Team from L – R.Niko Prins (PA Anaesthesia QEH) Rajive Jose (Plastics Consult QEH/ROH) Eva O’Grady (Plastics reg Cambridge rotation) Alex Pownall (ODP QEH) Chris Baldwin (Plastics Consult Sheffield Hand unit) Mike Waldram (Ortho Consult ROH/QEH TEAM LEAD) Shiv Chavan (Consult Anaesth QEH) Joel O’Sullivan(Upper Limb Physio QEH
“Sierra Leone in West Africa has a population of 7 million and gained independence from the UK in 1961. The Holy Spirit Hospital (HSH) was established in Makeni after civil war devastated the country between 1990 and 2002. The hospital was founded by the Catholic Bishop of the Makeni Diocese in response to the complete absence of medical care in the region, which is 3 hours drive from the capital Freetown and has a local population of 600,000. Today a 70 bed independent hospital is a well-recognised facility with two operating theatres, X ray, lab and pharmacy. There are on average 50 outpatients daily and 300 inpatient treatments per month. There is a resident general surgeon and maternity services but no other surgeons.
Dr Patrick Turay is the medical director at HSH and ReSurge Africa director. He welcomed us when we arrived. Surgical teams attend the hospital every 2-3 months from Europe and the UK. The BSSH, in conjunction with ReSurge, send teams two to three times per year in support of a long term goal to establish a Reconstructive plastic surgery and burns service in Sierra Leone, through the training of Surgeons, Anaesthetists, Nurses, Physiotherapists and other clinicians.
Ebola hit hard in 2014 with the suspension of all mission teams to HSH. 10,000 cases with 3200 deaths ravaged this very poor country with little infrastructure. There were 1200 cases in Makeni and the hospital had a receiving area, which still exists. Oxfam treatment points and patient education signs are still everywhere. We were the second BSSH team to visit HSH since Ebola and started preparations 6 months before departure, with immunisation, collection of hospital disposables and drugs and anaesthetic equipment, planning and education. We took out eight airline holdall bags of hospital equipment.
On our first day clinic we saw 48 patients, it was hot work. It worked best having a combined Ortho-plastic opinion, and we soon recognised the neglected and untreated conditions and sometimes the bizarre. We identified those for surgery following an agreed remit.
D iagnosis known
O peration known
C omorbidity low
1 one operation
In our week we saw 79 outpatients, 61% were male and the average age 34.1 yrs. There were no elderly, and ASA anaesthetic status was normally one. We treated a number of patients non-operatively, injecting keloid scarring, supplying splints and shoe raises.
The Theatre staff were competent, adaptable and cheerful and had worked with many teams
We completed 20 operative cases, under general, spinal and local/regional anaesthesia. We grafted a number of tropical ulcers that we pre-treated with acetic acid from diluted vinegar which we bought from the local supermarket to reduce the Pseudomonas infection. We started a rigorous swab count board and emphasized a complete WHO check culture.
There was no shortage of good surgical instruments although many were irrelevant, or packages out of date. There was a good range of sutures many of which we bought, but a shortage of bandages and jelonet. The postoperative nursing ward care was exceptionally high and the ward areas spacious and light. After our departure we have conducted online ward rounds of our cases via Whats App.
Michael (aged 3) had a burn contracture release and full thickness skin graft from groin by Chris Baldwin to a burn contracture in his first web space. Memunatu (aged 15) had untreated clubfoot and had never been to school. We debrided her foot ulcers in preparation for a German surgical team to do corrective osteotomies later this year
During our stay we taught on Plaster slab application, wound healing, advanced life support and burn injuries We donated Orthopaedic books to their library from the family of Mr Mohammed Arafa a West Midlands Hand surgeon, and BSSH member, who had sadly died.
We were well looked after in our guesthouse with three cooked meals a day, which we found we needed in the hot and humid climate. We slept under Mosquito nets and cold rainwater showers were very welcome. The local Star beer went down well at the end of the days work. Our time soon came to an end and we had seen and learnt so much.
It made us appreciate our own health service resources, but also the simplicity and effectiveness of uncomplicated hospital care, free of too much bureaucracy and political correctness. The staff we had the privilege of working alongside couldn’t have been more helpful, cheerful, and friendly.”