At home: Thomas Burke

On the evening of the attacks on the Benghazi consulate that killed US Ambassador J Christopher Stevens and 10 others on September 11 this year, Thomas Burke, a Boston-based emergency specialist visiting Libya, was just a mile away. And at the time of the attacks, Burke and two colleagues were on the phone with one of the victims, US diplomat Sean Smith. “We heard one explosion while on the phone with him and he quickly said he had to go,” says Burke. “We had no idea what was happening until many hours later, when it was too late to help.”

As chief of the Division of Global Health and Human Rights at the Massachusetts General Hospital, Burke had been given the task of helping to build up the Libyan medical trauma infrastructure, including the Benghazi Medical Centre emergency room. “We had recently been asked to build up leadership for the health system. But we were still in the planning stages, relationship building and setting out the expertise ... We spoke on the phone to Ambassador Stevens about our programmes about an hour before the attacks,” says Burke, now briefly back in the US and talking to me on his weekday home, a sailboat named Consultation docked in Constitution Marina in downtown Boston.

Burke, who teaches emergency medicine at Harvard Medical School and can often be found in the Massachusetts General emergency room, is no stranger to either trauma or relief work around the globe. But as he recounts the tragic Benghazi events that have since become a highly charged focus of the US presidential elections, with name-calling over lax security preparations and faded American influence in the world, Burke says that the less-discussed local Libyan public reactions were eye-opening.

“After the attack there were cries back home that we needed to attack Libya – many Americans were assuming that all Libyans are extremists. But the Libyans were incredibly welcoming. The day before the attack, I went out for walks and people would wave, jump out of cars to greet me, hold my hands. And what was hardly publicised was that after the attack, there was a pro-democracy, pro-ambassador march with thousands of people disbanding extremist militias. The American ambassador was a popular local figure.”

Indeed, the day after the attacks, Burke says he found himself consoling hospital staff in the casualty room that he had been asked to upgrade: “During the night, the wounded and those that died were brought into the fledgling emergency room. Many of the staff were sitting on the floor of the hospital crying, feeling an overwhelming sense of loss for the casualties, for the ambassador, for the democracy and freedom now at risk.”

Consultation’s main living area

Burke has taken a break from global and local emergencies to host me in his private refuge, a 42ft sloop (sailboat), Bavaria 42 Exclusive model with a teak and walnut interior. It is also an all-year, all-weather home. “I also have a house in Medford, Massachusetts, but my mailing address is the boat ... I never have to take it up. It works just as well on ice.” Jutting up behind the masts is Boston’s lit-up skyline, with the hospital within five minutes’ drive.

Burke says he finds solace on the sea. “It’s a place of peace, a place of reflection.” In the aftermath of the Benghazi attacks, Burke worries that squabbling over poor security arrangements will overshadow the local achievements of Stevens and his staff. “There has been a lot of political football about how he wasn’t protected enough by US marines. But he went out into the communities, into people’s homes himself. A lot of people in Eastern Libya had had the ambassador to dinner. He wanted to engage directly with the community. He was an amazing person.”

When not in Libya, Burke spends his time travelling to his own community health programmes in sub-Saharan Africa. “We have a large malnutrition programme in Uganda; an ultrasound school in western Kenya; a large maternal newborn and child survival programme in South Sudan.” His projects, he says, are community partnerships. “We focus on healthcare transformation through education and research. We go where asked; we never impose ourselves.”

Much of Burke’s work has involved training midwives and doctors. “We have been supporting the only medical students of South Sudan for the past four years. Most of the medical students are homeless. We’ve built homes for them and need to build more. There’s a medical school in Juba we’d been supporting for three years. It’s improving,” he says.

Another aim has been to create simple, life-saving medical technology: homemade devices, made from readily available materials. Well-intentioned technology devised for mass use, he says, can sometimes backfire.

View of Constitution Marina

“There’s a revolutionary method coming that gives you blood tests – blood sugar, malaria, HIV – from a single drop of blood dropped on to a piece of paper the size of a small stamp. But to acquire blood in a single use destroys the business model, because the lancet is so expensive,” he says. “It’s sometimes easier to do more harm than good in the world with the best intentions. Here’s a kit you thought could give you all these blood test results, but just one reuse of the lancet could spread HIV and other diseases to thousands of people.”

He is now in a hurry to develop an inexpensive lancet that self-destructs after one use and is also biodegradable: “We are working with biomaterial scientists at Harvard and MIT.”

The USS Constitution, the American warship launched in 1797, is docked nearby in the marina. “Officially, I think the US government could commission my boat in time of war. But I’m not sure it would be of any help.” Burke’s boat was made in Giebelstadt, Germany in 1998. “There was a sign in front of it when I bought it saying that none of the wood was from a rainforest, so I can enjoy it guilt-free.” The boat has three compact bedrooms and a tiny kitchen with a gas-powered stove. Tucked into the bookcases around the main cabin are works by Turgenev, books on sailing and a paperback titled The Soul of A Doctor: Medical Students Face Life and Death.

Burke likes to invite students at every level into his projects. “Everything we do includes students and young doctors.” The contrast in medical infrastructure can be sobering. “Yesterday I had a Harvard undergraduate who also came to Uganda shadowing me in the emergency at Mass General. It was astounding for him to witness the extraordinary technology at the top-ranked US hospital and compare it to Uganda, where children die of the simplest things.”

Kitchen area with teak and walnut finish

As we leave, Burke closes the boat hatch and taps the deck. “The boat is lined with Kevlar. It’s the same material used in bulletproof vests,” he says, explaining that Kevlar takes the place of fibre glass, resulting in a stronger, lighter boat.

Soon, Burke will fly back to Libya and continue improving the medical infrastructure. “We’re in close conversation with rising leaders in the Libyan government to continue in our efforts; to create emergency departments and medical management programmes. Senior leaders in Libyan healthcare are coming to Harvard in November. If you listen to what society was like under Gaddafi, it was full of horror. The Libyan people have fought to come out of dictatorship.”

As we make our way back along the docks, I ask whether an upgraded emergency infrastructure in Benghazi might have saved the US ambassador’s life. “It’s impossible to speculate. But 11 people died. If there had been an ambulance service, there’s a greater chance we could have saved lives, but we don’t know.”

We reach the marina gate and Burke stops to elaborate on an earlier thought. “It’s very hard to do good in the world. It’s very complicated. You have to think about the layers behind the layers. And then go deeply into what it means to get to the patient in the community, the human being.”

Favourite thing

Uterine balloon with laminated instructions: “The number one reason women die from pregnancy is bleeding,” says Burke, who has invented a do-it-yourself gadget devised from available materials used in a new way. “We’ve put together a device from a catheter and a condom inflated with water to apply pressure and halt uterine bleeding. It’s already saved lives in sub-Saharan Africa. Sometimes the most exciting medical solutions are the simplest.”

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