Tailor-made solutions: a new burns pressure garment service for Sierra Leone

When a deadly fuel tanker explosion took place in the capital, Freetown on 5^th November 2021, where over 120 people suffered severe burns, Momoh committed to learning an entirely new skill, sewing pressure garments for the long-term care of burns patients’ scars,

“My manager, Mr Ismalia Kebbie, the Head of Rehabilitation at the Ministry of Health [was working with the team from King’s Global Health Partnerships] and he chose me to make pressure garments because of my practical abilities, but I had never seen a pressure garment before, let alone made one.”

King’s Global Health Partnerships (KGHP) had mobilised quickly to support the burns response, and provide specialist training and mentorship to colleagues in Sierra Leone, to ensure burns patients received the right care. The work highlighted the need to build longer term, national capacity for burns care provision in Sierra Leone. Jessie Robinson, a volunteer burns physiotherapist from the UK who worked on the project explains,

“Two pressing needs of those patients affected by the explosion, were scar management and psychological support. In terms of scar management, the most important thing you can do is wear pressure garments over the burns. A pressure garment is meant to be tight fitting, so it can push the blood flow away from the scar, helping to make the scar less active and reduce scarring and discomfort.”

KGHP and colleagues from the NGO, Interburns had supplied some pressure garments for the burns patients in the immediate aftermath of the explosion, but there is an ongoing need for them. Pressure garments need to be replaced every two to three months, and need to be worn by the patient for 12-18 months after a severe burn.

“So we established a plan to locally source the fabrics, fastenings and any necessary materials to make the pressure garments here in Sierra Leone," Jessie continues. "Importing these materials is very expensive. In order to embed this into the National Rehabilitation Centre, it needs to be sustainable.”

Having found a suitable elasticated cotton in the fabric markets in Freetown, Jessie and Momoh set to work, creating some prototype arm and leg sleeves.

“Jessie explained to me how to measure for pressure garments and gave me a book with all the different patterns you can make for different areas of the body,” Momoh explains. “At the beginning I was totally lost! I knew how to take the measurements but converting the measurements into the patterns and then applying the patterns to the fabric material, was very difficult for me. I tried making a lot of garments, but they weren’t fitting well.”

Jessie arranged two live video calls with a colleague at Chelsea and Westminster NHS Hospital, Lamya Bouhali, a specialist pressure garment technician who trained Momoh in how to sew the garments.

“On the video calls, Lamya would sew technical patterns and explain to me what she was doing as she went along. Then she sent me some WhatsApp photos of patterns that I could practice. I really learned a lot. After those training sessions, I became more confident and I can say, for at least the socks and arm sleeves, I have no problems with those, I can do it.”

There are now plans to establish a physiotherapy department at the main hospital in Jui, east of Freetown, close to where the fuel tanker explosion took place and where the majority of the burns patients live.

With money raised from an emergency appeal, KGHP supplied two overlocker machines that are needed for technical zigzag stitching, used to sew pressure garments.

One is housed in Momoh’s workshop at the National Rehabilitation Centre, and the other will be at the new physiotherapy department in Jui, so Momoh can freely move between the two locations, and easily make adjustments when fitting pressure garments to patients based in Jui. The new unit hasn’t opened yet, so for now he works in a temporary tent in Rokupa maternity hospital when he sees burns cases in Jui.

“My first day of meeting all the burns patients in Rokupa made a big impression on me. It made me so motivated to do the job and focused me to learn more, because I knew that there are more people suffering with burns.”

The majority of patients from the explosion have hypertrophic scarring. Jessie explains, “Hypertrophic scarring is when burns scars can become raised, textured and discoloured. The scars impact function, cause contractures, and massively impact patients from a psychological point of view, and in terms of social reintegration or returning to work. So there is a great need for this service in Sierra Leone. And obviously not just for the survivors of this recent tragedy. Burns are a major public health issue in Sierra Leone, so unfortunately there will always be a need for this service in burns care.”

KGHP have provided two computer tablets and internet connection for a year at the National Rehabilitation Centre and for the new unit when it opens in Jui, so that Momoh can continue to connect virtually with colleagues abroad, for ongoing advice and support whilst the pressure garment service takes off.

“It has been so positive working with Momoh,” Jessie shares. “He really threw himself into this and has been so enthusiastic about learning and willing to pick up something new, so fast. It’s particularly special as this is the first burns pressure garment service in Sierra Leone, and with the direction of Mr Kebbie in developing burns care and rehabilitation nationally, we hope it will continue.”

Momoh echoes the sentiment, “It means so much to me that you’ve invested in me and that you’ve trusted me in learning this new skill. As a disabled person myself, having survived polio as a child, I am so happy to be working on this project, to help my companions. I feel so great!”