THursday Septerber 16

The rest of the HEARTT team went on the chopper to Nimba today, but we had a lot of cases scheduled, including the 16 year old with the burn contracture, so I decided to not take the Nimba trip. Adamah had suggested that I could do the contracture on Friday instead, but I didn't think that would be right after a lot of people worked to get him admitted yesterday.

Before we did him, however, we did several cases including a 34 year old woman with locally advanced breast cancer. She had come to the doctor complaining of a "knot" in her right breast for the past year or two. Rumor has it that she went to either Ghana or the Cote d'Ivoire and had a biopsy done, which might account for the open wound in her upper outer breast. She also had palpable matted axillary nodes. Moses and I talked about how one deals with such cases; he said that if he had seen her in the clinic he would have recommended that she return to wherever the biopsy was done. However, since she was admitted to the hospital, he felt an obligation to give her her money's worth and go ahead with the mastectomy. Not an ideal situation at all.

Then we did the burned boy. We excised the keloid/contracture from mid chest up onto his face and chin. We also tried to fix his extropion. I hope we have improved things for him, but I'm not sure. Serious burn care with rehabilitation and everything else necessary is just not available in Liberia. This boy needs far more than we are able to give him, but perhaps we have made a first step.

The Nimba travelers are back. They went to see this hospital built by the Chinese in a relatively remote area of Liberia. The facilities are beautiful, but whether it can function as a hospital remains to be seen. Hospitals require a lot more than just a building; it is not clear where the people in charge think they are going to get either the money or the staff to run it. For instance, they have 3 diesel generators to supply power to the facility, but it is estimated that it will cost in the range of $250,000 a year for the fuel. To say nothing of the fact that it is a 9 hour drive from the port of Monrovia where diesel comes in, and the roads are virtually all dirt. Oh, and the government is suggesting a budget of $500,000 a year for the hospital. No, the economics make no sense.