Tuesday September 14

The girl from yesterday is doing alright; we will just hope she keeps it up. We had 5 cases scheduled for today, but 3 were cancelled/postponed for a variety of reasons. So Moses and I repaired an incisional hernia in a large woman, and then bilateral inguinal hernias and an umbilical hernia in a 9 year old.

Then we went to the Outpatient Clinic and saw the usual wide variety of interesting and amazing pathology, in addition to a gazillion hernias in all ages. One notable patient is a 16 year old boy who had acid thrown on his face 5 months ago. It mostly struck the right side, so he has lost most of his right ear, and has a severe extropion from scar contracture; he says he can still see out of his right eye. In addition, and the area where I think we can help, the right side of his chin and mouth are essentially fused to his neck by contracture. He walks around with a towel covering his head and face.

After first seeing him, I asked Konneh what we could do. He appropriately said that the boy needs a plastic surgeon, but there aren't any in Liberia. So I suggested that we could and should at least try to help by releasing his neck contracture. He agreed, and then we spent a little time figuring out how we can get him admitted and done before I leave. I called Adamah, and he said that if it was something I wanted to do, then he would take care of surmounting the financial hurdles, which he did. So the hospital waived the usual fees for admission and surgery, and he will be admitted today for surgery either tomorrow or Thursday. Obviously this a just the first in a series of operations for this unfortunate man; I hope that we can eventually get him to the point where he doesn't feel the need to cover his head and face, but I know I am being wildly optimistic. After him we saw a woman with a bloody nipple discharge who needs a duct excision, and then another older woman with an advanced, fungating breast cancer. We will try to do both of those surgeries on Friday.

I am still waiting to hear if we will be going to Nimba tomorrow. This is the town and county where Adamah grew up, and by some remarkable circumstance it is where the Chinese have built a new hospital, complete with CT scan, to serve that area of Liberia. The Ministry of Health would like HEARTT to expand to that hospital, so Adamah wants to go up to see it. It is an 8 or 9 hour drive there from Monrovia, so using a few connections, he has been trying to get a UN helicopter to fly us there. I think they have agreed in principle, so now the only question is which day. If it is tomorrow I can do it, but if it is Thursday or Friday I won't be able to go as I have too much surgery to do before I leave on Sunday.