Early on Saturday morning, Sri Ram Shrestha awoke in his house in Nala, Kabhre, to find flames and smoke filling the air. He rushed upstairs to save his sleeping 32-year-old daughter, Ram Pyari Shrestha. But by the time he got to her, her face, hands and legs were severely burnt.

She was driven to Banepa Hospital, but because 40 percent of her body was covered with second and third degree burns, she was sent on to Bir Hospital, where she now lies shrouded in bandages, groaning in pain, her swollen face and lips smeared with soothing ointment. The hospital staff fear her lungs may have been damaged by smoke inhalation. Her father lost all his possessions in the fire and burnt himself during the rescue. "Whatever I could find, I spent it to bring my daughter here," he explains.

Duty nurse Nara Devi Bariya was not surprised when Shrestha told her he could not pay. Instead of turning his daughter away, staff immediately treated Ram Pyari, bandaged her and applied the necessary ointment. Of the nine patients in the unit, all except one are receiving free treatment. The charges are minimal - usually for medical supplies - but most patients end up not paying anything because it is generally the poor who come for treatment.

"Those who can afford it seek private help," says Bariya. "The patients who come to us are sometimes so poor that they not only can't pay for their treatment, but don't have enough money to go home."

Bir Hospital's burns unit, set up in 2001, is one of three in Kathmandu. Staffed by two dressers and five nurses, it is always full. Overflow patients are kept in the emergency ward until a bed is free, and patients receive protein-rich meals and snacks daily. The Krishna dispensary at the hospital provides some drugs for free to those with absolutely no money.

Most cases are women from poor households, and records at the Bir unit show that nearly two thirds of cases result from accidents, and nearly one third from self-inflicted burns. "It is usually married couples, where the men work and women stay at home," says Bir Bahadur Lama, counsellor at the burns unit. Most suicide cases result from economic problems. "The husband cannot fulfil basic economic demands, and our culture is such that couples don't really share their feelings, so it is usually the women who burn themselves as a last resort."

For more than three years the unit has been without a much-needed plastic surgeon. "The deeper wounds need surgery," says volunteer Wendy Marston. "But since the unit doesn't have a surgeon, patients take longer to heal." This means they also take up valuable bed space for longer.

Keshav Das Joshi, chief of the Plastic Reconstructive Unit at Kathmandu Medical College, says a major problem in dealing with such cases is the shortage of specialised burns units and plastic surgeons in Nepal. "In India it is estimated that around 0.5 percent of the population gets burnt," he says. "We estimate that the figure is similar here, which is quite significant."

In a month\'s time, KMC will open a new reconstructive plastic surgery and burns unit which will help to meet demand.

"There are so many accidents that should not be happening but do because of lack of awareness," says Marston. She says the government could make more use of radio to provide advice to illiterate families.

While Bir Hospital provides basic medical supplies, patients may have to pay for some expensive drugs themselves. The unit gets some support from international organisations and individuals, but there is always a need for more assistance. "The help does not necessarily need to be monetary," says Marston. "Those interested can contribute by providing things like protein-rich food, towels and bed sheets."

Despite the constant struggle to make ends meet, the burns unit provides vital, often life-saving treatment to a steady stream of patients. "The resources we work with may be limited and we may be understaffed, but those who work here are committed, and we always do our best," says Bariya.

Burns Unit, Bir Hospital: 01-422 1988 Ext: 358