TECHNICAL REPORT

SURGICAL CAMPAIGN FROM SEPTEMBER 18 TO 28, 2025, AT THE SIERRA LEONE KINGTOM POLICE HOSPITAL (FREETOWN, CAPITAL OF SIERRA LEONE).
DATES AND LOGISTICS

Freetown, the capital of Sierra Leone, is a destination where the Cirujanos en Acción Foundation has established ties since 2019, when the first surgical campaign was carried out in this city in West Africa.

The health center where the campaign was carried out was the Kingtom Police Hospital in Freetown, a facility belonging to the police, an institution with great influence and power throughout the country. In the past, this hospital only treated members of the police force and their families, but in recent years it has extended its medical services to the entire population of the area.

Dr. John Konteh (Deputy Director C Medical Superintendent) is in charge of Kingtom Police Hospital. He is an endocrinologist with extensive experience and training in London (England), which gives him a broad view of the global health situation and that of his country.

He has been the person with whom we have managed all the preliminary preparations, accommodation, transport logistics, and patients, whom he has been able to bring together through a prior appeal, gathering more than 300 people, taking into account the duration of the campaign.

Unlike other countries, obtaining a visa is very simple. Through the official government website www.evisa.sl, you can apply online and make the payment electronically ($80). In our case, none of the members of the expedition had any problems applying for it. Once the application is completed and the payment is made, the visa with its confirmation is received via email within 2-3 days.

The trip was organized by Halcon Viajes through Angelis, who frequently collaborates with Cirujanos en Acción on trips.
The entire team traveled from Madrid to Casablanca to Freetown.

Freetown International Airport (the largest in the country) is separated from the city by the sea, so the best way to get there is by bus, which drops you off at a small port where you can take a ferry to the city, which costs $45 per person.

At noon on the day of arrival, the five surgeons and the urologist in the group begin consultations, while the nursing and anesthesia teams organize the equipment to begin the operations the following day. There are seven full days of surgery, lasting approximately 12 hours (8 a.m. to 8-9 p.m.).

The return trip takes place on Sunday the 18th at 6:50 a.m., with the journey beginning at 2:00 a.m. to reach the airport by ferry.

Considering that there were 11 volunteers traveling, each with two 23 kg bags, we transported a total of more than 500 kg of materials and instruments to carry out the campaign.

As for accommodation, as in previous campaigns in Freetown, we stayed for the 7 days of the campaign at The Jam Lodge, a hotel with large single rooms, decent bathrooms, and air conditioning that allowed for a good night’s sleep. It was cheaper for each of us to make our own reservations on Booking.com than the rate offered by the hotel ($65).
With our flight schedules, we arrived at the hotel at 7:00 a.m. and check-in was at 3:00 p.m., but for $35, they let us check in at that time so we could shower and rest for 4-5 hours until 12:00 p.m., when they came to pick us up and take us to the hospital for the first time.

It took about 10 minutes to get from the hotel to the hospital, depending on traffic. For this transport, we had a large 20-seater van, which could fit all of us and Abumarah, a member of the police and a trusted person who accompanies you throughout the campaign.

NUMBER OF PATIENTS TREATED

During the seven days of the campaign, a total of 181 patients underwent 214 procedures:
TOTAL PATIENTS 181
TOTAL PROCEDURES 214
Women/Men 25/156
Children under 16 (16 or younger) 13/168

INGUINAL HERNIAS 125
Right/Left 72/53
Recurrent 10
PO Revision 2

UMBILICAL HERNIAS 10
EPIGASTRIC HERNIAS 6
SUBXIFOIDAL HERNIA 1
MIDLINE EVENTRATION 1

HYDROCELES 10
Right 6
CRYPTORCHIDISM 3
Right 1
SCROTAL CYST 1
SPERMATIC CORD CYST 2

LIPOMA 46
CYST 2
BIOPSY 2
ANAL FISSURE 1
KELOIDS 2

Two patients required surgical review for possible hematoma/bleeding within the first 12 hours. Both procedures were performed under local anesthesia and sedation in a brief surgery and without subsequent complications.
In addition, a total of 305 patients were seen. Most were seen on the first day and then between procedures.

THE LOCATION

Sierra Leone is located on the west coast of Africa and covers an area of 71,740 km². It has a population of over 8.4 million (2024 estimate), making it a small country compared to its neighbors. It borders Guinea to the north and east, Liberia to the southeast, and the Atlantic Ocean to the west, where it has a long coastline with beaches and a natural harbor of great importance.
The nation gained independence from the United Kingdom in 1961. Since then, it has gone through complex periods: the civil war (1991-2002) left more than 50,000 dead and caused severe social and economic deterioration. After the conflict, the country has made progress in democratic consolidation, with regular elections and peaceful transitions of power. It has also had to face serious health crises, such as the Ebola epidemic (2014-2016) and COVID-19, which affected its fragile economy.
Administratively, Sierra Leone is a presidential republic, divided into 5 regions and 16 districts.

English is the official language, but Krio functions as a lingua franca and more than a dozen local languages coexist, including Mende, Temne, and Limba. The country is both ethnically and religiously diverse: about 70% of the population is Muslim and about 25% is Christian, with peaceful coexistence that is a distinctive feature in the region.
The capital is Freetown, on the peninsula of the same name, on the Atlantic coast. Founded in 1792 by freed slaves from America and the Caribbean, its name means “free city.” Today it has more than 1.2 million inhabitants and is the political, cultural, and economic center of the country. Its port, one of the largest and deepest in West Africa, is strategic for regional trade.
The official currency is the Leone (SLE). In 2022, a redenomination process was introduced, removing three zeros from the old currency (SLL). (Currently, the approximate exchange rate is: 1 euro ≈ 24 SLE, 1 US dollar ≈ 22 SLE).
Despite its abundance of mineral resources (diamonds, rutile, bauxite, iron ore), the country remains one of the world’s most disadvantaged economies. Its GDP per capita is low and its Human Development Index (2023) places it in the low development group, although progress has been made in education, health, and governance since the end of the civil war.
In recent years, Sierra Leone has maintained relative political stability, but faces persistent challenges: corruption, youth unemployment, infrastructure deficits, and economic vulnerability.
The government seeks to diversify its economy into sectors such as agriculture and tourism and to attract foreign investment.
Although it is generally considered a safe country, it is advisable to take the usual precautions in isolated rural areas and avoid traveling at night in areas with little traffic.
Summary timeline:
• 1792 → Founding of Freetown.
• 1808 → Sierra Leone becomes a British colony.
• 1961 → Independence from the United Kingdom.
• 1991-2002 → Civil war.
• 2002 → Start of democratic reconstruction.
• 2014-2016 → Ebola epidemic.
• 2020-2022 → Impact of COVID-19.
• 2022 → Redenomination of the Leone.

THE TEAM

Our team consisted of a total of 11 volunteers:

• Nursing: Javi Madrazo, Patri Escrig, Mari Carmen Sánchez
• Urology: Ana Montoliu
• General Surgery: Paula Gonzálvez, Berta Lluch, Laura Fernández, Quique Colás, Cristina Reguero (3rd year resident)
• Anesthesiology: Kiko Llácer, Inma Giménez
HOSPITAL

The Kingtom Police Hospital in Freetown consists of several modules, one of which is used for emergency services and basic primary care; another where patients with highly contagious epidemic diseases that require isolation are treated and hospitalized.
The third module has two floors with several wards and an operating room divided into two modules with an adjoining room between them that serves as a sterilization area.

The surgical area described consists of five parts: two separate operating rooms (one of which is used to accommodate two surgical tables), a sterilization room, and a small adjoining room where they brought us fruit, coffee, and water.

In addition, next to the operating room with a single surgical table, there is another room with a refrigerator and bathroom that we used as a storage room, as it has several cabinets, tables, etc. And, being so close, it made it much easier for us to replenish supplies.
On the upper floor, they also gave us a locked room that we used as a changing room and to leave our belongings.

EQUIPMENT

The surgical instruments available at Kingtom Police Hospital are practically non-existent. For this reason, our team brought seven boxes of instruments for the campaign so that we could work safely, as well as two electric scalpels.

The hospital has an electric scalpel that works perfectly, but the instruments are only low-quality loose instruments that can be used in case of need (they are sterilized in metal trays with double cloth).
ASEPTIC TECHNIQUES AND SURGICAL EQUIPMENT

Sterilization is carried out using a thermal autoclave in the room between the two operating rooms.
This hospital has its own highly efficient staff (along with our nurse Javi, who monitored the equipment available for the surgeries on the three tables at all times).
In this area, Kabba plays a key role and helps you with everything you need.

ANESTHESIA

We work on three operating tables. Two of them are in the same operating room and the other is in the operating room just past sterilization. Both rooms have oxygen condensers.
The larger operating room has a Drager respirator (donated by the Bisturí Solidario foundation) that was repaired before our arrival. The ventilator works well, but due to an electrical problem a few days before we finished, the battery would not charge (it could be used manually without any problems), and they were waiting to check it.

In any case, the hospital also has the Ohmeda ventilator that they used previously, which works and can be installed in the other operating room.

In our case, almost all procedures (very few pediatric patients were treated because in less than two months there was a new campaign with pediatric surgeons) were performed with spinal/epidural anesthesia and local anesthesia plus sedation.
We brought all our own equipment and drugs. It is important to note that it is necessary to bring enough local anesthesia for infiltrations.
LOCAL STAFF

Dr. John Konteh, although absent from the surgical scene, has always been interested and attentive to any needs or problems that might arise.

Without a doubt, we also had the great help of David, a nurse who took care of all administrative matters and helped us with everything we needed. He was more present in the surgical area and always attentive.
We cannot fail to mention Mary, who from day one welcomed us with her smile and her unforgettable “good morning.” Always attentive to our needs, she brought us water, coffee, tea… as well as fruit and bread when we asked for it.
The surgical area had very cooperative and efficient staff. This hospital has good surgical technicians: Mohamed (head operating room nurse), Unisa (a great technician who also oversees sterilization), Raymond, Koroma…

There are also students who are eager to learn and who have assisted in many of the surgeries: Sheriff, Mohamed, Konneh…

In addition, if there is one area that works particularly well, it is the admission and discharge of patients by the orderlies led by Mohamed.

Finally, the pre-anesthesia/post-operative rooms run by nurses such as Bintu and Davida ensured that everything ran smoothly from the very beginning.
OUR LIFE IN FREETOWN

We arrived at Freetown International Airport on Friday, September 19, at 3:55 a.m.
Dr. John Konteh was waiting for us along with several members of the Sierra Leone police, which sped up the paperwork.
From the airport, we transferred to the ferry, which was necessary to reach Freetown on a 40-minute trip costing $45 per person (we also paid for the trips of the two local people who accompanied us).
We arrived at the port of Freetown and loaded all our luggage onto a police bus that took us to The Jam Lodge Hotel.
We had breakfast and went to our rooms to shower and rest for a few hours until 12:30 p.m., when we were picked up to go to Kingtom Police Hospital.
The welcome was very nice (led by Mary), and we immediately divided up the work to start organizing the operating rooms and seeing patients.
We had three rooms to see patients, so there were two surgeons in each room, always accompanied by local staff who helped at all times.
On that first day, we saw more than 200 patients and completed the first few days of surgery (we expect to perform 8 to 10 surgeries per table per day), leaving only surgical slots for the last few days.

The recruitment of patients at this hospital was fantastic, demonstrating the excellent preparatory work that had been done, which made it easier for our team to plan the operating rooms.
At the end of the day, since it was one of our surgeons’ (Quique) birthday, we asked to be taken to a special place for dinner and went to the beach where we ate delicious fish (spicy for everyone except the anesthesiologist). It was a tourist area with high prices, but the occasion warranted it.

The next morning, we had breakfast at 7:00 a.m. (we ordered breakfast the night before; it’s pretty good, with scrambled eggs, tortillas, pancakes, toast, etc.) and at 7:30 a.m., Abu picked us up with the driver and another police officer. We arrived at the hospital in 10 minutes because they were clearing the traffic.

We returned to the hotel around 9:00 PM. We had ordered dinner there ($15 per person), but we found it sparse and expensive for what it was (in short, we didn’t order any more dinners at the hotel during the campaign).

On Sunday, September 20, before starting the surgical day, accompanied by Dr. Konteh and Abu, we visit the district police headquarters, where the Inspector General of Police, Mr. William Fayia Sellu, welcomes us, thanks us for our work, and gives us the work permit for Sierra Leone that they had previously arranged for us (both doctors and nurses).
This is our daily routine. Upon arrival at the hospital in the morning, the surgeons visit the patients who underwent surgery the previous day, while the rest of the team begins to prepare the first three patients of the morning.

Mary is always on hand to bring us coffee, water, and fruit for mid-morning. Around 3:00 p.m., we all take a break and have some nuts, bars, sandwiches with cold cuts, tuna… that we brought from Spain.

The surgical day ended between 8:00 and 8:30 p.m. most days, with an average of 30 patients.

For dinner, with David’s help, when we finish in the operating room, we go to a takeaway place (fried chicken, rice, pizza, etc.) and take it back to the hotel, which has a nice space for us to relax together.
You can also buy beer there, but it’s best to order it the day before so it’s cold (in any case, since there are good refrigerators in the rooms, we went to the supermarket a couple of days and bought it there).

On Saturday the 27th, we check on the patients and collect the materials. When we finish, we go with David and Abu to visit the center, Cotton Tree, the market, Parliament, and Connaught Hospital.

In the afternoon, we return to the hotel (we pay $35 for “late check-out”), rest for a while, and are picked up to be invited to dinner with police personnel and other colleagues from the operating room and wards.
They give us a nice gift of notebooks and T-shirts as souvenirs.

After dinner and some dancing, they take us to the ferry that leaves at 2:00 AM. From there we go to the airport where a police colleague accompanies us through the police checkpoint (we need a report given to us by Dr. Konteh so we don’t have to pay a $25 departure tax).

Our flight to Casablanca was scheduled to depart at 6:50 a.m., but due to weather problems, we didn’t leave until three hours later. This wasn’t a problem because we had plenty of time for our Casablanca-Madrid connection.
We arrived in Madrid at 7:20 p.m. with no problems with our luggage, and from there we said goodbye to each other as we headed to our various final destinations: Valencia, Bilbao, Zaragoza, and Castellón.

CONCLUSION
STRENGTHS: Without a doubt, in my experience, this is the campaign that has had the best patient response. The pre-recruitment has been exceptional. Having Dr. Konteh available at all times before and during the campaign is another strong point.

On the other hand, the staff has been fully involved in the team and has participated at all times. It is important to support these campaigns with as much teaching and practice as we can. The interest they show is very high.
The orderlies and cleaning staff have also been extremely efficient.

It should also be noted that the operating room conditions are good; having a respirator provides a great deal of safety in procedures that require general anesthesia.

Finally, we felt very comfortable at all times and the gratitude they showed us was always mutual.

AREAS FOR IMPROVEMENT: Despite improvements in equipment, operating room conditions still need to be improved. Sometimes the lighting was insufficient (it is important to wear headlamps), the supply boxes are not complete or organized, and it is difficult to move the operating tables.
As in the previous campaign, the large difference between the number of male and female patients visited and operated on is striking (even taking into account that the pathology operated on is more common in men, the difference is excessive).

BUDGET

COST PER PERSON:

- Airline tickets with insurance €1,100.
- Hotel: approximately €500-550.
- Transport from place of origin to Madrid and back: €120.
- Visa €75.
- Ferry transport: €80 per volunteer.
- Living expenses to be covered by volunteers (provisions from Spain for lunches and dinners purchased in Freetown)
- Total amount around €1,900-2,000 per volunteer.

Report written by Inma Giménez Jiménez, campaign coordinator.

Surgeons in Action Foundation

A photo selection of the campaign is available at our Gallery