Lessons Given, Lessons Learned

Burn medicine and emergency medicine are two of the toughest specialties in healthcare. “Toughest” meaning their physicians and caregivers treat the most grievous injuries and regularly witness high levels of human suffering. Temple University Hospital’s burn and emergency medicine specialists fit this description, but nothing could have prepared them for what they would experience when they traveled to the African country of Sierra Leone on a medical-emergency mission back in November.

An Overwhelming Tragedy

On November 5, 2021, a gasoline tanker truck crashed outside of Sierra Leone’s capital city of Freetown. Hundreds of bystanders, including children, rushed to the scene to collect valuable gas that was leaking from the truck. An explosion followed, killing more than 150 people and injuring hundreds, many with severe burns. The country’s fragile healthcare system was immediately overwhelmed.

“This was a disaster…truly a disaster,” said Lisa Rae, MD, Director of the Temple Burn Center. “Two hospitals received the bulk of the patients, but they had little to no resources to care for them. And there is only one surgeon in the country with any burn experience. They were all doing their absolute best with what they had, but they had so little." 

“I kept thinking, what would I do if hundreds of severe burn cases walked into Temple at once,” she continued. “Forget Temple; I don’t think the entire city of Philadelphia could have handled what these hospitals were seeing.”

Temple Answers the Call for Help

The day after the tanker truck crash, Temple’s Maura Sammon, MD, Associate Professor of Emergency Medicine, received a phone call.

“The call was from Global Response Management, the NGO [nongovernmental organization] for which I’m Chief Medical Officer,” Dr. Sammon said. “The U.S. Ambassador from Sierra Leone called the NGO requesting help, and they in turn called me to ask if I knew any burn surgeons. I told him I knew an entire team. That’s how Temple got involved.”

The Sierra Leone government made a formal request for help, and visas were quickly processed for the members of the Temple team. Two days later, Dr. Rae, Dr. Sammon, and Temple physical therapist and wound care specialist Stephanie Velez Watson were on a plane to Sierra Leone, along with boxes of medical supplies that Temple had donated.

The members of this three-person team were among the first foreign healthcare professionals to respond. They would be followed by other Temple providers in the coming days and weeks.

“Temple was unbelievably generous with supplies. I don’t think I heard one ‘no,’ just ‘how much do you need?’” Dr. Sammon said. “The hospital and our departments were also great about letting us leave with very short notice and covering for us while we were gone. Dean Goldberg was incredibly helpful in
making this happen.”

When the three arrived in Sierra Leone, they were met on the airport tarmac by government representatives. They spent a night resting in a hotel, and the next day they were taken to the main medical center in Freetown, Connaught Hospital.

What they found there was unlike anything they had ever seen.

“There were rooms with patients lined up everywhere,” Dr. Rae said. “Eighty-four people had died on arrival, 54 had died in the hospital, and they were still caring for at least 60 seriously burned patients.

“The hospital didn’t have enough personnel, it didn’t have enough supplies, and it had very little pain relief to offer the patients,” she continued. “I’ve never been involved in a mass burn disaster, but this was something you couldn’t prepare yourself for. As desperate as the situation was, we found some incredibly devoted physicians, surgeons and nurses working around the clock to help these patients. It was remarkable.”

Grace Under Pressure

The three Temple specialists were immediately busy, working side-by-side with local healthcare providers.

“The large burns all needed operative management,” Dr. Rae said. “Because of the shortage of blood, we could only excise [remove dead tissue] from about 10 percent of the body surface at a time. We had just one operating room, which ran all day long. Surgeons worked in teams of two. The burns were often so extensive and spread out that each surgeon worked on a different extremity. The goal was to get your 10 percent done very quickly so you could move on to the next patient.”

While Dr. Rae operated, Dr. Sammon and Watson spent much of their time seeing patients and educating the local healthcare providers about burn care.

“I had brought a portable ultrasound with me, and I was able to train local staff to use it,” Dr. Sammon said. “Ultrasound can be used to make procedures like central lines and nerve blocks safer. After I left, Dr. [Jessica] Patterson continued the training, and my NGO was able to donate a portable ultrasound to the doctors there so they could keep learning how to use this technology.”

“I mostly helped with dressing changes, bedside debridement under ketamine, and educating the hospital’s physical therapy staff through lectures and hands-on demonstrations,” Watson added. “The staff was incredibly receptive to us and very eager to learn.”

The work was harrowing at times.

“The patients were absolutely aware of what was happening,” Dr. Sammon said. “Nobody was intubated, nobody was sedated. They’re all awake and getting next to no pain management because they had such limited access to medication. They see the person next to them being treated and they know
they’re next. They would listen to them screaming.”

In addition to Dr. Rae, Dr. Sammon, and Watson, other Temple personnel who traveled to Sierra Leone included Assistant Professor of Emergency Medicine Jessica Patterson, MD; surgical resident Lori Rhodes, MD; burn physical therapist Rachelle Pretz; and Burn Center nurses Elizabeth Leitch, Gideon Agyenim, Kati Marie Ehrgott, Natalya Ridkodim, and Richard Arbour. In addition, the Burn Center’s nutritionist, Stephen Clarke, consulted via Zoom with the Sierra Leone providers about nutritional supplements. The members of the team staggered their time in the country, together providing about a month’s worth of care.

“The goal was to complete most of the major operations over the first four to six weeks,” Dr. Rae said. “Many of the patients will still be in the hospital for months after that receiving care and physical therapy. One of the main things the local providers asked of us was help with long-term care, protocols, things we can teach them to help improve their care over the long term.”

A Lasting Impression

Each of the Temple team members who traveled to Sierra Leone has memories that won’t soon fade.

“For me, it was the young surgeon one year out of burn fellowship who had been tasked with managing 60 burn patients,” Dr. Sammon said. “Never in a million years could I have done what he is doing at such a young age. And he’s doing it with incredible grace, fortitude, and resourcefulness. Everyone we met was a sponge for knowledge. They are so committed to helping these patients. For me, that’s what I’ll remember.”

“We witnessed so much caring. That’s something you can’t teach,” Watson said. “I believe I learned just as much from the clinicians there in how to be resourceful and how to adapt to my environment. Everyone was so gracious, and I hope to be able to maintain contact with them to support the long endeavor toward healing, even if only virtually.”

According to Dr. Rae, who cares for burn patients every day at Temple, she will remember the small moments.

“The youngest patient was 13, and the nurses were struggling to get his hand to hang on the IV pole as a means of keeping his swelling down,” she said. “I came over and suggested another way to wrap it and hang it. I asked him if that was more comfortable, and he said yes. He relaxed a little because moving him was done and moving just a little bit was so painful. They had left him uncovered, and as I turned away, he asked me if I could cover him.
Just covering him and sharing that small moment of humanity…”

She trailed off with tears in her eyes. There was nothing more to say.

Epilogue:

After the Temple providers returned home, Global Response Management continued to staff a team of burn surgeons, nurses, and therapists to assist with patient care in Sierra Leone. Members of the Temple team remain in close contact with the local medical providers and receive updates on patients,
including the 13-year-old boy mentioned in this article, who is doing well and on the road to recovery.