Supporting a Project for the Provision of Free-Of-Charge Surgery for Adult Patients in Sierra Leone

Project location: Sierra Leone
Project start date: June 2012 - Project end date: December 2012
Project number: 2012-054
Beneficiary: Emergency ONG ONLUS


Sierra Leone is one of the poorest countries in the world: it is ranked 180th among 187 in the UNDP Human Development Report.
Eleven year since the end of the civil war, WHO's data confirm the poor conditions of the Country: life expectancy at birth is only 49 years; under-five (192 per 1.000 live births), infant (123 per 1.000 l.b.), neonatal (49 per 1.000 l.b.) and maternal (970 mothers per 100.000 l.b.) mortality rates are extremely high.
The health system fails to meet the needs of the population: the WHO report registers only 2 nurses and midwives, less then a physicians and just 4 hospital beds per 10.000 inhabitants.
In 2001 EMERGENCY opened a Surgical and Paediatric Centre in Sierra Leone. The hospital is based in Goderich, on the outskirts of Freetown, the country's capital. Since the beginning of the activities the hospital has treated 373,657 people (as of December 31, 2011). The Centre is still the only available healthcare facility for a large part of the population.
The Surgical Centre provides high-quality free-of-charge treatments in orthopaedics, trauma and emergency surgery. Surgical assistance fosters the physical rehabilitation of patients affected by traumas, fractures, malformations and other disabling injuries. These treatments are crucial to avoid a life of impairment in a country lacking in proper assistance. They also preserve adult patients' working capabilities, with positive effects for their families and for the society.
EMERGENCY also provides paediatric medical assistance and a feeding programme for malnourished children as well as hygiene and nutritional education for mothers.
Moreover the hospital offers a unique programme for the treatment of children suffering oesophageal burns caused by accidental ingestion of lye. It is a very common phenomenon among children in a country where lye is widely used for the home-making of soap.
EMERGENCY's cardiologists carry out periodical screening missions in Goderich. Patients that receive surgical indications are transferred to the Salam Centre for Cardiac Surgery opened by EMERGENCY in Sudan to be operated free of charge. The necessary post-operative follow-up is provided in Goderich.
In 2010 EMERGENCY began renovation works to enlarge and upgrade the facility in Goderich in order to meet the increasing needs of the population. Works are currently ongoing, without interfering with clinical activities.

EMERGENCY's Surgical Centre has been recognized as a training institution for anaesthesia nurses by the Ministry of Health of Sierra Leone.

In agreement with the Ministry of Health and Sanitation, EMERGENCY Surgical and Paediatric Centre began clinical activities in 2001 in order to respond to the growing needs of provision of healthcare.
EMERGENCY Surgical and Paediatric Centre has a capacity of 99 beds and it is composed of: Emergency Room, Out-Patients Department, Laboratory and Blood Bank, X-ray Department, two Operating Theatres, Sterilization, Intensive Care Unit, six Wards (one of which is dedicated to paediatrics), Physiotherapy, Pharmacy, Store rooms, Kitchen, Cafeteria, Laundry, Maintenance, three Offices, Generator room, Meeting room, Mechanical workshop, Children's room. The Paediatric Centre is contiguous to the hospital and it is composed of: two Out-Patients rooms, changing room, store room.
The hospital is supplied with high-standard state-of-the-art equipments.
The general objective of EMERGENCY's programme in Sierra Leone is contributing to the safeguard of the universal right to healthcare. The programme will help reducing mortality rates for surgical and paediatric causes, this last one complying with the 4th Millennium Development Goal.
The specific object of the project "Provision of free-of-charge surgery for adult patients in Sierra Leone"is to ensure and enhance access to free-of-charge, high quality surgical care to adult patients treated in EMERGENCY Surgical and Paediatric Centre.

- Triage: in the Emergency Room patients in need for surgery are evaluated, stabilized and transferred to the Operating Theatres. Less severe cases are medicated or treated in the dressing room.
- Out-patient Departments: patients in list for elective surgery are previously visited to monitor their conditions. Follow-up visits are held for operated patients, who received post-operative treatments and dressings.
- Provision of surgical treatments in the field of emergency surgery, especially abdominal, trauma and orthopaedic surgery and elective surgery.
- Hospital admission: patients are admitted in the 5 surgical wards after the operation. Patients in list for elective surgery may be admitted before the operation to monitor their conditions. Each morning a team composed of an international surgeon and national nurses and doctors visits the patients to assess their conditions. This is also an important opportunity for the training of local staff.
- Diagnostics: X-rays and Lab exams are available for further evaluation of in and out-patients
- Physiotherapy: Patients who underwent surgery receive physiotherapy treatments to facilitate their rehabilitation.
- Training on-the-job: local staff is constantly assisted by experienced international colleagues. EMERGENCY trains both medical personnel and administrative and technical staff.
All activities carried out in EMERGENCY Surgical and Paediatric Centre in Goderich, Sierra Leone, are provided completely free-of-charge and available 24/7.

Final beneficiaries of the project, which received a grant from the Nando Peretti Foundation, will be adult patients receiving high-standard free-of-charge surgical assistance to recover from trauma injuries, wounds and other diseases of surgical interest.
In 2011 the Surgical Centre registered 29,655 Out-patients and 2,524 In-patients admissions. The Operation Theatres performed 2,988 surgical operations.
Furthermore the local staff will receive professional training to improve their skills and proficiency. The training of medical staff helps to foster the development of the national health system by reinforcing the health workforce.
In addition, the training of administrative and technical staff will strengthen the management of the hospital in order to facilitate the future handover of the facility to the local Health Authorities.
EMERGENCY Surgical and Paediatric Centre employs 300 national staff members, including medical, technical and administrative staff, coordinated and supervised by 13 expatriates: 1 programme coordinator, 1 general surgeon, 1 orthopaedic surgeon, 1 junior surgeon, 2 anaesthetists, 5 nurses, 1 paediatrician and 1 logistician.

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