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Improving Burns Care in Sierra Leone

Cecily Borgstein

Partnership Lead, Sierra Leone, King’s Global Health Partnerships

01 July 2022

On the night of the 5th of November 2021, a tanker carrying fuel collided with another truck in Freetown, Sierra Leone. The fuel tanker was about to enter a filling station to deliver its fuel, so there was a significant fuel spillage which people rushed to collect. As the fuel was being collected, a fire broke out and the tanker exploded, killing more than one hundred people and injuring many more.

Over 120 seriously injured persons were taken to various hospitals including Connaught Hospital, King’s Global Health Partnerships’ long-term partner in Sierra Leone. Eight months since the explosion, over 80 people are still receiving regular outpatient care.

King's response to the tragedy

The King’s Global Health Partnerships (KGHP) team in Sierra Leone sprang into action to support the response to this tragedy. Along with health teams from Liberia, Senegal, America, Ghana and Italy, they worked to support the national teams, and delivered specialised education and training to ensure the victims were receiving the right care. They supported the international teams to work and train within the structures that were set up in Connaught Hospital and helped to assess needs and ensure appropriate services and consumables were being delivered. King’s fundraised over £85,000 to support the response.

Burns cascade training nutrition team Sierra Leone

Managing the long-term needs of burns patients

The explosion highlighted a particular gap in health service provision. Morbidity and mortality related to burns injuries is significant in Sierra Leone. New burns patients are admitted to Connaught Hospital, Sierra Leone’s main tertiary hospital, every week, many requiring intensive care in the hospital and ongoing care, post discharge.

Burns care in low-income settings is challenging because burns patients often have complex and long-term needs. To meet the needs of the victims of the explosion, as well as to build national capacity in burns care for future patients, KGHP used the funds raised to build a project focusing on education and training in burns care at Connaught Hospital.

It was important to ensure that the training and education started in the immediate aftermath of the explosion, was continued and embedded into practice in Connaught Hospital. Two specialist burns nurses and one specialist burns physiotherapist were recruited to work alongside the teams in Connaught Hospital to provide ongoing education and mentorship.

Learning from Burns specialist colleagues in Ghana

In addition, a multidisciplinary team of five members of staff from Connaught Hospital were supported to travel to Ghana and spend two weeks on the Burns Unit at Korle-Bu Training Hospital. They have returned and with the support of the volunteers, are cascading their learning to 20 other members of staff.

Practical session learning how to dress burn inj

The trip to Ghana [taught us about] the entire management of burns and the significant role of multidisciplinary teamwork in the management of burns patients. We learned a lot of good practices and dressing techniques from [colleagues] in Ghana, which today we are implementing and cascading to our colleagues. We know that there are still challenges at Connaught but with the good practices and knowledge attained from Ghana, we can help to create change and reduce the mortality rate of burns cases. We want to thank King’s Global Health Partnerships and their donors for their support in making our trip to Ghana, a successful one. – Maximilian Bangura, Nurse, Connaught Hospital, Sierra Leone

Patient review of all the survivors from the fuel tanker explosion

KGHP recently supported a patient review carried out by the Case Management Team who led the clinical response to the explosion, led by Dr Jalloh, the lead plastic surgeon in Sierra Leone. Over the course of a week, all of the survivors were invited to Connaught Hospital to receive a holistic review. They were seen by a doctor and nurse to assess their wounds; a physiotherapy team to assess their physical functioning and scars; a mental health and psychosocial team; and the nutrition team.

Practical training with nutrition team Sierra Leone

In Ghana, the teamwork was very strong on the ward rounds. Everyone's input was taken into consideration for the patient. In the nutrition department, food fortification was done on a daily basis, using their locally available food stuffs to improve the nutritional status of their burns patients. The nutritional assessment of patients using the 'ADIME method' and calculation of daily caloric and protein requirements was well understood, and we will replicate this in Sierra Leone to improve quality of care. – Mariama Lahai, Nutritionist, Connaught Hospital, Sierra Leone

KGHP provided burns' consumables so that wounds could be dressed, and bloods taken for each patient. We also collected information from each of the healthcare professionals to build a picture of the impact a burn has on an individual and their life and livelihood. We found that a significant number of people had been unable to return to work, many had ongoing, medical and rehabilitation needs and almost all had scars that were impacting their daily life, whether the scars were itchy or disfiguring, or a reminder of the trauma they had suffered.

Developing a pressure garment-making service

Finally, the review week helped to inform the next steps of care, including the development of a pressure garment-making service. Jessie, one of the burns volunteers has been working with a tailor, Momoh at the national rehabilitation centre in Freetown to teach him how to make pressure garments to help treat the scars of burns victims. KGHP has provided an overlocking sewing machine and some locally available cloth with which to make the garments. Momoh and Jessie are working together to make sure that all the victims from the explosion have the correct pressure garments, and Momoh will continue making them in the future.

The longer term aims of the project include:

Supporting the creation of a specialist burns unit in Freetown through training, mentorship and systems support
Developing a Burns Register at Connaught Hospital to inform longer term planning of a national burns care system and to drive quality improvement efforts.