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Monday, November 28, 2022

Sierra Leone blast health system strains

Sierra Leone blast health system strains

FRETOWN, Sierra Leone. When a gasoline tanker exploded in Sierra Leone last week, killing 98 people at the scene, many of the survivors included a motorcycle taxi driver who was stuck in a traffic jam and engulfed in fire.

The driver, Yusuf Kamara, was burned 80 percent of his body. But for a while, he could walk and talk – and worry about the $ 27 he lost in the fire, about three days’ wages.

“It was not baby money, not little money, and they all burned out,” he said in an audio recording, the last recording of his voice before his death.

Days after the bombing in Freetown, the country’s capital and largest city, the tragedy claimed more lives and put the country’s already fragile healthcare system to the test. The death toll rose from 98 to 144 as of Saturday, and even more survivors were still hospitalized on Friday.

In a country where there is no single burn unit and where life-saving medicines are not available or are running out, doctors and nurses are trying to prevent the infection of patients who have survived so far.

This is a titanic task. Most of the patients who are still in the hospital have burned more than 25 percent of their bodies. A hospital in Freetown, known as the 34th Army, had a fatality rate of around 60 percent. As patients die in another hospital, the emergency hospital, their beds are transferred to the injured, who were less affected and who could not initially be hospitalized due to lack of space.

While Covid-19 has not hit Sierra Leone, where there were only 6,400 cases and 121 deaths in the entire pandemic, the country is no stranger to health crises. The Ebola epidemic that began in 2014 has claimed the lives of nearly 4,000 people. In 2017, floods and mudflows killed hundreds of people.

But the severity of the blast injuries shocked even doctors who had survived previous crises. “I’ve never seen anything like it on a grand scale,” said Dr. Songor Koedeyama, the hospital’s medical superintendent, who volunteered after the blast to Connaught Hospital, the country’s main hospital, where most of the casualties were taken. …

Dozens of drivers and cyclists were killed and injured. Some were so poor that when they saw the tanker leaking fuel right before the explosion, instead of hiding, they rushed to collect some fuel. Many of those killed were the breadwinners of their families, so the tragedy plunges some of the most needy in this West African country into even greater despair.

From the moment patients began to flood hospitals, doctors, nurses, administrators, and government officials have worked around the clock to gather supplies and organize a patchwork response. By the morning after the explosion, an emergency coordination team began work.

But from the start, the weakness of Sierra Leone’s health care system showed itself. The hospital staff burns out quickly, and few can replace them. Government pharmacies cannot provide essential medicines, including medicines for acute pain and antibiotics. And doctors fear that it will only get worse.

The health sector in Sierra Leone is fragmented and a messy collection of public, private and non-profit programs. While the government is nominally responsible for this, it relies heavily on funding and supplies from foreign donors.

Patients living on a meager income regularly have to buy essential medicines from private pharmacies. But Lawrence Sandy, managing director of the National Health Supply Agency, said the government is taking over the bill for burn victims.

When he heard about the explosion, Mr. Sandy said, he went straight to the Connaught Hospital medical store, collected supplies there and handed them over to doctors. Due to the fact that basic supplies such as IV fluids ran out immediately after the accident, he went to a private pharmacy next door to buy more, he said.

“I just said that whatever you have, we will pay for it,” said Mr. Sandy.

But at hospitals across the city, families of several patients said they were still being ordered to pay for medicines and other supplies.

Caring for survivors who have come this far will become more and more difficult, according to Dr. Kilongo Papi Mulailwa, a surgeon who helped with the aftermath of the fire. Discharged patients will be required to return to specialized hospitals for weekly treatment throughout the year.

“Plastic surgery related to mobility, you will need a lot of physical therapy. All of this is very difficult to obtain in Sierra Leone, ”he said. “You can expect the next three months to be very difficult for those who survive.”

But the lack of antibiotics is causing a bigger problem.

“I fear that we do not want to start with this patient, and then we will not have enough of him for all the treatment, because they might develop resistance,” said Mr Sandy.

Those who survived worry not only about their own recovery, but also about the impact their absence will have on their families.

“I take care of my brothers, sisters and children,” said 25-year-old driver Ibrahim Sorie on Wednesday, lying on a bed at the 34th military hospital. His legs, arms and most of his head were burned, and in a whisper he said that he was in great pain. “I take care of everyone, I pay tuition fees. So now that the accident has happened, I just don’t know what I’m going to do. We really need government support. “

The families of those who have died, who have already lost loved ones and were injured, now also face financial ruin.

Mariatou Mansaray, sister of one of the victims, panicked as she was making ends meet, waiting for the morgue to empty the body of her younger brother Ibrahim on Thursday. She still does not know how the traffic police officer Ibrahim caught fire.

Shortly before his death, Ibrahim told her from his hospital bed: “I did not see fire, I saw only smoke.”

The morgue demanded $ 23 from her for washing Ibrahim’s body and $ 23 for an ambulance – more than what she earned in a month. In addition, she had to spend $ 165 to feed the mourners, a requirement in a country where funerals are extremely important. And then there was a seven-day funeral ceremony in the family’s home village.

“I have to take care of his child now, and I have two children, I have to take care of everyone,” she said with tears in her eyes, dressed in pink and purple lace for the funeral. According to her, her mother is sick and relied on Ibrahim’s monthly salary to survive. “It was already too much for all of us, and now that he’s gone, it’s even worse.”

Motorcycle taxi driver Yusuf Kamara from his hospital bed made a video message for his mother last Saturday, two days after the fire. “Tell my mom I’m not going to die,” he said. “Give her courage.”

On Sunday night, he called his cousin Memunat Kamara and asked her to make him some soup. But when she came with him the next morning, she was told that he was dead.

On the way to the funeral, Mr. Kamara’s 7-year-old son saw a motorcyclist.

“Look, dad is coming!” the boy said to his grandmother, not understanding what had happened.

“Everyone started crying,” said Ms. Camara. “There was not a single dry eye in this car.”

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