Our Story

Dave has always had a passion for SaLone, and found increasingly on visits home requests for endoscopic procedures by friends and family. Sierra Leone has a big heart, but is a resource poor country in Subsaharan Africa; with a population of 7.6 million. Medical services are rudimentary, with no colonoscopy or upper gastrointestinal (GI) endoscopy available for adults. Patients who needed an endoscopy or colonoscopy were required to pay for travel out of country, accommodation abroad, and for a private procedure, with costs estimating US$2000, four times the gross national income per capita (1).

In 2016 Choithram Memorial Hospital, a local hospital in Freetown, was able to invest in endoscopy equipment. Dave got together a team of endoscopy training specialists from the North of England with the aim to set up an endoscopy unit and train endoscopists in Sierra Leone. The team were awarded a grant from the British Society of Gastroenterology to develop training (2). Through the good will of Mr Harish Agnani, a representative of the Choithram Foundation in Freetown, Choithram hospital became our local institutional partner in the project and has provided free logistical and transport support for the visiting medical teams.

The Sierra Leone medical community embraced the project, and local senior consultants Dr Len Gordon-Harris and Dr Radcliffe Lisk interviewed and identified three initial trainees who have excelled with us. Through annual visits to the unit with intensive training courses, peer to peer assessment, and remote supervision have been trained to internationally acclaimed UK endoscopy standards in upper GI endoscopy and therapeutics for GI bleeding, and have commenced training in lower GI endoscopy (3).

Since 2017 the team expanded to include specialist endoscopy nurses who have trained local nurses in airway management during the test, using specialist endoscopy medications and equipment for therapeutic endoscopy, and decontamination and maintenance of endoscopy equipment.

The team not only wanted to bring skills training, but a functioning endoscopy service for Sierra Leone that demonstrates quality. The endoscopy unit is regularly audited against UK key performance indicators, and ensures consistent high quality endoscopy for all our patients.

Undertaking endoscopy has given new insights into GI diseases in SaLone which has been presented at conferences in Sierra Leone and the UK. In lower GI endoscopy we have challenged the historical assertions that adenomatous polyps and colorectal cancer are rare in Africa, with westernisation of the SaLone diet. Our recent cohort of 12 patients detected colorectal neoplasia in 7 cases (58%) (4). In upper GI endoscopy our team undertook an extensive audit of acute upper GI bleeding, showing a comparatively high mortality (8 deaths in 24 patients, 33%) in a relatively young population (median age 45 years, range 26-67 years) (5).

This work demonstrates the need for endoscopy in Sierra Leone, but access to services remains a huge challenge. Currently endoscopic procedures, although in country availability makes them much cheaper, are dependent on private funds by patients. Our next goals are:

• To continue to expand training in endoscopy throughout Sierra Leone to increase availability.
• To develop endoscopy centres outside of Freetown to increase access in country.
• To explore funding opportunities to develop public varices screening for those with cirrhosis, to prevent upper GI bleeding.
• To promote referral for endoscopy within Sierra Leone for those with dyspepsia, and encourage early eradication of H. pylori.

References

1. https://data.worldbank.org/country/sierra-leone
2. https://awoko.org/2016/11/23/sierra-leone-news-first-endoscopic-training-taking-place-at-choithram-hospital/
3. Wells C, Mountford C, Hancock J, et alPWE-100 Endoscopy training in sierra leone – successful remote supervision leading to a sustainable OGD serviceGut 2019;68:A246-A247
4. Nylander D, Hancock J, Wells C, et alPWE-052 Colorectal Neoplasia in Sierra Leone – We Will only find If We LookGut 2019;68:A197-A198.
5. Sowa M, Smith M, Curry C, et alPTU-063 Upper gastrointestinal bleeding (AUGIB) in sierra leone – audit of outcomes when minimal endoscopy accessGut 2019;68:A148-A149.