Temple University team travels to Sierra Leone to help burn patients after gas tanker explosion

When a petroleum tanker crashed on Nov. 6 in Sierra Leone, one of the world’s poorest nations, bystanders, including children, ran toward the disaster, trying to collect the valuable gasoline flooding the street. But then the vehicle caught fire. More than 140 people died in the explosion and at least 300 were injured, many with life-threatening burns.

A high-tech American hospital with a specialized burn unit would have been overwhelmed by the rush of critically injured patients, many with burns covering more than 60% of their bodies. But even in its capital city, Freetown, Sierra Leone’s outdated, dilapidated facilities — the main medical center, Connaught Hospital, relies on bed netting to keep out the mosquitoes that get in through broken windows — meant the doctors and nurses who snapped into action faced unimaginable challenges.

A team of doctors from Temple University, among the first foreign medical workers to respond, were stunned when they arrived at the hospital in early November to see how their local colleagues handled the crisis with so few resources.

“It’s a big, big disparity in what we saw there vs. what we normally see here and a huge testament to their medical knowledge, their tenacity, their ingenuity,” said Maura Sammon, an emergency physician at Temple. She also is medical director of Global Response Management, a nonprofit that provides emergency health services and humanitarian aid in countries experiencing conflict or war, including Iraq, Bangladesh, Syria, and Yemen.

Before the gas explosion, the Florida-based organization was already in talks to expand services to Sierra Leone, still struggling to recover from a civil war that killed or displaced a third of its citizens between 1991 and 2002. Today, about 60% of the population is under age 25, with an average age of 19, less than half the U.S. average of 39.

High illiteracy among young adults due to lack of schooling during and after the civil war underpins an unskilled workforce with few job opportunities.

With an adult population whose formative years were shaped by civil war and political turmoil, the West African country is “at a state that’s very dangerous,” where people have begun to accept disaster and tragedy as normal, said Samuel Cole, a 29-year-old Philadelphia resident who is from Sierra Leone.

“The value of life is decreasing in the sense that people are becoming so numb to it,” Cole said. “Yes, it’s sad, it’s shocking. But it’s also not surprising.”

Cole was separated from his mother during the civil war, and lived with grandparents until he was 7. When the war ended, he moved to London to be with his father. The two relocated to Philadelphia when Cole was a high school freshman. As president of the Sierra Leone Youth Association, Cole works with teenagers from Sierra Leone who are adjusting to life in the Philadelphia area.

“Even though we’ve had our civil wars, our issues, the country is still very peaceful and the people are fighters,” he said. “With all these things going on, the people still find a way to be happy and carry on with life.”

Some of the country’s biggest challenges — poverty, food insecurity, contaminated water — create health crises for which there is little medical care available.

The country has just one major hospital and roughly one doctor for every 33,000 people, according to the CIA World Factbook. In the United States, there is about one doctor for every 356 people.

When Sierra Leone officials approached Global Response Management for help after the gas explosion, Sammon worked with Temple leaders to pull together a team from the university’s renowned burn center. Within days, Sammon, Temple Burn Center director and surgeon Lisa Rae, along with a physical therapist specialized in burn recovery and a team of nurses were in Freetown to help patients.

Treating and recovering from burns can be a long, difficult process, Rae said. People with severe burns covering at least 20% of their body are at risk of multi-organ failure, due to an inflammatory response that can raise blood pressure to dangerous levels, cause swelling, and prevent proper blood flow.

In the United States such seriously burned patients are monitored closely for the first 48 hours, with one-to-one nurse supervision to change wound dressings and track vital signs. Dialysis machines and ventilators are available if patients’ kidneys or lungs begin to fail. Adequate fluids and nutrition are critical to reducing complications and often administered through tubes. Narcotic pain medications help ease these notoriously painful injuries.

“It is a challenge to even get those patients through that first 48-hour period,” Rae said. “A hospital with those few resources and large burns. ... With all the resources we have here [at Temple]. I don’t know that we could do that.”

The Freetown hospital didn’t have vital-signs monitors, ventilators, or dialysis machines, and each nurse attended to at least 10 patients. Most patients were being treated with the equivalent of acetaminophen and ibuprofen. The limited supply of more potent drugs was reserved for surgeries.

Sammon and Rae are back in Philadelphia, but others from their team will remain in Sierra Leone awhile longer. Global Response Management committed to four weeks of intensive support for burn victims.

Beyond that, the organization is evaluating the area’s medical needs to prioritize future projects, including the possibility of a dedicated burn center.

Though the gas-truck fire was particularly lethal, burn injuries are common in Sierra Leone, where lax building and vehicle regulations create dangerous environments. Many people cook on open fires in enclosed structures, which is another major source of burn injuries.

While the Temple doctors were in Sierra Leone to lend their expertise, they also learned from the local doctors.

Rae said what stood out the most to her was the care with which doctors and nurses comforted families, even though they had so many badly injured patients to attend to. They offered to connect grieving families to mental health services and tried to help them locate missing loved ones.

“There was a caring aspect beyond the medicine that permeated,” she said. “That moment where you say wait, people are suffering, let’s acknowledge that. That will change my life going forward.”