Expanding post-operative follow-up in rural Sierra Leone: A community-based protocol

Humanitarian surgeries are performed in low- and middle-income countries (LMICs) to help address untreated surgical disease. Post-operative follow-up is challenging but crucial to monitor recovery, detect complications, and assess outcomes. Establishing a comprehensive protocol in partnership with local healthcare personnel may improve patient adherence.

A retrospective review of missions from 2011 to 2019 to Sierra Leone by the International Surgical Health Initiative (ISHI). In 2017, a protocol was established with the following key elements: patient education, community leader recruitment, and logistical support. Patient demographics and follow-up rates were compared between groups.

In total, 396 patients underwent operations from 2011 to 2019. Most patients were male (84%), mean age 40 ± 14 years, and primarily underwent hernia repair (68%). Initially, follow-up rates of 205 patients were <5%; after protocol implementation, follow-up rates among 128 patients who received operations increased to 96-97%.

A community-based follow-up protocol in Sierra Leone yielded high patient adherence. The protocol emphasizes context-appropriate patient education and community engagement. Protocols are feasible and generalizable to patients cared for by international and hosting surgical teams.