”For this one, let me take the risk”: why surgical staff continued to perform caesarean sections during the 2014–2016 Ebola epidemic in Sierra Leone

Drevin, Gustaf; Mölsted Alvesson, Helle; van Duinen, Alex; Bolkan, Håkon A; Koroma, Alimamy P; Von Schreeb, Johan

Approximately 60 public and private health facilities at the district, regional and national levels regularly perform surgery in Sierra Leone. 26 Women who experience birth complications at peripheral health units are routinely referred to these facilities for consultation (CS, repair of ruptured uterus and hysterectomy). Most of those health facilities are first-level hospitals, typically staffed by a medical officer or clinical assistants known as surgical assistant community health officers (SACHOs), both with basic surgical training, who perform emergency obstetric surgery such as CS alongside general surgical procedures. Referral hospitals are located in larger urban areas, offering a wider range of specialised services and employ more surgical staff. 26 We define CS provider as any health worker involved in CS surgery or CS-associated hospital care before and after delivery, irrespective of level of training.