Screams of pain, overcrowded wards and the smell of burned flesh met Nurse Juma Wangila and Dr. Eline van Kooij from Médecins Sans Frontières (MSF), when they entered the Nakuru Provincial Hospital on Tuesday, February 3.

It was three days after an accident of catastrophic proportions had hit the town of Molo in Kenya's Rift Valley Province. A petrol tanker parked at the side of the road had tilted over and attracted hundreds of people looking for a little money in the leaking petrol. What made it explode nobody knows exactly, but in the spark of a moment more than 100 people were dead and about just as many critically burned.

Those with a fair chance of survival had been airlifted to hospitals in Nairobi. Patients, who either had minor burns or who were burned so seriously that they only had a slight chance of survival, were left for care mainly in the nearby Nakuru Provincial Hospital.

Faced with a chaos that any hospital would experience following a sudden huge influx of critically burned patients, the Kenyan Red Cross and the hospital had requested emergency assistance from MSF.

"About 57 patients were admitted, when we arrived," Dr van Kooij said. "The most severely burned were in a spare ward that normally was empty and as they had not yet been able to find additional beds, patients were lying on the floor without medication. There were only two nurses for all the patients, so the need for assistance was immense."

She and Juma Wangila joined MSF colleagues that had arrived the day before, and over the following weeks the team grew to more than 40 persons who worked alongside the staff of the hospital and other international volunteers.

A surgical team treated the burns, around 30 nurses cared for the patients, and a number of counsellors dealt with the mental pain of the patients and the grief of the relatives of the many who died.

Six hours to change a dressing

The treatment of patients with burns is intensive. While the skin protects against heat, cold, bacteria and helps maintain the fluid balance in the body, burns are like taps, letting out liquids, electrolytes, proteins and body heat as well as opening an entrance for bacteria.

"Even patients with burns covering just 10 percent of the body – approximately the equivalent of an arm – risk dying from a collapse of circulation and other complications," said Dr van Kooij, explaining why medical stabilisation during the first days is crucial.

Most of the patients MSF cared for in Nakuru Provincial Hospital were much worse off. The most seriously affected were on an average burned over 39 percent of their bodies. At the same time the number of patients was far higher than any normal hospital department specialized in the care of burns would normally handle.

"It was very intense in the beginning. We worked around the clock to keep the patients' drips running, giving them pain killers, changing their dressings and sheets that were soaked from the oozing wounds – we tried to make them as comfortable as possible in the given situation," Wangila added.

Later the prevention of infections and wound dressing would become the focus of treatment as this determines how well the burns heal and, subsequently, the need for skin transplants and risk of future handicaps. Over the course of two months, the surgical team carried out 71 surgical procedures on 32 patients - including 39 skin grafts. The nurses were responsible for the daily dressing changes.

"It took six hours to dress some patients and it was difficult, because we could hardly find any areas of their bodies to handle them, which were not burned," said Wangila. "Even with painkillers they were in a lot of pain and we had to work extremely carefully. Often the patient would need breaks to cope, and still they would be exhausted afterwards."

Emotional strain for patients and staff

Left with the most seriously affected patients, death was frequent in the wards of Nakuru Provincial Hospital.

"The patients would see friends, they had been talking to the day before, being pushed away to the morgue and they knew they themselves were in a critical situation. It was a really hopeless situation for them," Wangila explained.

A team of counsellors and one psychologist worked alongside the medical team to provide counselling to the patients and the relatives and friends left behind from among those who died from their injuries. They also provided psychological support to the medical staff, who had to cope with death and immense suffering every day.

"MSF assisted by bringing in structure, medical personnel, medication, surgery and psychosocial care… I also believe we brought hope for the patients, we were caring for," said Dr van Kooij.

Eline van Kooij normally works as a doctor for MSF in the Kibera slums of Nairobi. For three weeks, she assisted in the emergency in Nakuru.

Juma Wangila has worked for MSF in other emergency projects in Kenya. In the Nakuru-project he was the nurse in charge throughout the project.