Sierra Leone Update
Lungi airport sits across the wide mouth of the Sierra Leone River about 15 kilometers from Freetown – the
capital of Sierra Leone. To reach the city options include a helicopter ride, hydrofoil or ferry. We went by
helicopter. The ride was about twenty minutes.
For those of you who do not know, I am currently working at the EMERGENCY Surgical Centre in Goderich, a
village located just outside of Freetown. The plan is to stay three months. I arrived on August 30th and am
planning to leave on November 28th.
As a bit of background, Sierra Leone is a small West African nation situated on the Atlantic coast and bordered
by Guinea and Liberia. Area-wise it is similar to the state of Maine with a population of 4.5 million with almost half
that number living in the capital. As a former British colony the official language is English; although most of the
locals in the Freetown area, a city founded by freed slaves, speak Krio (Creole) which has some similarities to
English. My favorite Krio phrase is the greeting, “Aws di bohdi?” the meaning of which is “How are you?” The
standard answer is “Di bohdi fine.”
As for EMERGENCY, it is an Italian NGO with a mission to provide surgical assistance to civilian war victims. Other
surgical hospitals run by EMERGENCY are located in Afghanistan, Iraq, Sudan, and Cambodia. The hospital here
in Sierra Leone opened in 2001 and initially catered to the victims of the decade long civil war that devastated the
country’s infrastructure and impoverished its people. With peace stabilizing the situation in 2002 the hospital’s
mission has shifted to providing the local population with emergency surgical and orthopaedic care. All medical
care at the hospital is provided free of charge which is imperative given the widespread poverty of the country.
According to UN rankings, Sierra Leone is consistently among the world’s poorest nations; remarkably, even
worse off than Malawi.
The hospital is incredibly busy. In the three weeks since arriving, I’ve operated on over 80 patients. The cases
have mostly been incarcerated inguinal hernias (some requiring bowel resections), laparotomies for perforated
duodenal ulcers, and appendectomies. The relatively elective cases have included colostomy closures, a
thyroidectomy for a huge goiter and routine hernia repairs. A Brit orthopod who was here for three months left the
week after I arrived, but will return in mid-October. In the meantime a local doctor is covering most of the
orthopaedic cases. I cover him when needed.
The hospital has nearly one hundred beds and usually has a census slightly over that. Many of the patients
suffer from broken limbs and require long hospital stays and traction. There is a nine bed ICU and 6 fifteen-bed
general wards: two male, one female, one children’s surgical, one children’s medical and a spinal ward. Local
staff numbers approximately 240. Nurses are only hired from the private sector, although there are 20 Ministry of
Health nurses working and being trained to take over positions in the government hospitals. One current problem
in Freetown is that the two government hospitals are both closed for renovations. This has reportedly being
going on for over one year. There was also a nationwide nursing strike for the past three weeks and so smaller
facilities and outside hospitals were basically closed as well. The strike has now ended; we will see how this
impacts our work load.
I have been told that numerous small private clinics exist in Freetown and that much of the surgical needs of the
local population is undertaken at these facilities. I am not too sure about the quantity or the quality; although we
have had a number of patients present with post-operative complications from outside facilities and need
emergent operations.
I am the only international general surgeon and scrub on every surgical case. As for other doctors, there is Dr.
Piero, an Italian anesthesiologist, and three local doctors who operate: Dr. Lavale, who does mostly orthopaedics,
Dr. Mattia, a young doctor who has worked in one of the district hospitals, and Dr. Kamara, an older guy who had
some surgical training in Italy. Either one of these local docs or one of the international nurses covers casualty
(the ER) at night. On most nights I have been called in to operate. The other international staff includes 3
nurses and a physical therapist, all from Italy, and the Medical Coordinator who is from Finland.
As for life outside of the hospital, well, at this point I haven’t really had one. I spent a few hours twice on Sunday
afternoons at Lakka beach about 10 minutes further south from the hospital, and we once ventured into town for
a single meal during the ten-day period that our cook took her vacation. So I really have been living between the
guesthouse and the hospital. It’s all fairly comfortable. For this mission we are provided with housing,
transportation and meals. I have my own room, mosquito net, and bathroom and there is even hot water.
Electricity is a problem but there is a generator on every evening from 7 pm to 1 am, so the lights, fans and
satellite TV work. (I was able to see the reports of the devastation from Katrina on CNN and BBC)
Well, that’s all for now. I hope to get more updates out in the coming weeks.
And if anyone was wondering…yes, when you work for an Italian NGO you get pasta at least once a day.