ABSTRACT
In Sierra Leone, physicians face a high risk of burnout due to systemic challenges, with studies suggesting a gap in recognizing and addressing this condition. We explored public-sector physicians' experiences and perceptions of the organizational structures and characteristics needed to help them thrive in a resource-limited practice setting. We conducted in-depth, semi-structured interviews with 24 public sector physicians across Western Area Urban (Freetown), Bo, Kono, and Kambia districts in Sierra Leone. Thematic content analysis was carried out using both deductive and inductive techniques to generate codes and identify key themes. Physicians in Sierra Leone face multifaceted challenges that significantly impact both healthcare delivery and personal well-being. Our findings reveal that overwhelming workload and stringent schedules contribute to burnout, directly compromising patient care quality. The emotional burden of caring for patients with economic constraints in accessing treatment further exacerbates physician stress. Limited resources, such as insufficient medical supplies and personnel, foster a sense of helplessness among clinicians, leading to detachment and cynicism towards their ability to effect change. In the absence of formal institutional support, physicians often rely on peer support to manage burnout. These challenges collectively undermine physicians' ability to provide optimal care, as the emotional and physical toll affects their decision-making and engagement with patients. Within Sierra Leone's resource-constrained healthcare context, systemic reforms are necessary to address the root causes of physician burnout, and to improve patient care. Our findings suggest that implementing formal support structures, including counselling services and mentorship programs, is crucial. Improving working conditions through better resource allocation and infrastructure development is essential. Developing strategies to address the emotional burden of care, including robust training programs, could enhance physician well-being, reduce burnout, and consequently improve the overall quality of patient care in Sierra Leone's public health sector.
ABSTRACT
BACKGROUND: Ebola virus emerged in West Africa in December 2013. The ease of mobility, porous borders, and lack of public health infrastructure led to the largest Ebola virus disease (EVD) outbreak to date. INTERVENTION: The 2013 EVD outbreak signalled the need for laboratory diagnostic capabilities in areas without strong public health systems. As part of the United States' Department of Defense response, MRIGlobal was contracted to design, fabricate, equip, deploy, and operate two mobile diagnostic laboratories (MDLs). The first laboratory analysed blood samples from patients in an adjacent Ebola Treatment Centre (ETC) and buccal swabs from the deceased in the community in Moyamba, Sierra Leone. The second laboratory was deployed to support an ETC in Conakry, Guinea. The Department of Defense provided real-time quantitative reverse transcription polymerase chain reaction assays that were deployed and validated on-site. LESSONS LEARNT: Prompt and accurate molecular diagnostics reduced sample turn-around times from over 24 h to under 4 h. Experienced laboratory staff tested up to 110 samples per day and on-site engineering proved necessary for MDL setup and operation. As the Ebola response slowed, the sustainment of the MDLs' operations was prioritised, including staff training and the transition of the MDLs to local governments. Training programmes for local staff were prepared in Sierra Leone and Guinea. RECOMMENDATIONS: The MRIGlobal MDL team significantly contributed to establishing increased laboratory capacity during the EVD outbreak in West Africa. Using the MDLs for molecular diagnosis is highly recommended until more sustainable solutions can be provided.
ABSTRACT
5-Fluoroanthranilic acid (FAA)-resistant mutants were selected in homothallic diploids of three Saccharomyces species, taking care to isolate mutants of independent origin. Mutations were assigned to complementation groups by interspecific complementation with S. cerevisiae tester strains. In all three species, trp3, trp4 and trp5 mutants were recovered. trp1 mutants were also recovered if the selection was imposed on a haploid strain. Thus, FAA selection may be more generally applicable than was previously described.