Anaesthesia and Critical Care

Anaesthesia and Critical Care

Anaesthesia and Critical Care

MISSION AND VISION STATEMENT

MISSION

To provide healthcare services that meet the highest international clinical and ethical standards, promote and undertake research into health issues, and serve as an institution for both undergraduate and postgraduate training in medical and allied health professions

VISION

To be a leading healthcare institution in Sierra Leone and the West African region, known for its excellence in patient care, medical education, and research.

CORE VALUE

Healthcare Services: Delivering high-quality healthcare services to the population, ensuring accessibility and affordability.
Research: Conducting innovative research to address prevalent health issues and improve medical practices.
Education and Training: Offering comprehensive training programs for undergraduate and postgraduate students in medicine and allied health fields, fostering the next generation of healthcare professionals.

History of the Department of Anaesthesia and Critical Care

Since 2007 Dr Eva Hanciles worked for many years as the single anaesthetist covering both anaesthesia and ICU as well as teaching on the Diploma for nurse anaesthetist course. When the University of Sierra Leone Teaching Hospitals Complex (USLTHC) was established, she was made head of the Department of Anaesthesia and Critical Care in early 2017. Subsequently, the Department sought accreditation by the West African College of Surgeons (WACS) for training of residents in anaesthesia. Since the WACS stipulates a minimum of two consultant anaesthetists in order to obtain accreditation, Dr Eric Vreede, who in 2001 had started the training of nurse anaesthetists at PCMH, was employed in December 2017 as the second consultant.

In June 2018 the Department obtained accreditation from the WACS; full accreditation for the Diploma in Anaesthesia (DA) and partial for the Membership. On re-accreditation in 2021 partial accreditation for the Membership was extended and in addition partial accreditation for the Fellowship was obtained. The re-accreditation team suggested that two consultants would not be sufficient to cover all anaesthesia areas of the USLTHC and eventually in September 2024 a third consultant, Prof Israel Kolawole, was employed.

Formal training of residents started mid 2018 with a single doctor who obtained both the primaries and the DA. Unfortunately he was unfortunately killed in a road traffic accident in 2021. Nevertheless, slow growth followed leading to the current Department of three consultants, one specialist (an anaesthetist with the WACS Membership) and four residents.

The Department has also supported the development of anaesthesia in The Gambia by training their first resident to DA level at a time when there were only two Sierra Leonean residents. Her presence was instrumental in the growth of anaesthesia training at USLTHC.

The Department covers the anaesthesia and critical care services in both Connaught and PCM Hospitals, the consultants and resident anaesthetists also support the nurse anaesthetists in both hospitals. As a small and slowly growing department, services are under continuous review, development and growth.

Because of the shortage of physician anaesthetists, the Department relies heavily on the nurse anaesthetists at Connaught and PCMH. Therefore, training of nurse anaesthetists has always been part of our function. In addition, we have been pivotal in the (re-)start of the diploma and the BSc in nurse anaesthesia, both now under the Faculty of Nursing and Midwifery. The future of anaesthesia in Sierra Leone is teamwork between nurse anaesthetists and physician anaesthetists and we endeavour to train both cadres to have respect for each other.

PROFESSIONAL STANDARD HEALTH CARE

The Department of Anaesthesia and Critical Care envisions providing the people of Sierra Leone with safe, high-quality anaesthesia and critical care delivered by qualified professionals. We aim to ensure excellent patient care before, during, and after surgery, as well as for critically ill patients, while training the next generation of specialist physicians and nurse anaesthetists nationwide.

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Services provided

Anaesthesia: All forms of anaesthesia for surgical procedures are provided: general anaesthesia, spinal anaesthesia and sedation.

Regional blocks: Dr Mohamed Kargbo is a specialist in regional anaesthesia blocks that can be used during surgery and also for acute and chronic pain. A specialist service will be developed.

Anaesthesia clinic: Pre-operative assessment of surgical patients in advance of surgery. Workforce shortage means that a formal pre-operative anaesthesia clinic is not yet possible. In the meantime, through collaboration between department, difficult cases are co-managed and a system of early identification is being trialled.

Peri-operative care: The consultants and residents are trying to provide as much as possible comprehensive peri-operative care.

Teaching: All members of the Department are involved in teaching of 4th and 6th year medical students, rotating residents of other specialties, diploma and BSc nursing students.

Critical Care: The ICU is supervised, managed and coordinated by the anaesthetists and headed by Dr Hanciles together with dedicated nursing staff. 

Resuscitation: Cardio-pulmonary resuscitation as well as fluid resuscitation of the critically is led by anaesthetists

Pain management: On an ad-hoc basis chronic pain patients are managed with a view to develop a formal pain clinic.

Key partners:

Resurge Africa – supported training of our specialist in India and Ghana. The rotation to Accra for the late resident was supported by them.

Kings Sierra Leone Partnership – ultrasound training, support for systems in ICU.

Guys and St Thomas Trust, London teaching hospitals – regular online tutorials are held on Friday mornings.

Krio Descendants Union – North Carolina branch – The arterial blood gas machine was donated and continued supplies of the cartridges is taken care of by them.

The Department is always looking for additional partners, please contact the Department through USLTHC.

Department achievements

Residency training

  1. Four residents passed the primary exams
  2. Four residents passed the DA
  3. Two residents passed the Membership
  4. Numerous residents from surgery, internal medicine, O&G and family medicine rotated through the Department

Medical student teaching

  1. Anaesthesia teaching and clinical postings are now well established for 4th and 6th year students. This is important in order to give aspiring doctors an early taste of the specialty in the hope that some will choose this as their career.

ICU

  1. There is now 24/7 cover of the ICU by anaesthesia and rotating residents
  2. Availability of advanced respiratory support
  3. Availability of arterial blood gas measurements
  4. Introduction of Point of Care ultra sound diagnostics

Nurse anaesthesia training

  1. The restart of the Diploma in Nurse Anaesthesia after a stoppage of 4 years, is a milestone in the development of anaesthesia services in Sierra Leone. The Department has been the main driver for this.
  2. The Department also participates in teaching of BSc students

Equipment

  1. Modern monitors and anaesthesia machines have been installed

Supply of drugs and consumables

  1. Improved departmental systems as well as improved procurement by Connaught administration means fewer stock-outs.