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Leow J.J.,Surgeons OverSeas SOS | Groen R.S.,Surgeons OverSeas SOS | Kamara T.B.,Surgeons OverSeas SOS | Dumbuya S.S.,Surgeons OverSeas SOS | And 5 more authors.
Journal of Surgical Education | Year: 2011

Background: Surgeons OverSeas (SOS), a New York-based organization with a mission to save lives in developing countries, conducted a surgical needs assessment in Sierra Leone in 2008 which identified a large gap in surgical knowledge. We hypothesized that knowledge transfer could be improved by conducting workshops with significant local faculty participation. Design: Description of emergency and essential surgical care workshops (EESC) workshops and follow-up. Setting: Freetown and Bo, Sierra Leone. Participants: International and local health providers in Sierra Leone. Methods: SOS organized EESC workshops in collaboration with significant local surgeons' support. Data on subsequent workshops were recorded. Results: Fifteen instructors were identified and assisted with teaching. Nine of the instructors were specialists from Sierra Leone. Each workshop lasted 3 days. Feedback was gathered after these workshops Subsequent to the SOS workshops, 8 other workshops were undertaken by local surgeons in Sierra Leone, 5 of which were organized and taught solely by local surgeons working for the Sierra Leone Ministry of Health and Sanitation. Three other workshops were organized with external support. Conclusions: EESC workshops organized with significant local input are useful for knowledge transfer and empower local surgeons to conduct subsequent workshops on their own. © 2011 Association of Program Directors in Surgery.

Crowe S.J.,Centers for Disease Control and Prevention | Fu C.,Action Contre la Faim | Maenner M.J.,Centers for Disease Control and Prevention | Jambai A.,Sierra Leone Ministry of Health and Sanitation | Morgan O.,Centers for Disease Control and Prevention
Emerging Infectious Diseases | Year: 2016

In 2015, community event-based surveillance (CEBS) was implemented in Sierra Leone to assist with the detection of Ebola virus disease (EVD) cases. We assessed the sensitivity of CEBS for finding EVD cases during a 7-month period, and in a 6-week subanalysis, we assessed the timeliness of reporting cases with no known epidemiologic links at time of detection. Of the 12,126 CEBS reports, 287 (2%) met the suspected case definition, and 16 were confirmed positive. CEBS detected 30% (16/53) of the EVD cases identified during the study period. During the subanalysis, CEBS staff identified 4 of 6 cases with no epidemiologic links. These CEBS-detected cases were identified more rapidly than those detected by the national surveillance system; however, too few cases were detected to determine system timeliness. Although CEBS detected EVD cases, it largely generated false alerts. Future versions of community-based surveillance could improve case detection through increased staff training and community engagement. © 2016, Centers for Disease Control and Prevention (CDC). All rights reserved.

Kushner A.L.,Surgeons OverSeas SOS | Kushner A.L.,Columbia University | Kamara T.B.,Connaught Hospital | Groen R.S.,Surgeons OverSeas SOS | And 4 more authors.
Journal of Surgical Education | Year: 2010

Background: Although surgery is increasingly recognized as an essential component of primary health care, there has been little documentation of surgical programs in low- and middle-income countries. Surgeons OverSeas (SOS) is a New York-based organization with a mission to save lives in developing countries by improving surgical care. This article highlights the surgical program in Sierra Leone as a possible model to improve access to surgery. Methods: An SOS team conducted a needs assessment of surgical capacity in Sierra Leone in February 2008. Interventions were then developed and programs were implemented. A follow-up assessment was conducted in December 2009, which included interviews of key Sierra Leone hospital personnel and a review of operating room log books. Results: Based on an initial needs assessment, a program was developed that included training, salary support, and the provision of surgical supplies and equipment. Two 3-day workshops were conducted for a total of 44 health workers, salary support given to over 100 staff, and 2 containers of supplies and equipment were donated. Access to surgery, as measured by the number of major operations at Connaught Hospital, increased from 460 cases in 2007 to 768 cases in 2009. Conclusions: The SOS program in Sierra Leone highlights a method for improving access to surgery that incorporates an initial needs assessment with minimal external support and local staff collaboration. The program functions as a catalyst by providing training, salary support, and supplies. The beneficial results of the program can then be used to advocate for additional resources for surgery from policy makers. This model could be beneficial in other resource-poor countries in which improved access to surgery is desired. © 2010 Association of Program Directors in Surgery.

Park D.J.,The Broad Institute of MIT and Harvard | Dudas G.,University of Edinburgh | Wohl S.,The Broad Institute of MIT and Harvard | Wohl S.,Harvard University | And 93 more authors.
Cell | Year: 2015

Summary The 2013-2015 Ebola virus disease (EVD) epidemic is caused by the Makona variant of Ebola virus (EBOV). Early in the epidemic, genome sequencing provided insights into virus evolution and transmission and offered important information for outbreak response. Here, we analyze sequences from 232 patients sampled over 7 months in Sierra Leone, along with 86 previously released genomes from earlier in the epidemic. We confirm sustained human-to-human transmission within Sierra Leone and find no evidence for import or export of EBOV across national borders after its initial introduction. Using high-depth replicate sequencing, we observe both host-to-host transmission and recurrent emergence of intrahost genetic variants. We trace the increasing impact of purifying selection in suppressing the accumulation of nonsynonymous mutations over time. Finally, we note changes in the mucin-like domain of EBOV glycoprotein that merit further investigation. These findings clarify the movement of EBOV within the region and describe viral evolution during prolonged human-to-human transmission. © 2015 The Authors.

Curran K.G.,Epidemic Intelligence Service | Curran K.G.,National Center for Emerging and Zoonotic | Gibson J.J.,Center for Global Health | Marke D.,Sierra Leone Ministry of Health and Sanitation | And 6 more authors.
Morbidity and Mortality Weekly Report | Year: 2016

What is already known about this topic? Ebola Virus Disease (Ebola) is transmitted person-to-person through direct contact with blood, body fluids, or contaminated clothing and other personal items of symptomatic or deceased patients. Traditional funeral practices, including washing and touching the corpse, pose a substantial risk for Ebola transmission. What is added by this report? A single, traditional funeral of a prominent pharmacist was associated with a sharp increase in the number of reported Ebola cases in a previously low-incidence district of Sierra Leone. Twenty-eight laboratory-confirmed cases occurred in persons who reported attending the pharmacist’s funeral. Sixteen (57%) patients had direct contact days or weeks before the funeral, 21 (75%) reported touching the corpse, and eight (29%) died. Rapid and effective outbreak control limited the second and third generations to four cases each, including one death. What are the implications for public health practice? Because of the potential for high levels of transmission from a single patient or event, vigilant Ebola surveillance and rapid response are essential, and immediate, safe, dignified burials by trained teams are critical to interrupting transmission and controlling Ebola. Enhanced community-based surveillance strategies, such as a community event-based surveillance system, will be critical to quickly identify high-risk events and prevent ongoing transmission. © 2016, Department of Health and Human Services. All rights reserved.

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