Primary Trauma Care: Empowering individuals, strengthening organisations and enhancing systems

As the King’s Sierra Leone Partnership, we know that meaningful change takes time and only happens if it is truly owned by partners. We have been working in collaboration with our public sector partners – Connaught Hospital, the College of Medicine and Allied Health Sciences (CoMAHS) and the Ministry of Health and Sanitation – for a number of years, working together to help improve health outcomes in Sierra Leone. For 2018, one of our key aims will be to collaborate on making strategic and sustainable improvements to access to safe surgical care.

Through THET’s Africa Grants Programme, KSLP will be working alongside colleagues at Connaught Hospital to implement a locally adapted surgical safety checklist. This is based on the WHO Safe Surgery Checklist and part of the WHO Safe Surgery Saves Lives initiative and, when successfully implemented, will involve a checklist coordinator confirming completion of listed tasks at different stages of every operation. This will ensure operations are performed to high standards, adhering to international safety guidelines and ultimately leading to improved health outcomes for the patient.

It is important to note that KSLP’s support with surgery and trauma at Connaught Hospital is not a new development. With a significant unmet need (92%) for surgical care in Sierra Leone (Bolkan et al, 2016), KSLP volunteers embedded with our partners have responded to invitations to support strategic and sustainable improvements in access to safe surgical care since 2015.

In this time, KSLP volunteers along with our partners have been involved in a collaborative process of joint research to understand the baseline needs and current barriers to safe surgical care, co-designing project activities, and co-developing an implementation plan.

In line with King’s approach of empowering individuals, strengthening organisations and enhancing systems, this process has involved projects such as:

• Quantitative cross-sectional surveys of healthcare providers perceptions of patient safety practice and culture at Connaught
• A retrospective notes review of 360 trauma cases at Connaught
• Training of checklist coordinators
• Evaluation of surgical safety at Connaught making use of the WHO checklist audit tool
• A questionnaire-based trauma needs assessment
• Supporting the organisation of a National Surgical Forum and drafting of national surgical policy

After sharing the outputs of these assessments with our partners, it is clear that there is an ongoing willingness to drive change and development of the surgical system coming from Connaught Hospital’s management, surgery colleagues and KSLP. This will no doubt grow as the University of Sierra Leone Teaching Hospitals Complex develops, providing a key site for training the next generation of specialist surgeons in Sierra Leone. This is all possible due to accreditation from the West African College of Surgeons being awarded in 2016, a standard which must be maintained to allow postgraduate surgical training to happen at Connaught. This means trainee surgeons do not have to travel abroad for their specialist training, improving healthcare worker retention and providing a continuous pipeline of surgical specialists for future development.

We will soon be welcoming two long-term volunteers to begin work on implementing the surgical safety checklist, alongside delivering a sustainable primary trauma care course, and quality improvement projects aiming to reduce delays in surgical care. So, it seems 2018 looks set to be an exciting but busy year for surgery and trauma colleagues at KSLP and Connaught and we look forward to sharing updates of the progress with THET and the wider global health community.

For more information on surgery at Connaught Hospital, take a look at this video

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