Foreign Body Ingestion: Three Case Reports

Foreign body ingestion in adults is rarely reported in our environment. While the incident is commonly deliberate in adults, it is often accidental in children. As illustrated in these case reports, diagnosis is often challenging if the act is not witnessed or reported by someone, even at the onset of complications. A seven-week-old boy ingested a used razor blade given to him by his three-year-old sister. The incident was reported and the object removed at laparotomy.A 38year old woman deliberately swallowed a padlock-and-key apparently to attract her husband’s attention. Plain X-rays demonstrated a radio-opaque object first in the chest and then in the stomach. Both padlock-and-key were removed at operation. A 24-year old male with a psychiatric disorder was brought for treatment of an abdominal surgical wound that had failed to heal four months after appendicectomy. Wound treatment failed and exploration of the wound and laparotomy extracted metals and plastic objects.Diagnosis of foreign body ingestion in our environment is achieved by documenting a proper history, physical evaluation and often, plain X-rays. Removal of the ingested object(s) is accomplished mainly by surgical intervention. Recovery and prognosis in most patients are usually satisfactor

What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure

Objectives: To measure the financial burden associated with accessing surgical care in Sierra Leone. Design: A cross-sectional survey conducted with patients at the time of discharge from tertiary level care. This captured demographics, yearly household expenditure, direct medical, direct non-medical, and indirect costs for surgical care, and summary household assets. Missing data were imputed.Setting: The main tertiary level hospital in Freetown, Sierra Leone. Participants: 335 surgical patients under the care of the hospital surgical team receiving operative or non-operative surgical care on the surgical wards.Outcome measures: Rates of catastrophic expenditure (CE) (a cost > 10% of annual expenditure), impoverishment (being pushed into, or further into, poverty as a result of surgical care costs), amount of out-of-pocket (OOP) costs, and means used to meet these costs were derived. Results: Of 335 patients interviewed, 39% were female and 80% were urban dwellers. Median yearly household expenditure was US$3569. Mean OOP costs were US$243, of which a mean of US$24 (10$138 (63%) and US$34 (16$46 (21%) were indirect costs. Catastrophic expenditure affected 18% of those interviewed. Concerning impoverishment, 45% of patients were already below the national poverty line prior to admission, and 9% of those who were not were pushed below the poverty line following payment for surgical care. 84% of patients used household savings to meet OOP costs. Only 2% (6 patients) had health insurance. Conclusion: Obtaining surgical care has substantial economic impacts on households which pushes them into poverty or further into poverty. The much-needed scaling up of surgical care needs to be accompanied by financial risk protection.

Assessing unmet anaesthesia need in Sierra Leone: a secondary analysis of a cluster-randomized, cross-sectional, countrywide survey.

Objectives: To determine the unmet anaesthesia need in a low resource region. Introduction: Surgery and an\ue6sthesia services in low- and middle-income countries (LMICs) are under-equipped, under- staffed, and unable to meet current surgical need. There is little objective measure as to the true extent and nature of unmet need. Without such an understanding it is impossible to formulate solutions. Therefore, we re-examined Surgeons OverSeas (SOSAS) unmet surgical need data to extrapolate unmet anaesthesia need. Methods: For the untreated surgical conditions identified by SOSAS, we assigned anaesthetic technique required to carry out the procedure. The chosen anaesthetic was based on common practice in the region. Procedures were categorized into minimal anaesthesia, spinal an\ue6sthesia, regional anaesthesia, ketamine/monitored anaesthesia care (MAC), and general endotracheal an\ue6sthesia (GETA). Discussions: Ninety-two per cent (687 of 745) of untreated surgical conditions in Sierra Leone would require some form of anaesthesia. Seventeen per cent (125 of 745) would require MAC, 22% (167 of 745) would require spinal anaesthesia, and 53% (395 of 745) would require GETA. Conclusion: Analyses such as this can provide guidance as to the rational and efficient production and distribution of personnel, drugs and equipment

The demographics of patients affected by surgical disease in district hospitals in two sub-Saharan African countries: a retrospective descriptive analysis.

There is a growing awareness of the importance of surgical disease within global health. We hypothesised that surgical disease in low income countries predominantly affects young adults and may therefore have a significant economic impact.We retrospectively reviewed all surgical admission data from two rural government district hospitals in two different sub-Saharan African countries over a 6-month period. We analysed all surgical admissions with respect to patient demographics (age and gender), diagnosis, and procedure performed.Surgical admissions accounted for 12.9 and 19.8 % of all hospital admissions in Malawi and Sierra Leone respectively. 18.5 and 6.2 % of all hospital patients required a surgical procedure in Malawi and Sierra Leone respectively, with the low number in Sierra Leone accounted for in that many of the obstetric admissions were referred to a nearby Medicins Sans Frontiers (MSF) hospital for treatment. 17.9 and 10.5 % of surgical admissions were under the age of 16 in Malawi and Sierra Leone respectively, with 16-35 year olds accounting for 57.3 % of surgical admissions in Sierra Leone and 53.5 % in Malawi. Men accounted for 53.7 and 46.0 % of surgical admissions in Sierra Leone and Malawi respectively. An unexpected finding was the high level of patients who absconded from hospital in Sierra Leone after diagnosis but before treatment. This involved 11.8 % of all surgical patients, including 38 % with a bowel obstruction, 39 % with peritonitis and 20 % with ectopic pregnancy.Most people affected by disease requiring surgery are young adults and this may have significant economic implications

Assessment of environmental contamination and environmental decontamination practices within an Ebola holding unit, Freetown, Sierra Leone

Evidence to inform decontamination practices at Ebola holding units (EHUs) and treatment centres is lacking. We conducted an audit of decontamination procedures inside Connaught Hospital EHU in Freetown, Sierra Leone, by assessing environmental swab specimens for evidence of contamination with Ebola virus by RT-PCR. Swabs were collected following discharge of Ebola Virus Disease (EVD) patients before and after routine decontamination. Prior to decontamination, Ebola virus RNA was detected within a limited area at all bedside sites tested, but not at any sites distant to the bedside. Following decontamination, few areas contained detectable Ebola virus RNA. In areas beneath the bed there was evidence of transfer of Ebola virus material during cleaning. Retraining of cleaning staff reduced evidence of environmental contamination after decontamination. Current decontamination procedures appear to be effective in eradicating persistence of viral RNA. This study supports the use of viral swabs to assess Ebola viral contamination within the clinical setting. We recommend that regular refresher training of cleaning staff and audit of environmental contamination become standard practice at all Ebola care facilities during EVD outbreaks

A Surgical Collaboration in Sierra Leone

In the developing world a woman in labour, a child with appendicitis, or someone with a broken leg may die because of a lack of adequate surgical care. Such people are seldom served by hospitals and even if they are, the staff often lack essential resources and may be untrained. If patients can find a qualified surgeon, families must often provide the necessary supplies: gauze, intravenous equipment, scalpels, sutures and sterile gloves. The result is that far too often people die or are left disabled from conditions that could have been addressed with simple and cost-effective cures if they had been available. </jats:p