As the snow and cold weather began to take a grip on the UK, the NIHR GHRG-ST team busily planned our initial priority setting visit to Sierra Leone. Assembling a team of clinicians, health economists, trialists and global health scientists, we set off for West African country with a packed schedule in mind, determined to make the most of our visit. When we arrived, the contrast from the Yorkshire winter was stark, with average temperatures of 28 degrees Celsius we landed in Lungi International Airport and took the ‘Sea Coach’ across the Tagrin Bay to the capitol, Free Town. Here we began our visit with meetings in the main government healthcare facility Connaught Hospital and the College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, the only medical school in the country. Connaught Hospital is a large establishment with over 120 beds and is the capitols main referral centre. Despite this the hospital suffers significant constraints, from funding to post graduate training, and frequently can only offer limited services as it struggles in an attempt to meet the huge health burden of the city and country.
In the following days, we visited a range of healthcare facilities in Freetown including a well-functioning NGO hospital, Emergency Hospital. Here we say what may be possible given sufficient resources and innovative financing strategies. We also visited the Ministry of Health and Sanitation and our evenings were often filled with meetings with officials from the government and other organisations including the World Bank, covering topics such as policy planning and strategy, healthcare economics expertise building, healthcare financing and service provision.
After a few days in Freetown, the team packed up and moved in-land to the northern district of Tonkolili. Here we had visits with local district planning officers and discussed where the groups work could contribute best at a district level. We were hosted by an NGO hospital called Masanga Hospital. It is a severely constrained hospital, yet functions quite well despite this, and provides subsidised healthcare for local populations and also hosts the Surgical Training Programme (STP) from the NGO CapaCare. Here we saw how the trainees are trained, and what a huge difference this makes to the provision of surgical care at the hospital.
Following a couple of days in Masanga, observing and contributing to the STP and observing the delivery of surgical care at a general district hospital, we returned to Freetown for final meetings with coordinators and leaders from the National Surgical Forum of Sierra Leone. The National Surgical Forum are a collective of stakeholders from surgeons, healthcare workers, policy makers, patients and industry who all have an interest in improving surgical care for the Nation. Their primary role is to establish and implement a National Surgical Plan, which sets out the national strategy to achieving universal access to timely, safe and affordable surgical care. The NIHR GHRG-ST aims to be involved and contribute where needed.
Sierra Leone is a fascinating country and the people are warm and welcoming. The people trying to deliver surgical care in such challenging environments were so inspirational. The main areas the group felt our research can contribute include enhancing surgical postgraduate training, reducing infection after surgery and improving the management options for patients with lower-limb fractures and chronic wounds. We are now looking forward to working with our in-country partners to implement our initial projects aimed to improve surgical care and outcomes for the patients of Sierra Leone.
Inpatient ward at Connaught Hospital Freetworn
Operating theatres at Connaught Hospital
Sunset at Masanga Hospital
Surgical Training Programme at Masanga Hospital. Bowel anastomosis skills course
Main thoroughfare in Connaught Hospital
This research was commissioned by the National Institute for Health Research using Official Development Assistance (ODA) funding.
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.