Tuesday September 7

I came to the hospital today at 7:30 AM with Adamah to make rounds with him in the ER. For a variety of reasons having to do with the intern covering both the medicine floor and the medical ER, there was no one around who knew the patients well, and that got Adamah quite irritated. Later Nathan and I talked about it as a bigger question of how do you get people to accept the ethical and moral responsibility of professionalism. For many of the Liberian doctors (and I fear some younger physicians in the US) medicine is a job which they do to survive, but they don't have the sense of commitment and responsibility that is necessary for professionalism. But here, unless there is a sense that the future for them will be better, and that there will be rewards for hard work, then it will be hard to instill that in them.

Communication is a big issue. Sign-out in the ER was an issue, and anesthesia was complaining that they don't know enough about patients pre-op. It is a difficult problem to solve, like so many problems here or anywhere. Again, I think that developing a sense of professionalism along with a sense of responsibility to patients will go a long way toward solving these problems.

In the OR we started with a Lebanese gentleman who has a hernia. Unfortunately just before getting his spinal, he developed severe acid reflux and hiccoughs, and so anesthesia has postponed or cancelled his surgery. We are waiting to hear which. Konneh and I then did a hernia on a prisoner which went well. So then we did another man with an inguinal hernia and bilateral hydroceles, and then a perirectal abscess, and finally we did the hernia on the Lebanese man under MAC. The anesthesiologist was nervous about using much, so she asked me if I could do a regional nerve block and local. So that is what we did, using some Versed and some Ketamine, and local. I did it with Moses, fairly quickly and easily, and that kept everyone happy.

Now it is not yet 2 PM and we have finished our 4 cases much to everyone's surprise and delight. Tomorrow we might schedule more than 4 ! I went to clinic with Moses and saw an amazing variety of pathology. A 19 year old woman with a weird eruption on her nose and nasolabial folds which has been present for 15 years. I took pictures and hope that someone will help me figure out what it is. A young man who had a large portion of his lower lip bit off several weeks ago. An old man with a hard mass in the flexor compartment of his right forearm. A baby with torticollis. And a middle-aged woman with a huge abdominal mass which is probably ovarian in origin. We will try to get her in to operate on her. Then Konneh and I went to see a woman who is a friend of Aunt Jennie's who has a weird story including severe diarrhea, profound weight loss, atrial fibrillation, and an enlarged thyroid. Apparently her thyroid has shrunk considerably on medication, so I am inclined to keep that going.

Ben came over to the house, and then we went to the RLJ resort to drop off a package and have a drink. After that Dewalt picked us up and we went to PJ's Steakhouse where we met the other HEARTT people as well as some other ex-pats working for The World Bank, The Carter Center, WHO, and others. An interesting group and good conversation.