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World J Surg. 2010 Aug;34(8):1743-7. doi: 10.1007/s00268-010-0564-7.

Comparison of surgical care deficiencies between US civil war hospitals and present-day hospitals in Sierra Leone.

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Department of Surgery, UCLA Medical Center, Los Angeles, CA, USA.



Surgery is rapidly becoming a part of public health initiatives in developing countries.


In collaboration with the Sierra Leone Ministry of Health and Sanitation, a team of local surgeons and surgeons from the organization Surgeons OverSeas (SOS) used the WHO Tool for Situational Analysis to Assess Emergency Surgical Care to quantify surgical capacity in Sierra Leone. These data were then compared to data collected from the Medical and Surgical History of the Civil War, a work documenting surgical care and hospitals during the US Civil War.


There are 0.2 government hospital surgeons/100,000 people in Sierra Leone compared to 300 surgeons/100,000 soldiers in the Union Army. In Sierra Leone it is rare to have running water, fuel, anesthesia, and reliable X-rays. In comparison, US Civil War hospitals had reliable running water, fuel, and anesthesia. It is rare to manage open fractures, limb dislocations, amputations, and conditions requiring chest tubes in Sierra Leone, while these procedures were commonly employed in US Civil War hospitals.


Government hospitals in present day Sierra Leone lack the infrastructure, personnel, supplies, and equipment to adequately provide emergency and essential surgical care. In a comparison of present day Sierra Leonean and US Civil War hospitals, the US Civil War facilities are equivalent and in many ways superior. It is hoped that such a comparison will aid advocacy efforts so that greater resources are devoted to improving emergency and essential surgical care in low- and middle-income countries.

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