Connaught Hospital, established in the 19th century and commissioned in 1912 by the Duke of Connaught, Prince Arthur, is Sierra Leone’s main adult referral and teaching hospital. It is the country’s most important center for specialist and emergency care, it forms part of the University of Sierra Leone Teaching Hospitals Complex and tasked with training the next generation of doctors, nurses, and allied health professionals. For more than a century, Connaught has been the backbone of Sierra Leone’s healthcare system. Yet, for many Sierra Leoneans, it is still not the first choice when illness strikes. Instead, they often seek care in smaller private facilities, drugstores, or even with traditional healers before finally arriving at Connaught—too often, when it is already too late.
I have witnessed this pattern time and time again. I have seen relatives and loved ones choose private facilities, some for very genuine reasons. I have also watched others arrive at Connaught after exhausting every other option, only to present in critical condition. And I have cared for countless patients who might have survived if only they had come earlier.
The preference for private facilities is rooted in perception and experience. Private clinics are often smaller, cleaner, and appear better organized. Patients are seen almost immediately, with one-on-one consultations and rooms that may accommodate just one or two individuals as opposed to the “ward system” in public facilities. For many families, this feels dignified and reassuring. Staff in private facilities, with lighter patient loads, can afford to be friendlier and more attentive. By contrast, public hospitals like Connaught have historically struggled with overcrowding, long waiting times, and staff whose attitudes, under the strain of overwhelming workload, are sometimes less than welcoming.
But beneath the surface, the limitations of private care are stark. Most private facilities lack a full complement of specialists. In many, a single consultant represents an entire specialty. Advanced diagnostics and the capacity for multidisciplinary consultation are scarce. This creates dangerous gaps when complex conditions arise—strokes, cancers, surgical emergencies, or critical medical cases that require multiple inputs.
Connaught, on the other hand, remains the only hospital in Sierra Leone where a patient can be seen by a team of consultants, specialists, residents, medical officers, and house officers under one roof. It houses some of the best-trained physicians, surgeons, and nurses in the country. It offers multidisciplinary consultations in internal medicine, surgery, emergency medicine, and subspecialties that are unavailable elsewhere. For complex cases, this is the only place where life-saving care can be coordinated in real time.
The tragedy is that many patients arrive too late. In Sierra Leone, health-seeking behavior is generally poor. Few patients present to Connaught at the first sign of illness. Most will first try self-medication from a pharmacy or drug peddler. Others turn to herbal or traditional remedies. When symptoms persist, many seek out private facilities. Only when “wata don pass garri” do they come to Connaught. The data reflect this reality: close to 60 percent of deaths at Connaught occur in the Outpatient or Accident and Emergency Department, with patients dying within 24 to 72 hours of arrival. A further 38 percent are brought in dead, beyond the reach of medical intervention.
As a clinician, I have seen this cycle play out too often. I recall patients who had been treated for weeks at private clinics for what turned out to be surgical emergencies, arriving at Connaught only when complications had set in. I have also seen families who, out of fear of poor treatment, delayed bringing their loved ones to the hospital until the illness was irreversible. These are not isolated cases—they are the daily reality of our work.
I recall one middle-aged man who came in after weeks of being treated at a private clinic for “stomach upset.” By the time he reached Connaught, his abdomen was severely distended. Imaging revealed a ruptured intestine from untreated appendicitis. Despite emergency surgery, his body had been overwhelmed by infection, and we lost him within 48 hours. His story is not unique—his family had trusted the private facility, but the absence of surgical expertise there meant a correct diagnosis was never made. Had he come to Connaught earlier, he would likely be alive today.
On the other hand, I remember a young woman in her twenties who was brought directly to Connaught after suddenly developing difficulty breathing. She was seen immediately in the Accident and Emergency Unit, and within minutes a team of doctors, including a cardiologist and a physician specialist, were at her bedside. Investigations confirmed a massive blood clot in her lungs. She was treated with anticoagulants, stabilized in the Intensive Care Unit, and discharged two weeks later. Today, she is healthy and back to work. Her survival was possible because she was brought to Connaught first, where a team of specialists could act quickly and decisively.
These two stories illustrate the same truth: Connaught saves lives when patients come on time, but too many Sierra Leoneans arrive when the situation is already beyond rescue.
Of course, patients (and their families) are not entirely to blame. Connaught itself has contributed to the mistrust. Staff attitudes, strained by low pay and impossible workloads, have too often left patients feeling devalued. A nurse in a private facility may care for two or three patients, while at Connaught a nurse may be responsible for 15 to 20 at once. Burnout is inevitable. Salaries and conditions are poor, and discipline is inconsistent, weakened further by the Sierra Leonean culture of “Connectocracy,” where individuals shielded by powerful patrons (“Oga at the top”) flout rules. Equipment, too, wears out quickly: a blood pressure machine that may last six months in a private clinic may survive just one month at Connaught, simply because of the relentless patient load.
The reputational damage from years of such experiences has been severe. Families still share stories of neglect or corruption. Many continue to choose private care despite the risks, reinforcing the cycle of delay and loss.
But Connaught has been changing. Over the last five years, there has been a deliberate and sustained effort to rebuild and improve. I have been part of that journey, and I can attest to the transformation. Staff now undergo training in patient care and customer relations. Hygiene and environmental standards have improved, and the hospital has seen infrastructural upgrades. The number of specialists and subspecialists is greater than ever before, and many nurses and other healthcare workers now hold advanced qualifications. New units and departments have been established, expanding the range of services. With the installation of a 1.2 MW solar system by the GoSL/MoH and partners, Connaught now runs on uninterrupted power—something almost unimaginable a decade ago. Just as importantly, hospital management has been empowered by the leadership of the Ministry of Health to enforce discipline and accountability at the institutional level, ensuring that misconduct is addressed swiftly.
I have seen these changes firsthand: colleagues more motivated, patients expressing gratitude for improved services, and a hospital slowly reclaiming its reputation. Yet, I also know that these gains must be communicated to the public. If Sierra Leoneans do not hear and see the progress, the mistrust will persist, and patients will continue to arrive only when all else has failed.
Research reinforces what I have seen in practice. During the Ebola epidemic, formal health-seeking fell from 86 percent to 58 percent, while self-medication rose sharply. Informal providers—traditional healers, unlicensed drug sellers, and religious healers—remain central in urban and rural communities alike. With only about 35 percent of the population accessing national health services, and a doctor, :patient ratio far below the WHO benchmark, the importance of a strong, trusted Connaught Hospital cannot be overstated.
The path forward must be twofold. First, continued investment in staff, equipment/supplies, and infrastructure is essential to ensure that Connaught remains capable of providing specialist care. Second, and equally important, is rebuilding public trust through education, outreach, and engagement. Sierra Leoneans must be encouraged to seek care early, to rely less on self-medication and informal providers, and to see Connaught (and other public facilities) not as a last resort but as a center of hope. Staff must be disciplined and have a positive attitude to work; the client/patient should always be treated as a ‘King’.
Connaught Hospital is not perfect. It still faces many challenges. But it remains the only facility in Sierra Leone with the capacity to manage the most complex, life-threatening cases. I have seen its failures, but I have also seen its successes. I have seen lives lost due to delay and other reasons, and I have seen lives saved because a patient arrived just in time.
Health, as the saying goes, is wealth. For Sierra Leone to grow healthier and more productive, it must confront the deadly cost of mistrust in its public hospitals. Connaught is ready. It has improved. It has changed. And if Sierra Leoneans choose to trust it again—and most importantly, if they come early—Connaught will save their lives.
Disclaimer:
The views and opinions expressed in this article are solely those of the author and do not represent the official position of Connaught Hospital, the Ministry of Health, or any affiliated institution.
