FREETOWN CAMP, SIERRA LEONE. MARCH 2024
On this occasion we propose a new camp to the Police Hospital in Freetown, Sierra Leone, a place known from previous camps and well received thanks to Dr. John Konteh (Medical Superintendent Services) who facilitates the procedures at all times. Initially the camp was scheduled for the first week of December (December 1-10, 2023) taking advantage of the holidays of the Constitution Holidays, which allows volunteers to have more days off. However, on November 26, 2023 we received the news of an attempted coup d’état by an armed group through an attack on a military base and the release of more than 1000 prisoners in the city of Freetown. In view of the initial confusion, the airspace is closed and a curfew is imposed on the whole country, which is lifted in the following days. We always keep in contact with Dr. Konteh who transmits calm and encourages us to go ahead with the camp. However, after several days of close monitoring of events we decide to cancel the camp and look for a new date, assuming the risk of losing the airline tickets already issued.
After Christmas we got down to work again and set a new date, this time the first week of March (March 2-10, 2024). This new date forces us to restructure the team, mainly for labor reasons, being the members of the new camp the following:
Coordinator: Sebastián Fernández Arias (General Surgery).
Anesthesia (ANR): Ester Mora Azabal, Carmen Belmonte Cuenca and Martí Arquerons Aliaga.
General Surgery (CGD): Lucía Catot Alemany, Elisabet Julià Verdaguer, Elisabet Redondo Villahoz
Nursing (ENF): Samuel Jiménez Domínguez
FLIGHTS
Through Angelis (Travel Agent) we negotiated with Royal Air Maroc a change of flight dates. To do so, they ask us for several documents justifying the suspension of the camp due to the events that took place. We send a letter signed by the president of the Foundation (Dr. Butron Vila) and Dr. John Konteh (Police Hospital in Freetown, Sierra Leone). They allow us to change the flight with a surcharge of about 180€ per person.
We leave on March 2, 2023 from Madrid 3 people and 5 from Barcelona. We meet in Casablanca and from there we head to Freetown. The return is scheduled for March 10, 2023.
LUGGAGE
- Cabin suitcase for personal luggage (liquids, scissors, etc. are checked in with the 23kg bags).
- 2 pieces of luggage of 23Kg each for material.
EQUIPMENT:
In total, 8 people x 2 pieces of luggage of 23kg: 16 pieces of luggage for material.
It is carried in a plasticized mat checkered bag bought in bazaar that costs 3.20 €, there are different sizes, put one or two giant garbage bags inside and so the material is introduced (to avoid problems in case a zipper breaks). For the anesthetic material it is decided to use a large suitcase that is billed back. It is plasticized at the airport. For future camps, the use of more resistant bags can be considered, as these are easily broken.
Each volunteer is in charge of managing his or her material. We prepare an Excel table with a breakdown of the necessary material we have to control what we may be missing.
DOCUMENTS BEFORE THE TRIP
- Updated passport with more than 6 months of duration.
- Summarized CV in English
- Specialist title translated by a sworn translator. As in other occasions we resort to traductoralfredo@gmail.com that allows us to request it through internet and sends it to us in PDF for about 50€. The document is valid for future camps.
- Certificate of Suitability requested at the Medical Association (it has an expiration period of 3 months, so when the date changes we have to request a new one).
- Completed form for the Medical and Dental Council of Sierra Leone (MDSCL) to obtain official permits to practice in Sierra Leone.
- E-Visa (https://evisa.sl/#/home?redirect_uri=%2Fapplications). Visitor’s visa ($85). The cancellation of the trip forces us to get it again. It has an expiration period of 1 month.
INTERNATIONAL HEALTH
Each volunteer must request an appointment at their International Health Center in order to carry out the vaccination and preventive measures corresponding to Sierra Leone.
A self-generated document of recommendations can be obtained through the website of the Ministry of Health.
ACCOMMODATION
Booked March 2-10, 2024, 3 double rooms ($95 per night) and 2 single rooms ($75 per night). Breakfast is included (in our case coffee, juice and cheese omelet with a sausage) and we agreed on a dinner with the hotel for 200 leones (about 8€) per person per day consisting mainly of rice, pasta or cous-cous with chicken or fish.
DEVELOPMENT OF THE CAMP (March 2-10, 2024)
Day 2: Departure from the airport at 18:50 from Madrid and 19:10 from Barcelona. We meet at the boarding gate of the flight from Casablanca to Freetown.
Day 3: Arrival at the airport at 4:40. We pass the control and they ask us for the printed visa.
We are informed that 5 of the 6 suitcases that came from Madrid have not arrived, among them is included the electric generator. Fortunately all the suitcases arrive from Barcelona with all the anesthesia and surgery material, and the only suitcase that arrives from Madrid contains mesh and sutures, which allows us to carry out the camp. The lost suitcases will arrive in Freetown in 72 hours. At the checkpoint we indicate that we are carrying medical material for a camp at the Police Hospital and they let us through without scanning the suitcases.
We are received by Dr. John Konteh with a security policeman (Abu) who accompanies us throughout the camp.
Dr. Konteh takes care of getting the ferry tickets (50€ per person + Dr. Konteh and Abu’s ticket) and we arrive at the hotel around 8 am. We rest for about 3 hours and at 11 am we go to the hospital for patient selection.
Dr. Konteh does a great job with the selection of patients and we expect about 150 patients that we evaluate in teams of 2 while the anesthesia team and nurses are responsible for the preparation of the operating rooms and organize the material. Having only one electrical generator and only Samuel as a nurse, we decided to put two beds in one operating room and leave the other one free.
Since we did not have a respirator, we selected all those procedures that we could perform under spinal or local anesthesia and discarded those that required general anesthesia, such as patients with goiter or children. Most of the patients we evaluate are patients with hernias.
Finally, we prepare a report with the schedule for the whole week in 2 tables. For the first cases we select two or three simple hernias to “start rolling” and then we start with the more complex cases. In this way, if they have to be admitted for several days, we have the whole week available. On Friday we leave several cases of simple hernias and all local procedures.
Day 4-8: Surgery
The first day we are received by the Chief Inspector of Police (Mr. William Fayia Sellu) and in a brief formal act he welcomes us and gives us the permits to practice in the country. Only three members of the team wear T-shirts with the logo of the foundation, so in future camps we can consider wearing a T-shirt for each member of the team.
We work in 2 simultaneous operating rooms with the support of local staff that facilitates the activity at all times.
They have an autoclave donated by the “Surgeons in Action Foundation” but they do not use it because it is slow and they resort to pot sterilization to be more agile. We have adequate surgical material during all the interventions.
Dr. Konteh confirms that he is looking for a respirator and hopes to get it during the month of April. His intention is to be able to operate on goiters and children in future camps.
We encountered complex cases for both the anesthesia team and the surgical team.
During the week the surgical assistant of the hospital (Kelly) participates with us, who refers to know the Basini technique for the repair of inguinal hernias and puts special interest in learning the Lichtenstein technique.
Next to the operating room we have a small room where we are provided with tea, coffee and soluble milk as well as two large thermos flasks of water. We order food through the hospital staff and depending on the menu it costs between 1000-1500 leones for the whole team (around 8 euros per person). We usually eat separately from the local team. However on the last day (Friday the 8th) and given the good reception, we ordered food for the entire hospital team (about 32 people in total) for a price of about 200 Euros in total and we got together to eat and dance in front of Dr. Konteh’s office.
After the small celebration there are still a few patients to be operated on and the activity ends around 18h. We left partially collected all the material for the next day. As it was early, we went for a pizza dinner in the hotel area of Freetown.
All patients are collected and registered in the database provided by the organization.
Day 9: Collection of Material and return
We managed to operate on all the patients we had planned on Friday, March 8 and therefore on Saturday we went to the hospital later in the day only to collect the material and discharge those who were still in the hospital. Before going to the hospital we left all our bags packed and paid for the hotel (6 nights in total). We were left one of the single rooms to leave our luggage and rest during the day (which allowed us to take advantage of the air conditioning and get some sleep) since our flight was leaving early in the morning and we were scheduled to leave on the Ferry at 01:30.
Dr.Konteh together with Abu took us on a brief tour of Freetown (ministries, markets, etc). We had lunch at a hotel in the beach area and went back to the hotel to rest. At 19h they prepared a dinner in a hotel in the beach area with the Chief Inspector of the police and all the local team of the Hospital.
After dinner, we are returned to the hotel to rest until 12:30, when we are picked up at the hotel to go in time to the Ferry. At the ferry station we pack the little material we bring back (electric generator and surgical material usable for other camps). Dr. Konteh accompanies us to the airport to make sure that we are not charged exit taxes (we have a document from the ministry that supports it). Around 3 am we arrive at the airport and check in without any problem. We have a delay of about 3 hours on our departure flight from Freetown, but it does not affect our connection in Casablanca.
We enjoy a good breakfast and say goodbye until another time.
CAMP DATA
Patients
130 procedures were performed on 111 patients.
Inguinal hernia patients 71 (10 bilateral, 26 left and 35 right), of which 51 patients used mosquito mesh and the rest polypropylene mesh.
Patients with midline hernia 11 (8 umbilical and 3 epigastric).
Patients with hydrocele 6
Procedures with local 37
Expenses
Tickets:
- 1070 + 180 (change of date) x 6
- 1400 + 180 (change of date) x 1
- 1080€ x1
Total 10160 €.
Ferry: 50€ each way per person (+ 4 extra tickets for Abu and Dr.Konteh): 1000€.
Visa: 85$ (78€) x 8 persons (total: 624€)
Hotel (including breakfast):
- Single room (x 6 nights): 450€/person.
- Double room (x 6 nights): 538€ (269€/person)
- Total: (450×2) + (269×6): 2514€.
Meals:
- Hotel dinner (x 5 days): 41.25 €/ person
- Hospital meal (x 4 days): 35€/person
- Team meals: 200 in total
- Dinners outside the hospital: 15€ x 8 + 18€ x 8= 120 + 144= 264€.
- Total: 785.25€.
Total cost of the camp: 10160 + 1000 + 624+ 2514 + 785.25 =15083.25€.
CONCLUSIONS:
Making a simplistic analysis of the success of the camp and basing it only on the number of patients intervened, we can conclude that a good camp has been carried out since 111 patients are a lot of patients for 5 days of work.
However, I believe that the success of the camp lies in 3 factors:
- The figure of Dr.Konteh and the previous selection of patients that has allowed us to schedule the whole week on the first day. As well as his constant presence and willingness to solve any problem that might arise.
- The local team of the Police Hospital working as a machine perfectly meshed with the team of Surgeons in Action throughout the week.
- The harmony of the group of volunteers who, despite the fact that most of them were participating in a camp for the first time, knew how to adapt to the working conditions and assume their roles with the sole purpose of adding and facilitating the work of others.
Sebastián Fernández Arias
Campaign Coordinator
You can visit our Gallery for a photo selection of the campaign