Sunday September 19

We had a few drinks at Rob's house along with the Minister of Defense and the Minister of Maritime Affairs; they were both quite interested. What we were doing, and interesting to talk to about Liberia. Rob and his wife Clare were also quite fun to chat with. Then we went out to the Red Lion where they had a live band. Eventually Ben arrived; we met a crew from CNN and they were interesting to talk to.

Now I have packed up and I am ready to leave. As it turns out, Madame President is on the same flight with us, as she is going to NYC for the Clinton Conference and then the opening of the UN General Assembly. I believe she will be speaking at the Clinton Conference. So a lot of her staff as well as Aunt Jenny are on the flight with us. Adamah talked to the Delta manager at the airport about upgrading me to Business; she came back and said it would be $2000+ to do so. He mentioned this to Aunt Jenny, and that he was pissed about it; she has spoken to someone so we will see what happens. In the meantime Adamah and I agreed that, at his insistence, we could switch in Accra...but when we boarded he insisted that I take 4F, so here I am. As it turns out, the purser on the flight is an ex-girlfriend of his ! So he is sitting in Business Class to Accra at least, and they are working on an upgrade to Atlanta. He says that he really doesn't mind flying in coach; I have to say that I really like the legroom and ability to sleep in the up front seats on long flights. So I am feeling less and less guilty about taking his seat !

I think this has been another useful and educational trip for me. There is a certain excitement which comes from being present in a country which is really just be beginning to recover from a horrible war. While the Liberians have every right to be angry with the world and their lot in it, and depressed, and feeling hopeless, they do not appear to feel that way at all. They appear optimistic for the most part, and eager to progress with rebuilding their devastated country. There is so much that needs to be done, and it will take a lot of time and money and patience; they certainly seem to have the will and determination to accomplish it. Personally, I don't that they would have made nearly as much progress as they have without the steady hand and vision of President Sirleaf. This 70+ year old woman could easily be living an easier life anywhere else in the world, but here she is working 12 to 15 hour days trying to make Liberia a better place. I doubt that any other Liberian politician would have had the success that she has had in convincing creditors to forgive Liberia's debt to the extent that they have.

In terms of the medical/surgical work, i think it was useful for me to come and do 38 cases with Moses and Konneh. I think there was mutual education, and I certainly have a better feel for what they are dealing with professionally. I am looking forward to coming back here in March with residents, and I think we can continue the mutual education process. If we were to pick one big area to concentrate on, perhaps it would be to introduce the concept of short stay surgery. There really is no need for a healthy, educated, motivated patient to stay in the hospital for 3 nights, including a pre-op night, for a hernia repair. Addressing this would free up some needed beds, potentially make it cheaper for the patient, and would really be moving in the direction they need to go. Clearly there are hurdles to cross: anesthesia and the bureaucracy are two which spring to mind immediately. But these are not insurmountable problems; we just need to find the Liberian solution to solving them.