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


Since 2001, the Italian NGO Emergency runs a Surgical and Paediatric Centre based in Goderich, in the surroundings of Freetown, the capital of Sierra Leone.

The hospital provides high quality free-of-charge treatments and it represents the only access to healthcare services for a large part of the population. The Centre is open 24/7 and offers surgical assistance to adults and paediatric patients in the fields of emergency surgery, trauma and orthopaedic surgery and elective surgery. The adjoining Paediatric Centre offers medical assistance to children.

In order to maintain high standards of surgical care, the hospital has been recently renovated and upgraded, by adding a new surgical unit made of three Operating Theatres (two of which are already operational), Sterilization, Intensive Care Unit and a guest house to provide free hospitality to relatives and attendants of in-patients coming from remote areas. The facility is also composed of Emergency room, Out-Patients Department, Laboratory and Blood Bank, X-ray Department, 6 Wards, Physiotherapy, Pharmacy, store rooms, kitchen, cafeteria, laundry, maintenance, 3 offices, generator room, meeting room, mechanical workshop, children's room. The hospital has a capacity of 100 beds. The Paediatric Centre is composed of two Out-Patients rooms, a changing room and a store room and shares medical facilities, domestic services and the guest house with the Emergency Surgical Centre.

The hospital employs around 310 members of local medical, administrative and technical staff coordinated and supervised by 13 expatriates. International staff is also in charge of the continuous training of the local doctors and nurses by assisting them during all the clinical activities, such as the operations and the morning shift in the wards. Also the technical and administrative staff is tutored in order to improve the management of the hospital.

Since the beginning of the activities the hospital performed 26,724 operations to adults and children. 25,386 patients have been admitted to the wards for surgical reasons and 244,020 have been visited in the OPD.

The project "Provision of free-of-charge surgery for adult patients in Sierra Leone" is intended to support the Surgical and Paediatric Centre in Goderich by covering part of the costs for providing surgical assistance to adult patients for a period of five months starting from August 2012. The activities carried out in favour of the beneficiaries of the project are: first aid and stabilization of patients in the Emergency Room, pre-surgical and follow-up consultations and application of plaster and dressings in the surgical OPD, x-ray and lab exams in the diagnostic department, surgery (a new fully-equipped Operating block, including an Intensive Care Unit, is operational since August 2012), hospitalization, physiotherapy services. Patients are attended by about 260 members of national staff appointed to the surgical facility, trained and coordinated by a team of experienced international staff.

During the first three months of implementation of the project, activities were carried out in line with the objectives. Patients coming to the hospital for surgical emergencies are stabilized in the Emergency Room and transferred to the Operating Theatres. Patients in list for elective surgery are previously visited in the OPD. After surgery they are admitted in one of the 5 surgical wards. Less severe cases are treated in the dressing room. X-rays and Lab exams are performed in the Diagnostic department. Operated patients come to the OPD for follow-up and they receive physiotherapy treatments in order to facilitate their rehabilitation.

From August to October 2012, the Surgical Centre in Goderich performed 749 surgical treatments to 570 patients. The total surgical procedures have been 866: 463 trauma orthopaedic procedures, 206 general emergency procedures, 197 general elective procedures.

In the same period 960 patients have been admitted in the hospital, of which 598 for surgical reasons, 237 children and 367 adults. Every day, on average, 98,6% of the 82 hospital beds in the surgical wards are occupied, which confirms the necessity of a qualified and free-of-charge hospital in the area.

The OPD performed 7,780 new consultations of which 2,130 for surgical reasons, 1,435 adults and 695 children. 2,139 follow-up visits have been provided to operated patients.

786 patients were submitted to 3,500 physiotherapy treatments to facilitate their rehabilitation.

The pro quota of the hospital activities related to adult surgical patients has been estimated for each accounted month of the project.

In August, 130 adult patients (39%) have been admitted out of a whole of 206 (61%) surgical admissions and 335 total admissions. 494 (18%) new consultations in OPD have been performed to adult patients out of a whole of 730 (27%) new visits for surgical reasons and 2.693 total new visits. Therefore the average ratio of adult patients in the hospital for this month is 29%.

This results prove to be quite constant both in value and in percentage in the accounted period: 28% in September (106 adult admissions, 37%, out of 169 surgical admissions, 59%, and 288 total admissions; 439 new consultations in OPD to adult patients, 19%, out of 666 new visits for surgical reasons, 28%, and 2.364 total new visits) and 29% in October (131 adult admissions, 39%, out of 223 surgical admissions, 66%, and 337 total admissions; 502 new consultations in OPD to adult patients, 18%, out of 734 new visits for surgical reasons, 27%, and 2.723 total new visits).

Unlike expected at the end of the first accounted period (01/08/2012 - 31/10/2012), the number of adult patients treated for surgical reasons in November and December 2012 registered a slight decrease due to a temporary shortage of staff. As a matter of fact, in November 2012 the Ministry of Health and Sanitation recalled most of the doctors that had previously been posted to Emergency's Surgical and Paediatric Centre to employ them in hospitals in remote provinces. This sudden lack of qualified medical staff forced Emergency to reduce the workload of the hospital in order to maintain the quality of the health services provided.

Admission criteria for surgical patients were restricted to only life threatening conditions, general surgical emergencies, and traumatology only for patients under 14 years of age. Two wards of the Surgical Centre were closed temporarily in November and December until new doctors were posted to this hospital by the Ministry of Health and Sanitation. Thanks to continuous negotiations with local authorities the role of Emergency Surgical and Paediatric Centre in the national healthcare system of Sierra Leone has been strongly reaffirmed and resulted in 7 new medical officers and house officers posted to the hospital thus enabling it to fully resume regular activity at the end of December.

Although the contraction of the activity, the hospital kept on providing high-standard services to a considerable number of patients, complying with the expected achievements of the project "Supporting a project for the provision of free-of-charge surgery for adult patients in Sierra Leone", which was to ensure and enhance access to free-of-charge, high quality surgical care to adult patients treated in Emergency's Surgical and Paediatric Centre.

The care provided to adult surgical patients has been estimated to represent 23% of total hospital activities in November and 24% in December, 4 to 5% less than the average data for the first accounted period (28%).

The average number of adult patients admitted to the hospital in November was 90 (31% of total admissions) and in December 78 (29%), thus registering a slight decrease if compared to the average data reported for the first accounted period, 122 (38%).

In November the OPD performed 380 (15%) new consultations for surgical reasons to adult patients out of 2,556 total new consultations; in December 458 (19%) out of 2,445; the average for the first accounted period was 478 (18%) out of 2.593 total consultations.

The average bed occupancy rate in the surgical wards in November and December has been 74.7%, almost 24% less than during the previous accounted period, as a result of the above mentioned shortage of doctors.

Overall, from August to December 2012 Emergency's staff performed 1,484 surgical procedures: 759 trauma orthopaedic procedures, 316 general emergency procedures, 387 general elective procedures, 22 non trauma orthopaedic procedures. The total number of hospitalized patients was 1,519, 883 of whom were admitted for surgical reasons, 348 children and 535 adults. The OPD carried out 12,781 new consultations, of which 3,368 for surgical reasons, 2,273 to adults and 1,095 to children. 3,366 follow-up consultations have been provided to patients who had already been treated in the Surgical Centre. 5,343 physiotherapy treatments were performed to 1,226 patients to foster their rehabilitation.

Since 2001 Emergency has treated 435,446 people in Sierra Leone (as of December 31, 2012).

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