REPORT
SIERRA LEONE CAMPAIGN November 2024
POLICE HOSPITAL.
TECHNICAL REPORT
Dates and logistics deployed
The team of volunteers was in charge of collecting all the consumables needed for the campaign including surgical gowns, sheets, sterile surgical drapes, sutures, different types and sizes of mesh, urinary catheters, sterile and non-sterile gloves and sterile and non-sterile gloves, sterile and non-sterile gloves as well as a large quantity of drugs (general anaesthetics, local anaesthetics, muscle relaxants, antibiotics, opioids, analgesics, etc.) and disposable anaesthetic material, including spinal anaesthetic needles, laryngeal masks, endotracheal tubes and other necessary material.
The Hospital Universitario 12 de Octubre in Madrid made a donation of a large amount of medication including anaesthetics, analgesics, antibiotics and vasoactive drugs through the anaesthesiologist of that hospital, Dr. Ana Hermira.
The Ramón y Cajal Hospital in Madrid made an important donation of drugs through Patricia Arenas.
Johannes Mühlbacher of Bartholomäus Apotheke in Vienna, Austria, made a donation of drugs through Dr Valéry Solari.
The airline tickets were obtained through Angelis, who works as a ‘Free Agent’ for the agency Halcón Viajes. The tickets were purchased with Maroc Airlines, which allowed the transport of 2 bags of 23 kg per person plus cabin baggage up to a total of 10 kg.
Our contact in Sierra Leone was Dr John Mumuneh Konteh, an endocrinologist, Deputy Director & Medical Superintendent of the Kingtom Police Hospital and he was the person with whom we maintained continuous email communication on all aspects of the preparation process. He was always readily available for any queries or additional information.
- Documentation. Dr Konteh provided us with the necessary forms to obtain a temporary licence to practice medicine in Sierra Leone, a simple procedure to follow.
- VISA. There is no difficulty in obtaining a VISA as the process is simple and easy and takes less than 5 days. The cost is about 80$.
The group of volunteers, based in various cities in Spain, as well as Vienna and Bucharest, met at Madrid airport from where they left on Thursday 21 November at 19:00 for Freetown with a stopover in Casablanca where we met Dr Alejandro Unda from Malaga. Dr Alina Costache went directly to Freetown from Bucharest and we met her at Freetown airport on Friday 22 November at 3:00 am.
The campaign ended on Saturday 30 November 2024 and the team arrived in Spain on Sunday 1 December at 12:00.
PATIENTS. A total of 170 procedures were performed on 141 patients during the seven-day campaign.
ADULTS PATIENTS: A total of 105 surgical procedures were performed in 86 patients, 77 men and 9 women. Patients ranged in age from 18 to 65 years (median 43; interquartile range 35-55). The following procedures were performed:
Lichtenstein: 74 procedures
Nyhus: 11 procedures
Hernioplasty: 1 procedure
Ligation hernial sac: 1 procedure
Excision lipomas / desmoid tumour: 12 procedures
Hydrocelectomy: 4 procedures
Onlay: 1 procedure
Evacuation + drainage of postoperative haematoma: 1 procedure
Most cases were performed under spinal anaesthesia (78 patients) and the rest under local anaesthesia. In all cases with sedation according to the patient’s needs. It is worth noting the high number of patients with large and long-standing hernias, which led to long surgical times..
PAEDIATRICS PATIENTS. Sixty-five procedures were performed in 55 patients, 8 girls and 47 boys. Patients ranged in age from 1 to 17 years (median 11; interquartile range 8-14). The following procedures were performed:
Herniotomy: 46 procedures
Herniorrhaphy: 10 procedures
Orchidopexy: 5 procedures
Excision lipomas / queloids: 4 procedures.
COMPLICATIONS: A postoperative haemorrhage occurred after removal of a lipoma on the thigh in an adult patient requiring surgical exploration and evacuation and a good outcome. We were subsequently informed that there were no complications following our departure from Freetown.
Two volunteers were pricked and the HIV rapid test was negative in both sources, so no preventive measures were necessary.
CAMPAIGN REPORT
THE PLACE.
The Republic of Sierra Leone is located in the Gulf of Guinea area between Liberia and Guinea Conakry. The country ranks 181 out of 191 in terms of the Welfare Index (HDI). The current population is about 8.7 million. Life expectancy at birth is 60 years, and only 43% of the population is literate. The official language is English, although the rural population speaks other languages such as Creole, Men or Krio and sometimes requires a translator to understand them. Since the end of the war in 2000, there has been steady economic progress, interrupted only by the Ebola epidemic of 2014, although there are no universally established social structures. The political situation in the country is stable with some tension induced by the rivalry between the two major political parties. The last democratic elections were held in June 2023. We were always accompanied by a security officer and driver, both from the Sierra Leone Police.
THE TEAM was composed of a total of 13 volunteers:
- General &Abdominal Surgery: Teresa Butrón Vila. Juan Pablo Alarcón Caballero. Beatriz Castro Andrés.
- Paediatric Surgery. Alejandro Unda Freire. Valéry Solari.
- Neurosurgery: Alina Costache.
- Paediatrics: Emilia María Tallo Martínez.
- Aneshesiology: Ana Hermira Anchuelo. Irene Merino Martín. Santiago García del Valle (team leader).
- Nursing: Patricia Arenas Suárez. Nuria Guardiola Morales. Mª Carmen Ibáñez Santamaría.
HOSPITAL. The Police hospital is a construction with two two-storey buildings separated by a small avenue that serves as access for patients and workers. Initially intended for the medical care of police personnel and their families, it has now been extended to the civilian population.
It has General Medicine, Obstetrics, Paediatrics and Preventive Medicine services, as well as a basic laboratory. It has the support of the Freetown University Hospital for tissue analysis and complementary examinations (radiology, ultrasound, etc). It has two operating theatres, but no basic monitors or anaesthesia machines, although it is worth celebrating that on the day of our departure a technician was setting up a new anaesthesia machine (Dräger Atlan™) in the largest operating theatre with Isoflurane and Sevoflurane vaporisers, a machine donated by the NGO Bisturí Solidario, which is already operational according to what I have been informed.
There is no laboratory service, although rapid tests for HIV and malaria are available. There are no permanent, permanent doctors in the hospital, although during the first few days we had the presence of a doctor in training in anaesthesia, Tamba James Jabba, who had to be absent due to a family problem. There is a very efficient nursing staff for pre- and post-operative tasks, as well as cleaning, orderlies and sterilisation, all under the coordination of Mr Unisa Sesay Incharge, who is in charge of solving and channelling all our requests. There are two operating theatres available, both equipped with air conditioning and separated by the sterilisation room. In the larger one we placed a second operating table (always of suboptimal quality) to perform adult surgery, while the other was intended for the paediatric population. We work with our own pulse oximeters and PANI equipment as there is no monitor. They have two oxygen concentrators and the only suction system is very weak, ineffective in case of having to aspirate blood or fluids in moderate or high quantity.
Although we carried quite a lot of specific surgical instruments, it was not necessary to use them except on a very ad hoc basis. It was organised by boxes on the first day and sterilised in a high-pressure steam cooker. It was complemented by the paediatric surgical material that Dr Solari and Dr Unda brought with them. We transferred two diathermy generators from Spain and the hospital itself had another two, but when we started to use them on the patients, two of them broke down and we were unable to work on more than two surgical tables for the first two days, which meant that we were unable to operate on all the patients initially scheduled. Surgical lights are scarce and of very low intensity and difficult or impossible to handle, making it necessary for Surgery to use photophores
We were provided with sterile tissue gowns and surgical drapes because, due to an error on our part, we moved an insufficient amount of these materials.
They have a very limited amount of drugs. They had a sufficient quantity of sera for the patients they treated.
ANAESTHESIA. The lack of an anaesthesia machine forces almost all procedures to be performed under spinal anaesthesia (many surgeries lasting more than 2 hours) combined with sedation or even general anaesthesia under spontaneous breathing. Fortunately, future missions will be able to count on at least one modern anaesthesia machine.
OUR DAILY LIFE
We arrived at Freetown International Airport on Friday at 2:30 am and there were no difficulties with customs formalities. Dr John Konteh was waiting for us with Abu Marrah of the Sierra Leone Police who would be our companion throughout the campaign activities. From the airport we transferred to the ferry, which took about 40 minutes and cost $45 per person (one way) to get to Freetown and we also paid for the two local people who accompanied us. We arrived at the port of Freetown and loaded all our luggage onto a police bus which took us to the Jam Lodge Hotel, centrally located and with good facilities, including security. The price was $85 with breakfast. In general, despite being a poor country, hospitality is not cheap, even by European standards.
After a few hours rest, we went to the Police Hospital (10 minutes drive) where we unpacked and organised the equipment and did the patient screening and pre-anaesthetic assessment in all patients scheduled.
Trabajamos durante 7 jornadas (de sábado a viernes inclusive).
As a general rule we started our surgical activity at 8:30 and finished around 22:00 with a short break for lunch in a room adjoining the operating theatre. Although it was possible to order prepared food from outside, we were satisfied with the good fruit that was brought in every day: grapes, tangerines, bananas, pears and avocados.
After the day’s work we had dinner at the hotel, a menu that we had previously ordered in the morning (rice, chicken, pasta, fish, etc.). After dinner, it is necessary to order breakfast the next day (fresh juices, omelette, fried eggs, toast and coffee). The rooms are comfortable, spacious, with mosquito nets on the windows, shower and air conditioning (remember to bring an English plug).
On Monday 25 November we were received by the Inspector General of Police, Mr William Fayia Sellu, who presented us with the individual Temporary Licence to practice medicine in Sierra Leone.
Saturday 30 November was spent visiting the local market in Freetown and the Tacugama chimpanzee reserve, some 20 kilometres from the capital. We then had lunch at a resort on a nearby beach.
Later that evening, before leaving for the airport, we were invited to a dinner with all the Police Hospital staff who worked with us.
The group left Freetown at 2:30 am and arrived in Madrid on Sunday 1 December at 12:30 without incident.
CONCLUSION
Site’s strengths: There is probably a large population that would benefit from CeA surgery as the population has large and very advanced hernias. The people were very warm to us and continually expressed their gratitude. The nursing team is very efficient although they are not able to assist with surgical tasks. Staff were very interested in learning the basics of anaesthesia
Improvement objetives: It is desirable to improve both the lamps and the operating tables, as they should be of adequate size and have the capacity to vary their height and change the position of the patients during surgery. Most of the adult patients operated on were male, which may simply be a biological problem or a certain gender bias in the selection of patients, an aspect that is difficult to verify. It would be interesting to carry out training processes for nurses in the operating theatre.
BUDGET
COST PER PEOPLE: Flight tickets between €1000 and €1100. Hotel and meals about €650. VISA 80€. Total amount around €1700-€1800 per volunteer.
Signed on behalf of the whole team of volunteers:
Santiago García del Valle
