Sierra Leone, December 2022

  •   Sierra Leone 2022
  •  Sierra Leone 2022
  • Sierra Leone 2022
  • Sierra Leone 2022
  • Sierra Leone 2022
  •   Sierra Leone 2022
  • Sierra Leone 2022
  •  Sierra Leone 2022
  • Sierra Leone 2022
  •  Sierra Leone 2022
  •  Sierra Leone 2022
 MISSION SUMMARY:

Date: December 1st - December 11th, 2022
Location:  Kabala General Hospital, Kabala, Sierra Leone
Team Size: 18
Length of Mission: 11 days
Team Leader: Ziad Sifri 

 BACKGROUND OF MISSION

This was ISHI’s seventh mission to Kabala Government Hospital in Kabala, Sierra Leone. The hospital has seen many more changes since our most recent visit in December 2019, prior to the shutdown of travel and humanitarian trips brought on by the COVID pandemic.  The ISHI team was invited back to KGH with approval from the Republic’s Ministry of Health, local municipal, and hospital leadership.

OBJECTIVES OF MISSION

We anticipated providing both clinical care and the exchange of both technical as well as clinical information. We planned for adult surgical cases including repair of umbilical, inguinal, and femoral hernias, mass excisions, and hydrocelectomies. Furthermore, we planned to train local health care staff and members of community with bleeding control exercises with the Stop the Bleed course. Additionally, we planned to donate the remainder of our surgical supplies to help support care provided by local staff. 

Patients were alerted weeks before the mission via recruitment from the local healthcare team. They were then phone-screened by the local healthcare workers to ensure efficient triage. We planned to 1) collaborate with the local clinical team to provide surgical and medical care 2) teach capacity building of local providers daily, including providing continuing surgical education to the non-physician surgeons and nursing teaching, and Stop the Bleed Training and 3) continue to support local humanitarian and charitable initiatives such as the local amputee clinic and the Kabala Blind School.

The objectives of the mission were:

Patient Care planned:

  • To perform about 50 major surgical operations in 5 operative days.
  • To deliver medication, supplies and equipment as donations to Kabala General Hospital, particularly surgical instruments needed by local staff in addition to mesh for inguinal hernia repairs.
  • To provide follow-up care to the patients who underwent surgery. 

Teaching planned:

  • Teach local staff at bedside, the wards and in the OR.
  • 2-3 hours of informal teaching per day.
  • To teach the American College of Surgeons Bleeding Control course. 
  • To teach courses hosted by nurses at the Kabala Nursing School. 

Other Projects planned:

  • Support of an orphanage in Freetown by Anne-Marie
  • Support of the Kabala Blind School
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    SUPPLIES AND EQUIPMENTS

    ISHI used medications and supplies already in inventory/storage, as well as purchased on site at Kabala General Hospital.  Further perishable and non-perishable supplies such as suture and medication were obtained by donation from MAP/Ethicon, the Afya Foundation, Brother’s Brother Foundation, and Americares. We utilized ISHI surgical instruments. In addition, many of the supplies used were re-processed and sterilized from the RECOVER Program out of Rutgers – New Jersey Medical School. Packing efforts were supported by medical student and hospital volunteers in Newark, NJ,

    TRAVELS

    The ISHI surgical team flew from New York City to Lungi, Sierra Leone on Thursday, December 1, 2022, arriving on the evening of Friday, December 2. That evening, we received initial briefing of triage day and engaged in ice-breaking activities. The following morning, the team traveled from Lungi to Kabala, breaking at Makeni to acquire commodities and additional medical supplied. We arrived at Kabala General Hospital with ISHI medical and surgical supplies and were greeted by local staff, after which we settled into our residence for the week, Weinday’s Guest House, constructed by Mr. Peter Conteh.

    On Sunday, the team initiated patient triage, scheduled surgeries, and set up the OR suite and patient wards. We were greeted by a host of local administrators, nurses and nursing students, health officers, and environmental support, with whom we held a brief conference to discuss mission goals and logistics. Operative days began on Monday and concluded on Friday. During the evenings, the team enjoyed various cultural activities such as a visit to several paramount chiefs/local tribal leaders and a group hike up Kabala Mountain (not for the faint of heart). We also enjoyed many a game of football with the locls. On Saturday, we traveled to the sprawling village of Bafodia, surprised by many patients who received surgical care on prior ISHI trips. That night, we held a thank-you appreciation party for the Kabala General Hospital local staff. On Sunday morning, most of the team departed back home after a visit to the Blind School, while a small team remained to perform patient follow up and further education. During the course of our trip, we were interviewed by the Ministry of Health and filmed by local news organizations. 

     PATIENTS AND LOCATION

    Patients were alerted, screened, and evaluated weeks before the mission via recruitment from the local healthcare team. We planned to 1) collaborate with the local team to provide surgical and medical care 2) teach capacity building of local providers daily, including providing continuing surgical education to the non-physician surgeons and nursing, and Stop the Bleed Training, and 3) continue to support local humanitarian and charitable initiatives such as the Kabala School of the Blind. 

     MISSION ACHIEVEMENTS:

    Volunteers: 

    • from the United States as well as from Canada, all volunteers had a safe and enjoyable experience.
      Patient Care: 
    • Performed 62 procedures on 60 patients
    • Triaged/performed general surgical consultations 130 patients in addition to point-of-care ultrasound evaluation of pathology 
    • Performed short term follow up and treatment/consultation for post-operative issues – 97% follow-up rate
    • Delivered and donated medication & supplies to Kabala General Hospital

    Teaching:

    • 20-30 hours of hands-on teaching, demonstrations, case-discussions between ISHI and local RNs
    • Participation of local anesthesia and surgical staff in numerous operative cases for continuing surgical education and bidirectional knowledge exchange
    • Stop The Bleed Training and one-year follow-up to medical and non-medical personnel 
    • Daily teaching of junior local nurses in the OR
    • Continued knowledge exchange and collaboration with the local CRNA
    • Continual knowledge exchange between ISHI and local ward nurses

    Community

    • Donation of funds to the School for the Blind for repair and supplies for the children
    • Fundraising by Debbie Livingston for soapmaking vocational training for the Blind School students

     Cultural Activities:

    • Cultural projects – Bafodia 
    • Paramount chief house visits + welcome
    • Kabala Mountain
    • Drumming circle
     LOCAL TEAM IN SIERRA LEONE:
    Peter Conteh – Hosted the team at the guesthouse in Kabala and provided everything necessary for the ISHI team to thrive. Peter, who had previously introduced the group to the culture of the Koinadugu district by guiding us through Kabala, remains a vital link to  providing us with context by demonstrating the need for our care in the region with heart-breaking stories resulting from lack of access to safe, affordable surgical care.
    Dr. Stephen Fornie – Medical superintendent, KGH, responsible for providing the space, stuff, staff and patients needed to complete the mission.
    Dr. Tarawalie – District hospital house officer, KGH, responsible for supporting the clinical care provided at the hospital 
    Samba Jalloh – Freetown medical house officer, GSHead CEO. Instrumental in communication and logistics ahead of, during, and after the mission, and participated in patient care, operative cases, and post-operative follow-up. 
    Hassan Kanu, CHO – surgical health officer 
    Lamin Marah CHO – Local anesthetist, working intimately with the ISHI team in the preoperative phase and in the OR with the anesthesia team, as well as in follow-up of patients post-operatively.
    Bona Turay, CHO – Intensivist 

    ISHI VOLUNTEERS AND RESPONSIBILITIES:

    Surgical Team:  David H. Livingston MD, Ziad C. Sifri MD, Deviney A. Rattigan, MD, Peter F. Johnston, MD, Fatima S. Elgammal, MD, Yaagnik Kosuri, MD
    Anesthesia Team: Amber Zendner, MD, Philip Knowles, CRNA
    Post-Anesthesia Recovery/Ward: Stephanie Burroughs, RN, Kimberly Gray, RN, Kristin Knowles, RN, Nadia Sohan, RN 
    OR Nurse/Tech: Tracey Bradley, RN
    Artist in Humanitarian Cultural Initiatives:
    Debbie Livingston 
    Mission Coordinator & Logistics Support: Ziad Sifri, Jessica Schwartz, William Zendner, Fatima Elgammal 

      SPECIAL THANKS:
     

    Thank you to all 2022 volunteers for all the hard work and making it a successful and memorable mission and a heartfelt thank you to all of our donors that make our missions possible! Thank you to Saving Lives Initiative for advice and guidance. Finally, a special thank you to the ministry of health (and Mariam Sow) for all of the assistance.

    Thank you to all the workers of KGH who participated in every phase of patient care and without whom the mission would not be possible!

    Logistical Support:

  • Americares, the Afya Foundation, Brother’s Brother Foundation, and MAP International for donating surgical supplies and materials.
  • Rutgers - NJMS RECOVER Initiative – medical student volunteers organized the collection and re-processing/sterilization of clean/unused medical supplies that would otherwise be discarded from the operating room and other patient care areas. The salvage of such supplies represents an enormous environmental benefit.
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    Surgical care:

    We are happy to report that the ISHI team completed 62 safe operations on 60 patients. The mission included patients 15 to 60 years of age, from various towns throughout the region. With our strong operative team, we performed simple to recurrent inguinal and femoral hernia repairs, hydrocelectomies, and mass excisions. Kimberly Gray RN and Tracey Bradley, RN remained at KGH after the mission to follow up and reported no major issues and high levels of satisfaction amongst the patients. 


    Knowledge and skills exchange:

    Education continued to be a major focus of the 2022 Sierra Leone mission. Our nursing team provided contextually appropriate formal and informal lectures on complex wound care and hand hygiene to the local nurses to expand their knowledge base and strengthen relationships with the local staff. Bedside knowledge exchange occurred throughout the day in the wards.


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