Update: Sierra Leone 2009-2
The President of Guinea, a press conference, and a chest tube


The President of Guinea:


A muted "
pop!" then silence. We all flinched, hastily glanced around, laughed - nervously, and then
breathed an audible sigh of relief. Dr. Kabineh, the young Sierra Leonean ear, nose and throat
specialist had just opened a can of Coke. It had made a bit more noise than usual, nothing dramatic -
that is, nothing dramatic were it not for the presence of fifty or so heavily armed young soldiers in
camouflage fatigues, red berets and wrap around sunglasses frenetically scurrying about the main hall
of the Palace du Peuple. Is there a manual that these guys read about how to dress and act? Are they
required to watch a lot of late night TV? Why did they all look like hip-hop gangstas or B-movie
mercenaries? I sorta understand the majority carrying automatic weapons; but one especially
fashionable chap had a long belt of large caliber machine gun bullets draped around his neck like a
shawl. All this was occurring just minutes before the opening ceremonies of the 49th West African
College of Surgeons (WACS) annual conference. We were in Conakry, the capital of Guinea. Surreal is
really the only word to describe it.

So sure, last time I checked in I was in Freetown, Sierra Leone, however, this past week I was in
Guinea. Yup, the same Guinea where there was recently a military coup d'etat. The country that is now
run by a military junta led by Captain Moussa Dadis Camara - His Excellency, President of the Republic
of Guinea, Commander-in-Chief of the Armed Forces, President of the Conseil National de la
Démocratie et du Développement, CNDD. Yep, quite a mouthful and I'm still not sure how a Captain can
outrank a General, but I guess in third world politics this is how it goes. As a bit of background, Guinea
was the first former French colony in Africa to gain independence in 1958. On December 23, 2008,
Lansana Conté who had been President since 1984 died; that's when Captain Camera stepped in. The
people so far are supportive. So far.  

So, what was I doing in Guinea? Well, as the WACS conference was being held in Conakry; and it is
relatively close to Freetown; and almost all the Sierra Leonean surgeons were going - heck, I decided
to go too. We assembled on Saturday morning and by 10:30 a.m. had hit the road. Unfortunately, we
were unable to use the air-conditioned large bus promised to us by the Sierra Leonean President.
Instead 22 of us jammed into a smaller vehicle for the 300 mile journey. It only took us 11 hours. We
passed over-laden minivans and at times traveled over rutted unpaved roads. As this is the dry
season, we used surgical masks to breathe through the clouds of dust that enveloped us as we drove
with the windows open in the un-air conditioned 90+ degree heat.

Overall the trip was rather uneventful, and of course at the border crossing there was the obligatory -
fill out a form, then get an exit stamp in your passport, then go to customs, then get an entrance stamp,
then, oh, this country just had a coup and you're not getting paid and you want to eat and so you will
demand money - well, the senior surgeons in the group were adamant that they would not pay any
bribes. So discussions went back and forth. At one point the local army commander appeared in order
to "solve the problem." He and I were actually able to communicate in Spanish (I'm thinking the Cubans
had a hand in that) as my French is not so hot. Finally we were on the road again; we hadn't had to
pay, however, we agreed to transport two junior officers to Conakry, and then give them the equivalent
of $10 for return car fare. We hadn't paid. But we had.

We arrived in Conakry at night and were met by a vehicle from the Sierra Leonean Embassy and
guided to our hotel, Le Petite Bateau. It was a relatively lovely place, large swimming pool, out on a
jetty, a restaurant with tables overlooking the water. The rooms were not the greatest, but we got a
decent rate - and there was even air conditioning and running water: so, a veritable palace.

We arrived on Saturday, toured the Medina (the market section of town) on Sunday and on Monday
went to the opening of the conference. Things were rather disorganized. Sessions didn't begin on time,
and then there was the swarm of soldiers taking over the building, Ultimately His Excellency, Captain
Camara spoke. He looked rather eccentric, appearing on stage wearing sunglasses and the academic
gown and hat of the College over his military uniform. I listened to his speech with the simultaneous
translation, a rambling discourse, something about respecting science and medicine; something about
asking the people of Guinea to forgive the government's previous transgressions. There were
supposed to be more academic sessions in the afternoon, however, that never happened as the
building was literally taken over by the President, his cabinet, other party loyalists and of course the
young soldiers. Outside the building, the scene was completed by a few "technicals" (black pickup
trucks with a large caliber machine gun mounted on the back) to assure security.















So, what was my overall impression? The city was peaceful and relatively calm; the people seemed
content. The president seemed medicated and the soldiers seemed nervous and inexperienced.
Actually, I'm not too optimistic that there will be stability in Guinea in the long-run; but I'm hopeful that
we were there at the beginning of a new peaceful era, rather than (to mix metaphors) during the
honeymoon before the storm. Time will tell.

For the return trip to Freetown, three of us left a few days before the rest of the gang. We returned via
the same road, 11 hours, but this time we hired a car to the border and from there hired a taxi to take
us to Freetown. Of course we were asked for money at the multiple checkpoints and this time it was just
easier to pay. Not ideal, but it worked. We arrived safely back in Freetown - relieved to be back "home."

A press conference:

When Susan Braun, a profession portrait photographer and the wife of my college roommate, Eric
Braun, offered to come out to Sierra Leone for about 10 days to document some of the work Surgeons
OverSeas (SOS) is doing at Connaught Hospital I thought it would be a great opportunity. Early in her
stay, she met with the hospital Matron and Mr. Turay, the hospital administrator. They asked her what
specifically she was going to do with the photographs - I got to thinking (always a trouble inducing
event), yes, we were planning to use the photos for the website and to help with fundraising and for
presentations, and maybe even a traveling exhibition, but weren't these pictures really the property of
Connaught Hospital, and the Ministry of Health, and the people of Sierra Leone?










Photo by Susan Braun

So, my first thought was that we should have a final slideshow presentation for the Connaught Hospital
staff. After a bit more thinking and discussing we came up with a larger plan. Things at Connaught
Hospital have improved dramatically over the last year - that was good news and something that the
general public and the international community should be aware of. At the same time it is not really the
role of SOS to promote that. I asked Dr. TB Kamara and Mr. Turay how they felt about having a press
conference at the hospital during which we would show Susan's photographs. That led to some
discussions with the Ministry of Health. The final decision was for a press briefing with the Minister of
Health, Dr. Soccah A. Kabia on the developments at Connaught Hospital along with a slideshow
presentation and a formal delivery of the pictures to the Minister.

So, on Friday morning at 11 a.m., after the requisite delay and minor logistics issues, the press briefing
began. There were over a dozen journalists, plus a TV cameraman and photographers, the Minister
and other ministry senior staff, along with Connaught Hospital senior staff, Susan, me, and Dr. Richard
Gosselin. As an aside, Richard is an orthopaedic surgeon who has worked in Sierra Leone at the Italian
NGO hospital on 12 separate occasions and who I'm very happy to say agreed for this visit to take a
look at Connaught and help TB and the guys come up with a plan for improving orthopaedics (and do a
few operations). As there is no orthopaedic surgeon at Connaught and almost no orthopaedic
equipment, in the short-term we are trying to figure out how to improve basic ortho care and batting
around ideas to improve care for the country as a whole. We've got some interesting ideas.

As for the press briefing, the presentations went well, everyone really enjoyed the slideshow and then
the questions began. There were real questions. Why were there deficiencies? What was being done
about it? What about the water situation? Sterility? There were answers and a good exchange. A
decision was made to host similar press briefing on a quarterly basis so that accomplishments could be
highlighted and problems addressed. Overall everyone, the press and the ministry, seemed very
pleased. So, what had started out as a visit to take pictures to document SOS' work led to an even
bigger and very positive development for the local Ministry of Health and the press. I'm pretty pleased
and am eagerly waiting to see what gets printed on Monday.











Photo by Susan Braun


A chest tube:

On the clinical side, I've only done about a dozen operations; however, the other day one of the house
officers, Dr. Smalle, showed me a chest x-ray of a patient with a very large pneumothorax (air trapped
around the lung). Fortunately now there are chest tubes at Connaught (due to SOS efforts) and Dr.
Smalle was able to place the tube, under my observation. This may not see like too big a deal,
however, this is the third such case I've supervised, and remarkably this time last year the patient would
have been referred to another hospital about an hour away and might easily have died. Last February,
Peter and TB determined that this relatively simple procedure could only be performed in 36% of
hospitals in Sierra Leone due to either a lack of supplies or training. Through the supplies and training
provided by SOS and in partnership with the World Health Organization, we are looking to significantly
improve this statistic.










Photo by Susan Braun

I also got some feedback from Dr. Sesay, the only Sierra Leonean surgeon for the entire south and
east of the country. He participated in one of the emergency surgery training workshops we ran this
summer and told me that the training was definitely useful and that he and the other participants
frequently refer to the WHO manual "Surgical Care at the District Hospital." He is now eager to lead
workshops where he will train other health care workers. We are planning to have our first district
workshop next weekend in the town of Makeni. The plan will be to have a 2 day session when doctors
and nurses from three of the surrounding districts assemble to be taught by local surgeons.

As for what's next? Well, when I was in Conakry I met up with Dr. Lawrence Sherman one of only about
three Liberian surgeons currently working in Liberia and the person who conducted a surgical
assessment of all 16 government district hospitals using a standardized WHO survey. As there have
been some issues at the JFK Hospital in Monrovia; Lawrence and I had some interesting and
productive discussions. Bottom-line is that if I can coordinate the logistics, I'll fly to Monrovia for a few
days later this week to meet with him and the folks at the Ministry of Health. Also in Conakry I met up
with Dr. Sani Rashid, a general surgeon from Niger who is the Coordinator for Training in District
Surgery. I asked him about the possibility of assisting and he was very eager to have some help. When
I mentioned that Reinou was in Dakoro, he said it would be no problem for me to work at their district
hospital along with the local doctor and help to improve the level of emergency surgery. So looks like
some time in the coming months I'll be able to brush up on my French.

Best to everyone,

Adam
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