PIH Responds to Urgent Need in Wake of Sierra Leone Fire Explosion

Support for survivors includes medical and mental health care

Posted on Nov 17, 2021

Dr. Marta Patiño and the clinical team discuss PIH's response following the explosion in Freetown.
PIH's Dr. Marta Patino conducts rounds with the staff of Connaught Hospital at Connaught's intensive care unit, where the majority of burn victims were taken after the accident. Photo by Abdul Hamid Kanu for PIH.

Late in the evening of Friday, November 5, the phone calls began between Partners In Health staff in Sierra Leone: A car and a fuel tanker had collided in the capital city of Freetown, resulting in an explosion and a widespread fire. Hundreds of people were engulfed in flames. Many of them had already been on the road, in their cars commuting, or on foot selling goods. Many others had rushed over from home, empty jerry cans in hand, looking to capitalize on the leaking tanker as a free source of fuel.

Officials report that 98 people died on the scene, and 158 were transported to hospitals across the city, in critical condition with up to 95% of their bodies severely burned.

And the news didn’t stop there. Among the injured, PIH staff learned, was a colleague: Fleet Manager Hassan Bunduka, who had been driving home to his family when he was caught in the blast.

PIH’s response to the disaster began immediately. At 3 a.m., a vehicle departed Kono District, where the majority of PIH clinicians work in the eastern part of the country, to bring Clinical Services Lead Dr. Marta Patiño and General Surgeon Dr. Kilongo Papy Mulailwa to Bunduka’s bedside and then to Connaught Hospital, Sierra Leone’s largest public hospital, where the vast majority of victims were taken for care. A vehicle loaded with medical supplies from PIH’s warehouse in Kono, such as central IV lines and gauze, followed soon after, to donate to the hospital’s intensive care unit.

Relief efforts have only grown from there. Now entering its second week, PIH’s response is centering on all five pillars of our work—staff, stuff, space, systems, and social support—in partnership with the government of Sierra Leone and other nonprofits.

The goal: to ensure survivors of this disaster have the resources they need to heal in the short and long term.

Tragically, on November 7, Bunduka succumbed to injuries sustained from the disaster. As of November 16, he is one of 148 people who have passed away, with 52 still receiving care across five public and private hospitals in Freetown—none of which have the resources to offer specialized care for burns.

“Emergencies tell you something about the health system,” Dr. Bailor Barrie, executive director of PIH in Sierra Leone, said, sharing an idea often cited during the country’s struggle with Ebola. “There is no burn unit in the country; the expertise of burn care is not available. So it tells you that the health system is weak, and incapable of handling such an unexpected crisis.”

Staff in Sierra Leone are grieving while also managing the complexities of an ever-evolving medical crisis and putting together a social support program for survivors that will carry over into 2022.

Six Days, Six Weeks, Six Months

PIH staff have divided the fire explosion response into a rough timeframe, captured by the phrase “six days, six weeks, six months.” The phrase represents a response that is immediate, mid-range, and long-term, with each stage overlapping with the next to ensure that survivors—and the clinicians caring for them—have the right resources.

“I really see PIH’s utility in the mid- and long-term, ensuring that patients have comprehensive, lasting support,” Barrie said. “We’re positioned to provide services to patients to make their chances of survival increase and to holistically help them be functional and reduce their suffering.”

Such support would include financial aid to make up for lost wages, as many survivors are the primary or only earner in their family; food packages, so that survivors have the nutrition required for continuous healing; mental health care and counseling; and accompaniment through ongoing medical care from specially hired community health workers (CHWs) trained to provide logistical and moral support amid a difficult healing journey.

“Plastic surgery, dealing with mobility, you’ll need a lot of physical therapy. All of which are very difficult to get in Sierra Leone,” Mulailwa explained to The New York Times. “You can anticipate that the next three months, for the ones who survive, will be very difficult.”

PIH staff are currently devising a program to provide all of these resources as more patients begin to recover. PIH has already hired nine mental health CHWs and two CHW supervisors to work with patients upon their discharge from the hospital, connecting them with continued medical care and helping them through their trauma. Two specially hired psychosocial counselors will provide additional counseling and support. After completing their training this week, their direct work with patients will begin on November 22.

But, as Mulailwa suggested, even for patients who have survived this long in the hospital, nothing is guaranteed. This is partially due to the severity and extension of their burns, which make them susceptible to fatal dehydration, sepsis, and illnesses like pneumonia, which spread in hospital settings, especially those with poor ventilation and inadequate capacity for infection prevention and control.

Providing Medical Personnel, Essential Supplies

PIH clinicians are currently working alongside Connaught Hospital staff to prevent these conditions. Since November 10, Patiño, alongside Frank Rogers, a scrub nurse at PIH-supported Koidu Government Hospital in Kono District, and Sarata Sillah, PIH Sierra Leone’s interim director of nursing, have been working at Connaught Hospital, providing clinical support and expertise in the intensive care unit, where 27 burn patients remain as of November 16. (Four remain in critical condition at Connaught, and nine remain in critical condition across all hospitals.) On November 13, they were joined by Dr. Sterman Toussaint, a surgeon with experience in burn care and PIH Liberia’s clinical services lead, who was dispatched to the site along with other medical personnel by the government of Liberia.

These clinicians’ direct experiences in the hospital each day are informing how PIH is assisting with Connaught’s space and supplies. Amid an outpouring of donated medical supplies—including from the government of Liberia, enabled by PIH Liberia—PIH staff in Kono have been sending equipment to the hospital, with vehicles regularly driving from the PIH warehouse to Connaught to fulfill requests for supplies: 10 vials of glucose here, 300 blood bags there.

Also, in response to the hospital’s severely limited laboratory and blood bank capacity, PIH loaned Connaught a refrigerator to store more blood safely; an ambulance to transport blood between hospitals for the next month; and reagents for lab technicians to be able to carry out tests, as well as a cutting-edge, portable lab testing device that can conduct vital tests at patients’ bedsides.

PIH staff are continuing to monitor how best to support the disaster response, attending government emergency response meetings and providing strategic insights on how to overcome persistent obstacles, which include the availability of antibiotics and nutritional support for patients prone to infection and in need of more calories than ever before, especially two weeks into their hospital stay.

“Every team is working to make possible the best support for the patients,” Patiño said. “I see this is having a clear impact in the care we are providing. This extraordinary work is even more remarkable with the terrible and devastating loss of our colleague Hassan.”

Patiño also noted that the government’s response, which PIH and other partner organizations have been supporting, has been “swift and organized,” clearly informed by its experience with Ebola and bolstered by international teams of clinicians visiting to provide expertise in burn management and rehabilitation. Still, critical medical gaps remain—a familiar story in Sierra Leone, where centuries of injustice have left health facilities direly under-resourced and ill-equipped to handle even some routine health problems, let alone a mass influx of burn patients.

“Sierra Leone has people who are well-trained and who really know what to do” Patiño said. “Given the resource constraints, the care being delivered [in Connaught’s intensive care unit] is outstanding.

“But there are not enough of them, and they don’t have the supplies and the facilities necessary to do a high-quality job,” she continued. “There are two plastic surgeons in the whole country, and they’re very good. But how are you going to manage this situation with two plastic surgeons? It’s impossible.”

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