• T Peter Kingham, Thaim B Kamara, Meena N Cherian, Richard A Gosselin, Meghan Simkins, Chris Meissner, Lynda Foray-Rahall, Kisito S Daoh, Soccoh A Kabia, and Adam L Kushner.
• Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. peter@humanitariansurgery.org
• Arch Surg. 2009 Feb 1;144(2):122-7; discussion 128.

HypothesisLack of access to surgical care is a public health crisis in developing countries. There are few data that describe a nation's ability to provide surgical care. This study combines information quantifying the infrastructure, human resources, interventions (ie, procedures), emergency equipment and supplies for resuscitation, and surgical procedures offered at many government hospitals in Sierra Leone.SettingSite visits were performed in 2008 at 10 of the 17 government civilian hospitals in Sierra Leone.Main Outcome MeasuresThe World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was used to assess surgical capacity.ResultsThere was a paucity of electricity, running water, oxygen, and fuel at the government hospitals in Sierra Leone. There were only 10 Sierra Leonean surgeons practicing in the surveyed government hospitals. Many procedures performed at most of the hospitals were cesarean sections, hernia repairs, and appendectomies. There were few supplies at any of the hospitals, forcing patients to provide their own. There was a disparity between conditions at the government hospitals and those at the private and mission hospitals.ConclusionThere are severe shortages in all aspects of infrastructure, personnel, and supplies required for delivering surgical care in Sierra Leone. While it will be difficult to improve the infrastructure of government hospitals, training additional personnel to deliver safe surgical care is possible. The situational analysis tool is a valuable mechanism to quantify a nation's surgical capacity. It provides the background data that have been lacking in the discussion of surgery as a public health problem and will assist in gauging the effectiveness of interventions to improve surgical infrastructure and care.

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