title: Surgery in the time of Ebola: how events impacted on a single surgical institution in Sierra Leone.
abstract: BACKGROUND
  The mortality and morbidity of Ebola extends far wider than those contracting the disease. Surgical activity in Sierra Leone has been severely disrupted by the epidemic.
  
  
  METHODS
  This is a retrospective study examining the effect of the 2014-2015 Ebola virus epidemic on surgical activity in a Sierra Leone's main teaching hospital.
  
  
  RESULTS
  The impact of national and local events on surgical provision is illustrated by the experience of Connaught Hospital, Freetown Sierra Leone. Surgical activity fell dramatically in August 2014, the month when the most health care workers died and continued to fall to just 3% of expected activity. Two of eight surgeons at Connaught Hospital died of Ebola.
  
  
  CONCLUSIONS
  The example of Connaught Hospital serves as a graphic and poignant illustration of the difficulties faced by surgeons in low resource settings when dealing with the acute effects of a natural disaster. In any future epidemic, high levels of preparedness, training and protection, in addition to liaison with public health teams early in an epidemic, may allow surgeons to carry out at least some of their duties without the very high levels of personal risk seen here.In a country with so few specialists the loss of 25% is disastrous and will result in long term capacity reduction.
authors.affiliation: Department of Surgery, Connaught Hospital, Freetown, Sierra Leone.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Bundu
authors.affiliation: King's Sierra Leone Partnership, King's Centre for Global Health, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Surgery, Connaught Hospital, Freetown, Sierra Leone.
authors.forename: A
authors.initials: A
authors.lastname: Mansaray
authors.affiliation: Department of Surgery, Connaught Hospital, Freetown, Sierra Leone.
authors.forename: T B
authors.initials: TB
authors.lastname: Kamara
authors.affiliation: King's Sierra Leone Partnership, King's Centre for Global Health, London, UK.
authors.forename: L M
authors.initials: LM
authors.lastname: Hunt
mesh_terms: D058872:Epidemics; D013502:General Surgery / Q000706:statistics & numerical data*; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D006784:Hospitals, Teaching; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D012189:Retrospective Studies; D012807:Sierra Leone / Q000453:epidemiology; D066231:Surgeons / Q000600:supply & distribution*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data* / Q000639:trends; D062606:Tertiary Care Centers; D000078329:Workforce
keywords: Delivery of health care; Hemorrhagic fever, Ebola; Sierra Leone; Surgeons