By Ishmael Sallieu Koroma
For three years, one of Sierra Leone’s most important public institutions has been attempting to redefine itself under pressure, scrutiny and growing public expectation.
Now, a deeply personal reflection by Dr. Mark Kapuwa, Hospital Care Manager of Connaught Hospital, has reignited public conversation not only about reform at the country’s main referral hospital, but also about the daily realities patients continue to face inside its walls.
On Tuesday night, Kapuwa published a lengthy statement on his personal Facebook page marking three years since assuming leadership of the hospital in May 2023.
Part memoir, part institutional assessment and part leadership reflection, the statement painted the picture of an administrator attempting to steer one of Sierra Leone’s most pressured hospitals through difficult political, financial and structural circumstances.
“History was made — and in many ways, we are still living through it,” Kapuwa wrote.
His appointment, he recalled, followed an intense interview process before senior Ministry of Health officials, including the Chief Medical Officer, permanent secretaries and directors.
One question from the interview, he said, never left him.
“How would you manage a difficult and large institution like Connaught, where some of the staff are even your seniors?”
His answer was rooted in what he described as a leadership philosophy centred on engagement and communication.
“I will engage, I will listen more, and I will communicate.”
Kapuwa said the approach was influenced by leadership and hospital management training at the University of Washington, where he learned that institutions are transformed not simply through authority, but through trust and inclusion.
“Leadership that listens is leadership that learns,” he wrote.
A hospital carrying the weight of a nation
As Sierra Leone’s principal referral hospital, Connaught occupies a unique and often overwhelming position within the country’s healthcare system.
For decades, the institution has struggled under the pressures of overcrowding, inadequate infrastructure, staff shortages and limited medical equipment, while simultaneously serving as the final destination for some of the country’s most critical medical cases.
Kapuwa acknowledged that many questioned his decision to accept leadership of the hospital.
Some warned him the institution was “too troubled” to fix. Others urged him to remain in Kenema, where he had previously earned recognition for managing difficult hospitals.
Still, he accepted the role during a politically tense period ahead of Sierra Leone’s 2023 elections, at a time when public institutions faced mounting pressure and resources were increasingly constrained.
“It was clear from day one that success would depend on collective effort,” he wrote.
According to Kapuwa, his administration focused on improving sanitation, staff engagement, accountability systems, patient-centred care, financial discipline and institutional organisation.
He argued that Connaught today is cleaner, more organised and more patient-friendly than it was three years ago.
But even within his own reflection, Kapuwa admitted the hospital remains far from where it needs to be.
“We are not where we need to be yet,” he acknowledged.
Patients describe a different reality
Even as hospital management points to reform efforts, some patients continue to describe experiences marked by frustration, informal payments and poor treatment.
Among them is veteran Sierra Leonean journalist Sitta Turay, who publicly recounted his experience at Connaught Hospital in a Facebook post published on April 21.
Turay described what he called an exhausting and humiliating experience from the moment he entered the hospital compound.
“My experience at the Connaught Hospital in Freetown was not funny,” he wrote.
According to him, the problems began at the triage section, where he alleged that one worker demanded money for filling out forms.
He further claimed that a woman at the entrance to the triage unit insisted patients purchase face masks for five leones, despite neither the seller nor several nurses reportedly wearing masks themselves.
“I gave them five hundred New Leones to stop that extortion,” Turay wrote, adding that he pleaded with staff over the practice.
Turay also alleged that patients were asked to pay informal fees during blood sugar testing, while laboratory procedures required official payments backed by receipts.
He criticised the outsourcing of X-ray services and accused some hospital workers, including nurses, of behaving loudly and disrespectfully toward patients.
“The workers including nurses are noisy like they are in our common market called Dove Court,” he wrote. “Zero respect for patients.”
He further alleged that security personnel demanded money from visitors before allowing them entry into the hospital premises.
Turay indicated that he was still receiving treatment at the time of his post and promised to share more details later.
“We have to stand for our country so that things will change,” he wrote.
His comments sparked widespread reactions online, with many Sierra Leoneans sharing similar frustrations about conditions in public hospitals, while others defended overworked healthcare workers operating under extremely difficult conditions.
Reform versus reality
The contrast between Kapuwa’s institutional reflection and Turay’s patient experience highlights a deeper tension within Sierra Leone’s healthcare system.
On one side are administrators and medical professionals attempting to improve services within severe resource limitations. On the other are ordinary citizens confronting the daily realities of overcrowding, informal payments, delays and strained patient care.
Healthcare analysts say both realities can exist simultaneously.
Public hospitals across many African countries continue to struggle with underfunding, staff burnout, infrastructure deficits and weak accountability systems — pressures that often create fertile ground for patient dissatisfaction and informal practices.
In his own statement, Kapuwa acknowledged many of those persistent problems, including staff attitudes, infrastructure gaps and equipment shortages.
He also warned that declining donor support and wider global economic uncertainty mean Sierra Leone’s healthcare sector must increasingly rely on innovation, efficiency and stronger local solutions.
But perhaps the most striking line in his reflection was also the simplest:
“The patient must be treated as King.”
For many Sierra Leoneans, however, the central question remains whether that principle can move beyond aspiration and become everyday reality inside the country’s most important public hospital.
As debates continue online and patients continue to tell their stories, Connaught Hospital remains both a symbol of national healthcare ambition and a reminder of how far Sierra Leone’s public health system still has to go.
