Update: Sierra Leone 2009-1
Connaught Hospital, Freetown, Sierra Leone 51%, the President of Sierra Leone and MIT.
I hope that 2009 is off to a good start for all of you; for me, once again I'm back at Connaught Hospital
in Freetown, the capital of Sierra Leone. Back in the same duty house, the one without running water -
but its fine, in fact, I'm just now after almost 3 weeks getting over my initial shock. The shock wasn't just
the fact that Sierra Leone was recently ranked last (177th) on the United Nations Development Index,
or the fact that 26% of children born here die before their 5th birthday, but the fact that through the
Society of International Humanitarian Surgeons and our program, Surgeons OverSeas (SOS), we have
actually had a significant impact.
A year ago, Peter Kingham along with Dr. TB Kamara, the Chief of Surgery, and now also the Director
of Connaught Hospital, did an assessment of surgery at hospitals throughout Sierra Leone. We then
sat down with the local surgeons and the Ministry of Health and developed a strategy to tackle the
most pressing problems as they related to surgical care. Subsequently, we conducted training
workshops, began supplementing the salary of surgical support staff, provided goggles, boots and
aprons to limit possible HIV exposure, and brought in a 40' container of supplies and equipment.
We had hoped that our contributions would have some sort of benefit - but we never dreamed at the
actual results. We tallied the operative caseload at Connaught, and what we found was a 51%
increase in the number of operations performed in 2008 versus 2007. In discussing this with TB, he
fully credits SIHS. He stated that our interventions directly led to an increase in staff morale, decreased
absenteeism and the ability to undertake emergency operations. The total caseload went from 460 to
697 - because of SIHS, and of course with the help and support of many of you.
But before we take all the credit, I really have to credit TB, the other local surgeons and the staff. They
were the ones who did the majority of the work, we just provided some support (mainly moral and some
financial). It was encouraging to hear that another emergency surgery workshop was completely
organized and undertaken by the local surgeons last fall. We are now planning to continue the
workshops at many of the fourteen district hospitals throughout the country in an effort to help train
the local nurses and support staff. These workshops will almost totally be conducted by the local
surgeons and physicians.
So, that's all great news from a short-term prospective, but what about the long-term, what about
sustainability? Well, for that we are assisting with the initiation of post-graduate medical training - a
surgical residency program. TB and the other surgeons hit a slight snag when the funding for the
accreditation for this program was caught up in government bureaucracy. It is for this reason, that I
and a number of other surgeons, all Fellows of the West African College of Surgeons, visited the State
House and had an audience with the Honorable Ernest Bai Koroma, President of the Republic of
Sierra Leone. I must admit, I was a bit nervous having never spoken to a President. We spent almost
half an hour discussing post-graduate training, support for the health system and I even had the
opportunity to explain briefly about our successes and the great work being done at Connaught by TB.
So, all in all, things are progressing. I've met numerous times with Dr. Soccah Kabia, the Minister of
Health and he is pleased and excited. He has put effort into upgrading the intensive care unit at
Connaught, and I'm excited to say that Dr. Michael Sinclair will be arriving in March to spend six weeks
in Connaught; hopefully teaching the new residents and assisting to upgrade the standards of the ICU.
Also, Dr. Richard Gosselin, an orthopaedic surgeon who has been on 13 missions to Sierra Leone, will
be arriving on February 8th to assist with orthopaedic cases and make recommendations for improving
orthopaedic care at Connaught. In fact, the operating room staff was so excited to hear about Dr.
Richard's arrival that they are readying an additional operating room to be designated strictly for
orthopaedic surgery.
Really, the hospital is abuzz. A major concern for us is the continued lack of running water. We've had
multiple meetings with the Ministry of Health, and I even mentioned it to the President's chief of staff.
The most promising development is a meeting that TB and I had with the chief British military engineer
at IMATT (International Military Assistance and Training Team) - the international military unit stationed
in Freetown that was initially for security, and now mainly a training organization. I'll keep you posted
on developments.
The last bit of news was that for the past 3 weeks a team of four MIT Sloan School of Management
MBA students stayed in the duty house (yes, the one without running water) to undertake research
into developing a sustainable business plan for improving surgical care locally. A local newspaper
wrote about their visit and it is on-line here. I don't want to give away too many details at the moment,
but I will say that they were wildly successful and have even been approached by a Venture Capitalist.
As things with that project develop, I'll certainly pass the news on.
So, that's it for now. Sorry no pictures this time, but on February 1, Susan Braun, a professional
photographer is arriving and will be documenting our work and profiling many of the staff, so I'll try to
include some of her photos in the next update.
Best to all,
Adam
PS: For those of you who are curious, Reinou is not here this time, she's heading off to Niger to work
at an emergency obstetrics program for Doctors Without Border, but we're planning to meet up in June
or July in Mali and take a camel caravan to Timbuktu.
www.adamkushnermd.com
www.humanitariansurgery.org