Background

In Sierra Leone, only pregnant women and children under the age of five have the right to free medical treatment. The rest of the population is required to pay for healthcare that is of a low standard and often difficult to access, due to long distances and poor road conditions.

The Ebola epidemic of 2014-2016 further weakened the country’s fragile healthcare system. During this period, over 200 health workers died following exposure to the virus, making it even more challenging to bring the outbreak to an end. EMERGENCY’s Goderich Surgical Centre was the only hospital which remained open for the duration of the epidemic, working in challenging conditions to continue to provide free, high-quality care to our patients.

The Center

In 2001, EMERGENCY refurbished an abandoned medical clinic in Goderich, a small community on the outskirts of Sierra Leone’s capital, Freetown. Given a new lease of life, the newly refurbished clinic became the Goderich Surgical Centre. To meet rising demand and expand capacity, two new wards were built in 2003. Our Goderich Surgical Centre is today the reference point for surgical care throughout Sierra Leone, with a particular focus on traumatology.

Initially restricted to emergency and war-related surgery, our admissions criteria have gradually expanded to additionally include: traumatology; urgent surgery for the treatment of conditions such as hernias and intestinal perforations; and elective surgery.

To date, EMERGENCY surgeons have performed 57,007 surgical procedures. 4,193 of these operations were carried out in 2017 alone. Since 2001, the centre has seen a total of 361,310 outpatient consultations and has admitted 42,306 patients for further care.

The Soda Program

EMERGENCY’s Goderich Surgical Centre delivers a unique programme for the treatment of corrosive oesophageal lesions caused by the ingestion of caustic soda (sodium hydroxide). The widespread use of caustic soda in Sierra Leone is primarily due to a campaign launched at the end of the civil war, that taught women how to produce soap at home. Although initially effective, this campaign has had unexpected effects: the transparent color of the soda confuses children, who, mistaking it for water, ingest it.

The extent of the problem is underestimated and there are no official statistics on nationwide incidence rates. Families often turn to traditional medicine and young patients arrive too late to seek proper care, thus worsening the damage caused by ingestion.

Burns caused by the ingestion of caustic soda prevent proper swallowing due to oesophageal narrowing. Depending on the outcome of endoscopic examination (assessing oesophageal dilatation), dietary requirements can be established to ensure correct feeding: a tube may be placed in the stomach for feeding if the oesophagus is closed or obstructed. The prevention of malnutrition is a fundamental component of the programme: patients must be medicated appropriately and, where required, fed with a balanced liquid regimen.

Once in the programme, children return to the center for periodic health checks and may undergo further treatment (if their condition requires it). Since the commencement of the Soda Programme in 2007, more than 3,000 patients have been treated. During 2017 alone, 213 children were treated following the ingestion of caustic soda.