result in serious burns.

The injury sustained during masquerades by persons presenting to our centre after burns is usually extensive and in most cases fatal. This is due to a combination of factors:

• big>the nature of the materials used for such costumes, which are highly flammable;
• big>the manner of wearing the costumes tightly on the body from head to toe;
• big>the fact that the masqueraders are culturally taken to be spirits and are therefore not expected to undress in the open;
• big>the reluctance to seek help from orthodox medicine, as noted in the first case.

It has been suggested that there should be explicit publicity campaigns during major festivities, concentrating particularly on the risks of death and severe disfigurement and disability as the result of sparkler injuries.3

We suggest public awareness campaigns should be conducted by radio and television, especially during festivity periods. This would help to lower the number of disasters resulting from this fun-producing cultural practice.

Barring very young children from being involved in masquerades would reduce mortality from these preventable injuries.

RESUME. La mascarade est un usage culturel très commun au Nigeria, et en manière particulière au Nigeria oriental. La mascarade est souvent célébrée pendant un événement social, les funérailles, les réceptions pour fêter un nouveau logement, à Noël, à Pâques et en effet à la plupart des célébrations. Toutefois, il arrive que des personnes subissent des brûlures accidentelles et se présentent à notre centre des brûlures. Les lésions, normalement très étendues, sont exemplifiées dans les deux cas présentés. L’éducation de la population reste la manière la plus importante pour réduire ce problème.

Bibliography

1. Sheller J.P., Muchardl O. et al.: Burn injuries caused by fireworks: Effects of prophylaxis. Burns, 21: 50-3, 1995.
2. Sei L.C., Lo S.K.: Epidemiology of fireworks injuries: The national electronic injury surveillance system, 1980-89. Ann. Emerg. Med., 107: 423-5, 1994.
3. Singh S.: Sparklers as a major hazard for burn injury. Burns, 23: 369-72, 1997.
4. Chondhary S., Streets C.: Horrors of Halloween. Burns, 24: 278-9, 1998.