Written by Dr Zosia Bredow
Edited by Anisa Jafar & Gabrielle Prager
Dr Zosia Bredow
Sierra Leone has some of the worst health outcomes in the world. It is 181 out of 189 countries on the UN’s Human Development Index, and life expectancy at birth in 2021 was 60.1 years (global: 71.4 years).1 Many people in Sierra Leone die prematurely from preventable or treatable causes.2 Emergency Medicine is not a specialty in Sierra Leone, nor is emergency care formalised nationally.
King’s Global Health Partnerships (KGHP) were asked by the Ministry of Health and Sanitation (MoHS) of Sierra Leone in collaboration with World Health Organisation (WHO) to help strengthen emergency care provision across the country.3 In 2021, a team of 8 Emergency Room trainers were recruited from Sierra Leone and the UK to:
- Create and deliver a 7-day contextually-targeted Training of Trainers (ToT) course in emergency care
- Support the roll-out of emergency care training and provision nationally to at least 250 emergency workers in government hospitals across 16 districts in Sierra Leone
The first week in-country was spent consulting with WHO, MOHS, National Emergency Medical Services(NEMS) and other emergency care stakeholders to develop the emergency care course. This was based on existing validated courses such as WHO/AFEM’s Basic Emergency Care, Primary Trauma Course, and South African Triage Scale and aimed to balance breadth with depth in order to create a sustainable model such that the trainees became trainers after 7 days. We prioritised systems development throughout the course, targeting a level of resources that not every facility yet had, but that every facility could reach once budget prioritisation included emergency care. Our team consisted of local experts who took the lead on elements such as trauma and airway training. Myself and 2 British colleagues took the lead on other elements such as triage and simulation training. All teaching materials and course standards were reviewed and approved by a board of national clinical stakeholders prior to course commencement.
Straight afterward, we picked up our completed training packs from the printer’s shop and were off to Makeni, the focal city of the North and the hub for our first course.
Delivering training to a room full of a partner nation’s senior healthcare delegates is an overwhelming prospect. Despite some nerves, we knew our content was solid and relevant according to our time spent in stakeholder consultation. However, this was a new and unknown audience. Thankfully, the sea of new faces soon broke into smiles and engaged immediately in what, for many, were new training concepts of simulation and reflection. Our training room became a forum for discussion of the variance of emergency care systems between each hospital, and through each simulation peer-peer learning and development ideas were shared. After an exhausting week of training together with our new colleagues and friends, we all agreed how proud we felt of what we’d collectively achieved.
The second training week was easier in the southern hub city of Bo. As faculty, we had learnt from reflections and feedback from the first course and tweaked our content and delivery. The delegates were different, but just as inspired, just as inspiring.
There was a huge sense of shared achievement throughout. All cascade training was shared on the community of practice WhatsApp groups we had created, and when the training beat our initial target of 250 clinicians we all celebrated the impact we’d had.
This photograph illustrates something of the programme’s tangible success; it was taken just before a mass casualty event in Freetown where hundreds of victims required emergency burns treatment. We had simulated burns patients in our training.
This 4-bed emergency room had been newly created, using existing resources collected from around the hospital, by one of the teams after returning from our Training of Trainers course. 4 Previously emergency patients would have had to wait to be seen on a general ward. It was a prioritisation that was realised just in time within a project requested and dictated by local and national stakeholders.
Since this project ended, Sierra Leone’s Ministry of Health has worked further with WHO to complete a prioritisation review of the nation’s emergency care services. Subsequently, KGHP have secured funding for further emergency care projects, including training in ultrasound across multiple district hospitals – and are always looking for new volunteers– https://www.kcl.ac.uk/kghp/volunteering
All photographs taken with consent for publication, training and education purposes
References:
- United Nations 2022, Human Development Index, Sierra Leone vs world average 2021 <https://hdr.undp.org/data-center/human-development-index#/indicies/HDI>
- Carshon-Marsh, R. et al. 2022, ‘Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018-20’, Lancet Global Health, 10(1):e114-e123
- KGHP Corbett et al. 2021, Strengthening Emergency Care in Sierra Leone, <https://www.kcl.ac.uk/strengthening-emergency-care-in-sierra-leone>
- KGHP 2021, Freetown Explosion Caring for Burn Survivors in Sierra Leone, https://www.kcl.ac.uk/news/freetown-explosion-caring-for-burn-survivors-in-sierra-leone
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