Wednesday September 8

I have developed a head cold, but I am thankful that I packed some Sudafed. Today we did 3 cases: a urethral stricture, bilateral hernias, and at last the young man with the periumbilical mass. The urethral stricture was a youngish man who had a laparotomy a few months ago. According the Moses and Konneh, pre-operatively the nurse put in a
Foley but not all the way,and then blew up the balloon disrupting his urethra and causing a subsequent stricture. We attempted to dilate the stricture, but couldn't pass any of the rather large sounds thru it. Eventually we opened his bladder, and then his membranous urethra, and finally we managed to get both a retrograde Foley through his urethra, or neo-urethra, and then also a supra pubic tube. Honestly I'm not sure we left him any better off, but we shall hope. The second case was bilateral minimal hernias which Moses and I did fairly quickly . The final case was the mass,which turned out to be an enormous cancer involving his transverse colon and stomach, and he had liver mets. It was clearly unresectable, so we just closed him up .

Tonight Simon arrived, and after dinner here with Erin, Nathan, and James, we all wen with Ben to Golden Beach to have a few drinks while sitting at the shore and listening to then surf. it was quite a pleasant evening.

The place where I am staying is not far from the hospital, and is a house with 3 bedrooms. Apparently the hospital rents it for use by visiting doctors. This section of Monrovia has no electricity supply ( 80% of the homes in Monrovia are not connected to the national grid) so we have a generator stalled in the carport. It's hard to know which is more annoying: the sound of the generator running or the smell of diesel exhaust. I think I have gotten used to the sound, so I would go for the smell as being the most annoying ! Anyway, 2 boys Frederick and another are paid to watch and care for the place. It is in the middle of some pretty poor housing, so I imagine that having guards is rather important. Adamah explained to them early on what he expected from them, and they seem to understand; they are friendly and helpful and I believe trustworthy.