Lessons from Chaos #4: For want of a lightbulb…

Operating in Sierra Leone

For want of a nail the shoe was lost;

for want of a shoe the horse was lost;

and for want of a horse the rider was lost,

being overtaken and slain by the enemy,

all for want of care about a horse-shoe nail.

• Benjamin Franklin

Like the above proverb, once in Sierra Leone there was almost no surgery for want of a lightbulb.

In 2008, Surgeon OverSeas (SOS), the NGO I helped found, was involved in the first assessment of surgical need in the country. One of the findings was the lack of lights in the operating rooms. Turns out it was a lack of lightbulbs. SOS co-founder, Peter Kingham, came back to New York with a sample lightbulb and his stepfather was able to source the lightbulbs to a factory in China. We ordered 500 lightbulbs and sent them along with a container of medical supplies.

Unfortunately, while the container was enroute we got an urgent message. “There is only one lightbulb left in the overhead light at Connaught Hospital.”

We were at a loss.

Luckily an SOS member was just about to fly from New York to Freetown. Hours before his flight he took a taxi, collected the five sample lightbulbs, made his flight and was able to deliver them to the hospital just in time. 

Surgery continued, but it was an important lesson on how supplies and equipment were needed to keep things going.

It was a lesson I’d learn again and again.

To provide quality care, a combination of personnel, infrastructure, procedures, equipment and supplies were needed.