title: An assessment of surgical and anesthesia staff at 10 government hospitals in Sierra Leone.
abstract: OBJECTIVE
  Strengthening workforce capacity to deliver essential surgical and anesthesia care has been identified as a strategy for addressing the unmet burden of morbidity and mortality in under-resourced countries. Sierra Leone is one of the poorest countries in the world and faces the challenge of stretching limited resources to provide appropriate health care for a population of 6 million.
  
  
  OBJECTIVE
  To investigate the training of surgical and anesthesia staff in Sierra Leone and to build an evidence base for future health care policy and training programs tailored to local needs.
  
  
  METHODS
  Health care professionals who conduct surgery or deliver anesthesia at 10 of the 23 government hospitals in Sierra Leone were surveyed regarding training and clinical practices. This study surveyed 36 of 70 surgical staff (51%) and 38 of 68 nurse specialists (56%) nationally.
  
  
  METHODS
  Descriptive analysis of demographic details, training levels, and reported needs for future development.
  
  
  RESULTS
  Thirty-six surgeons were surveyed in study hospitals, of whom the majority had limited surgical specialization training, whereas most anesthesia was provided by 47 nurse specialists. All consultants had postgraduate qualifications, but 4 of 6 medical superintendents (67%) and all medical officers lacked postgraduate surgical qualifications or formal surgical specialist training. The number of trained anesthesia staff increased after the introduction of the Nurse Anesthesia Training Program in 2008, funded by the United Nations Fund for Population Activities, increasing the number from 2 to 47 anesthesia staff based at the study hospitals. Although 32 of 37 nurse anesthetists (86%) reported having attended training workshops, 30 of 37 (>80%) described anesthesia resources as "poor," reporting a critical need for anesthesia machines and continual oxygen supply. Of the 37, 25 specifically mentioned the need for a better-functioning anesthesia machine and 16 mentioned the need for oxygen.
  
  
  CONCLUSIONS
  To address unmet surgical need in the long term, accredited local surgical specialization programs are required; training of nonphysician surgical practitioners may offer a short-term solution. To develop safe anesthesia care, governments and donors should focus on providing health care professionals with essential equipment and resources.
authors.affiliation: Department of Population Sciences and Humanities, University of Birmingham, Birmingham, England.
authors.forename: Emily
authors.initials: E
authors.lastname: Vaughan
authors.affiliation: College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
authors.forename: Frances
authors.initials: F
authors.lastname: Sesay
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Adaora
authors.initials: A
authors.lastname: Chima
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Mira
authors.initials: M
authors.lastname: Mehes
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lee
authors.affiliation: Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Dzifa
authors.initials: D
authors.lastname: Dordunoo
authors.affiliation: Department of Public Health, Epidemiology, and Biostatistics, University of Birmingham, Birmingham, England.
authors.forename: Alice
authors.initials: A
authors.lastname: Sitch
authors.affiliation: Department of Population Sciences and Humanities, University of Birmingham, Birmingham, England.
authors.forename: Gilles
authors.initials: G
authors.lastname: de Wildt
authors.affiliation: Department of Surgery, Connaught Hospital and College of Medicine Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
authors.forename: Thaim B
authors.initials: TB
authors.lastname: Kamara
authors.affiliation: College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
authors.forename: Bailah
authors.initials: B
authors.lastname: Leigh
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: John
authors.initials: J
authors.lastname: Sampson
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D013502:General Surgery / Q000193:education*; D006297:Health Services Accessibility / Q000458:organization & administration; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education* / Q000600:supply & distribution; D008875:Middle Aged; D020380:Needs Assessment; D012807:Sierra Leone; D011795:Surveys and Questionnaires; D000078329:Workforce