Emergency and Critical Care Capacity in Kono, Sierra Leone

Paul Sonenthal, MD

Fellow, Pulmonary and Critical Care Medicine at Brigham and Women’s Hospital

PGY-6

April 24, 2019

Located in West Africa, Sierra Leone has suffered some of the worst health outcomes in the world. After the Ebola outbreak in 2014-2016, the health system in Sierra Leone was crippled with substantial challenges in human resources for health, due to loss of staff to Ebola and disruption of education and training programs. Efforts to rebuild the health system are underway, with continued need for improved quality of care in health facilities, particularly in public hospitals.

Most acutely sick patients in Sierra Leone are managed at district hospitals. Currently, 22 hospitals function as secondary district facilities and referral centers, managing critically ill patients (i.e. severely sick patients, with life-threatening conditions such as shock and respiratory failure) sent from the primary level. The management of these patients is critically deficient due to lack of skills among the health care workers.

View from the entrance at Wellbody Clinic

In the 2016 Annual Health System Performance Report, the Sierra Leone Ministry of Health and Sanitation (MOHS) emphasized that lack of human resources is “a major contributor to the poor health outcomes seen in Sierra Leone,” and identified “ongoing in-service training and support for all cadres of [health care workers]” as a key priority.

Kono District, in eastern Sierra Leone, has a population of 506,000 and is served by Koidu Government Hospital (KGH)—a secondary hospital with 170 beds and the only referral center in the district. At the epicenter of a brutal civil war and then Ebola, Kono district suffers from a particularly striking lack of skilled health workers, a high burden of disease and health outcomes that are routinely worse than the rest of the country.

During my fellowship in Pulmonary and Critical Care Medicine, I have collaborated with Partners In Health (PIH), to support taking initial steps towards addressing the gaps in critical care capacity at PIH-supported sites. I am currently working with a team of critical care and emergency physicians at Brigham and Women’s hospital to develop a mixed-methods survey to assess critical care capacity as well as a series of training workshops for front-line health workers on topics in Emergency and Critical Care Medicine.

With the support of the Partners Center of Expertise in Global and Humanitarian Health, I traveled to Kono District on March 23^rd, with a plan to meet with local stakeholders and solicit input on the survey instrument we are developing, as well as to provide clinical training and support at KGH and a satellite facility, Wellbody Clinic.