Wednesday March 16
We all packed last night in anticipation of a busy day. We had breakfast at the Guest House, and then were invited to have breakfast with Madame President. So we went next door to her house, and after taking pictures with her, we sat down for another breakfast, She thanked me for my note sent the previous day, in which I thanked her for her hospitality and congratulated her on being named the Commencement speaker at the Harvard graduation this year.
Adamah told her about the young mother whose 3 year old son's hernia we fixed on Monday. I can't remember if I wrote his, but the woman has been disowned by her family because she is Muslim and she married a Christian; she is totally illiterate, and has no understanding of time or money. Anyway, the President's reaction immediately was that we will do something to help her. She said she would try to get her a job or something. By the time we got to the hospital about 20 minutes later, the President had already spoken to Dr. McDonald about her and a process had started. I guess it is one of the things about a small country that people in positions of power can more easily do things to help, perhaps; I think it is also a testament to President Sirleaf that she naturally and quickly responds to problems in this way. At the end of breakfast, she announced " it's time to do the people's business" and set off to work.
We went to hospital to say goodbye to patents and staff. As before, the next thing after "goodbye" was "when are you coming back?" there really was a sense of warmth and affection on both sides with our goodbyes, which was quite gratifying. While I was at the hospital Sondra Tyler caller. she had just received the note I left at RLJ on Sunday, and the guy from the Philanthropy Secretariat had forgotten to tell her that I was there looking for her. In any case, they were having a busy time, and they are scheduled to visit JFK on Thursday. I asked her to speak with Dr. McDonald personally, andnshe said she would. We agreed that we would have a nice long conversation when we bother were home.
Adamah was in meetings so we went to Front St. with Dewalt and Albert driving to go shopping at the mask store; additionally drums were purchased across the street. Then we went back to the Guest House to have lunch, say our goodbyes to the staff, and wait for Adamah to come so we could leave for the airport. He was rather late, so we didn't leave the Guest House till 3:35, and we drove like a bat out of hell to the airport. I was sitting in the back so I could see the speedometer well, and Albert hit 140 km/hr, or 87 mph on the two lane road to the airport, dodging taxis and trucks, and intermittently giving me cause to wonder if we would make it alive to the airport. Fortunately we did make it, arriving around 4:15 for our 5:30 flight; initially they said they wouldn't check us in because it was too late, but some phone calls were made and eventually we did get checked in and through security to board the plane. I told Adamah that next time maybe I would make my own arrangements to travel to the airport !!
We are now in Atlanta on the way home.
Thursday, March 17, 2011
Wednesday, March 16, 2011
Tuesday March 15
Tuesday March 15
Today is a national holiday celebrating the birth of the first President of Liberia, Mr Roberts, so we did a short schedule. We biopsied a groin node on Joseph N, a 20 year old who looks like he has a Burkitt's lymphoma despite being so,what older than usual for it. I will bring the nodal tissue back to Waterbury, where our pathologists have become quite interested in looking at Liberian tissue samples for us. As fate would have it, just the other day I was talking with some of the pediatric residents and attendings at dinner, and they told me about a protocol they have been using with success for Burkitts using methotrexate, cyclophosphamide, and prednisone. I asked them today if they would be willing to try it on Mr Nah if his pathology shows Burkitts, and they said absolutely, so we shall see what happens.
After Mr Nah we did Hans B, a 30s aged economist with the Ministry of Finance, who has a located pleural effusion from TB. He has one chest tube in place, but apparently still has an effusion, so Dr Mike asked if we would do a typewriting and decortication. Santiago and I discussed it several times, and in e end we decided that it just wouldnt be the right thing for us to do for all sorts of reasons, including anesthesia, post-op pain control and breathing, the fact that we are leaving tomorrow, and the fact that neither of us are boracic surgeons. So we put another chest tube in, and didn't get much drainage despite significant manipulation, but we decided to leave well enough alone.
This afternoon we had a fascinating trip to Toode Mission School, about an hour away, and we were accompanied by Adamah's Aunt Ophelia ( she is married to Varney, the Presidents brother). Ophelia is a fascinating woman who has her Masters in geology or something, and has taken on this school as her project. In fact, the school was started by the President's mother, and was pretty much destroyed during the war. Ophelia now has it up and running with 106 students, about 30 being day students and the rest boarders. Boarding costs about $550 a year, but no one is turned away for lack of ability to pay, and in fact none of the students are paying full fees. The age/grades go from kindergarten to 10th grade. The students we met were great: healthy, happy, friendly, and outgoing ! A group of the girls sang for us, and everyone smiled for the many cameras. The current principal is a retired school administrator from Bridgeport, CT who volunteered in the ED at Bridgeport Hospital where he met Adamah and became interested in Liberia. He was looking for an opportuntity to use his skills where they were really needed, and this came along, so he is spending 4 months helping in Liberia. It was quite an inspiring visit, and I particularly enjoyed the opportunity to chat with Ophelia about how this project came to happen for her.
On the way back we stopped at the graves of Adamah's father, and of his uncle Dr. Varsay Sirleaf, which are quite close to the school. Then we drove back to Monrovia and stopped the family compound where two of his brothers live, and we discovered that there was a big celebration going on, perhaps because of the holiday, and President Sirleaf was there. There were a lot of people sitting at tables outside, and she came out to say hello. Then we had dinner, and after dinner when she was leaving she came to where we were to take pictures. Protocol does not allow her to have photos taken with people in shorts, so Santiago and I were out. But she told Adamah that she would meet us in the morning for pictures, so that works out better as Jenn and Eric did not make the trip; her Tubman's revenge continues to be a problem.
Today is a national holiday celebrating the birth of the first President of Liberia, Mr Roberts, so we did a short schedule. We biopsied a groin node on Joseph N, a 20 year old who looks like he has a Burkitt's lymphoma despite being so,what older than usual for it. I will bring the nodal tissue back to Waterbury, where our pathologists have become quite interested in looking at Liberian tissue samples for us. As fate would have it, just the other day I was talking with some of the pediatric residents and attendings at dinner, and they told me about a protocol they have been using with success for Burkitts using methotrexate, cyclophosphamide, and prednisone. I asked them today if they would be willing to try it on Mr Nah if his pathology shows Burkitts, and they said absolutely, so we shall see what happens.
After Mr Nah we did Hans B, a 30s aged economist with the Ministry of Finance, who has a located pleural effusion from TB. He has one chest tube in place, but apparently still has an effusion, so Dr Mike asked if we would do a typewriting and decortication. Santiago and I discussed it several times, and in e end we decided that it just wouldnt be the right thing for us to do for all sorts of reasons, including anesthesia, post-op pain control and breathing, the fact that we are leaving tomorrow, and the fact that neither of us are boracic surgeons. So we put another chest tube in, and didn't get much drainage despite significant manipulation, but we decided to leave well enough alone.
This afternoon we had a fascinating trip to Toode Mission School, about an hour away, and we were accompanied by Adamah's Aunt Ophelia ( she is married to Varney, the Presidents brother). Ophelia is a fascinating woman who has her Masters in geology or something, and has taken on this school as her project. In fact, the school was started by the President's mother, and was pretty much destroyed during the war. Ophelia now has it up and running with 106 students, about 30 being day students and the rest boarders. Boarding costs about $550 a year, but no one is turned away for lack of ability to pay, and in fact none of the students are paying full fees. The age/grades go from kindergarten to 10th grade. The students we met were great: healthy, happy, friendly, and outgoing ! A group of the girls sang for us, and everyone smiled for the many cameras. The current principal is a retired school administrator from Bridgeport, CT who volunteered in the ED at Bridgeport Hospital where he met Adamah and became interested in Liberia. He was looking for an opportuntity to use his skills where they were really needed, and this came along, so he is spending 4 months helping in Liberia. It was quite an inspiring visit, and I particularly enjoyed the opportunity to chat with Ophelia about how this project came to happen for her.
On the way back we stopped at the graves of Adamah's father, and of his uncle Dr. Varsay Sirleaf, which are quite close to the school. Then we drove back to Monrovia and stopped the family compound where two of his brothers live, and we discovered that there was a big celebration going on, perhaps because of the holiday, and President Sirleaf was there. There were a lot of people sitting at tables outside, and she came out to say hello. Then we had dinner, and after dinner when she was leaving she came to where we were to take pictures. Protocol does not allow her to have photos taken with people in shorts, so Santiago and I were out. But she told Adamah that she would meet us in the morning for pictures, so that works out better as Jenn and Eric did not make the trip; her Tubman's revenge continues to be a problem.
Tuesday, March 15, 2011
Monday March 14
Monday March 14
Jenn had to take the day off today as she has developed rather severe Tubman's revenge. We went in thinking that we would have a couple of small cases to do, but as often happens that was not the case. We found several emergencies to keep ourselves busy for most of the day.
First Yuk did a hypospadius repair with Konneh, and while she was doing that, Santiago, Eric, and I went to the ER to see a couple of patients. One was a man with a large scrotal mass, and the other was a man with peritonitis who was guarding and tympanitic, and looked like he was either obstructed or perforated or both. Then we had a call from Jenn saying that she had received a call from the mother who had shown up at the Guest House yesterday with her 3 year old son Santa saying that now they were at the ED. So we went in search of them, and found her and the 2 kids, one strapped to her back, and all of her worldly possessions in a blue plastic bag she was carrying on her head.
I should back up a day. When Santiago, Adamah, and I came back from our visit to JFK with the President, we found a woman with 2 young children sitting in the carport with a policeman standing next to her and the two psychiatrists also staying in the Guest House sitting nearby talking to her. The story was that she was from Nimba County; she is Muslim and had married a Christian who died in a car accident 7 months ago; as a result of the marriage she was ostracized from her family, and had no means of support; and her 3 year old son had a large communicating hydrocele. The policeman had taken pity on her, and had brought her to the Guest House because he knew that Adamah was in town and that HEARTT could possibly take care of her. So anyway, after much discussion, we said that we would take care of her, and that she should come to the hospital in the morning. In fact, Jenn asked her to come at 9:30 AM, but Adamah pointed out that she is illiterate, and actually had no concept of what 9:30 meant.
Anyway, she showed up, and had actually remembered to keep Santa NPO, so there was a good chance we could do his surgery today, if we could get through the necessary hoops. Fortunately we ran into Mary, the Clinical Coordinator, who took charge and made sure that it was all done expeditiously.
We went back up to the OR to learn that the next case was another emergency, but this one had been admitted yesterday with a strangulated right inguinal hernia. Why his surgery wasn't done yesterday by Dr. Muvu remains a mystery. Anyway, he is 33 years old and had a huge recurrent hernia. Yuk and I started the case under spinal, but found on opening the sac that his right colon was in it and dead. We converted to a laparotomy, and after some urging by me, anesthesia converted him to general anesthesia. On opening his abdomen, we found more dead bowel, but some still alive, so I asked Santiago to scrub in. We ended up resecting about half of his small bowel, and his right colon up to mid-transverse colon. At one point I saw his blood pressure was 50, and I was pretty convinced he was not going to survive. We removed his dead bowel quite expeditiously, and also his dead right testicle, and gave him an ileostomy.
After that we learned that the man with the acute abdomen in the ED had expired; I thought he was sick, but I was surprised at the speed of his demise. Moses went to see the man with the scrotal mass, and said that it was filariasis (elephantiasis) and did not require surgery. So Yuk and I did the 3 year old next, and that was uneventful, while Moses and Santiago did an incarcerated umbilical hernia next door.
On post-op rounds, we saw the man with the strangulated hernia and now with an ileostomy. He looked remarkably good for what he had been through. I explained that we had to remove half of his intestines, and that he had a temporary ileostomy which could be reversed in a couple of months. He held out his hand to shake mine, and said "thank you" in a very heartfelt way. As Santiago said, he knew he had been close to death, and he appreciated that his life had been saved; it was quite a memorable moment.
We came back to the Guest House to find Jenn in about the same condition; she said that the staff, especially Catherine and Welke, had been checking on her during the day. Having collected the necessary supplies from the hospital, we then did a little home surgery in the kitchen to remove a 3 cm lipoma from Catherine's upper arm; while conditions were somewhat primitive, the surgery was successful !
Santiago, Catherine the psychiatry resident, and I then went for dinner at Cafe Jamal with Yuk, Melissa, Robyn, and Guy, a visiting medical student from Oxford. We had an interesting conversation on a number of topics, and then back here for bed.
Jenn had to take the day off today as she has developed rather severe Tubman's revenge. We went in thinking that we would have a couple of small cases to do, but as often happens that was not the case. We found several emergencies to keep ourselves busy for most of the day.
First Yuk did a hypospadius repair with Konneh, and while she was doing that, Santiago, Eric, and I went to the ER to see a couple of patients. One was a man with a large scrotal mass, and the other was a man with peritonitis who was guarding and tympanitic, and looked like he was either obstructed or perforated or both. Then we had a call from Jenn saying that she had received a call from the mother who had shown up at the Guest House yesterday with her 3 year old son Santa saying that now they were at the ED. So we went in search of them, and found her and the 2 kids, one strapped to her back, and all of her worldly possessions in a blue plastic bag she was carrying on her head.
I should back up a day. When Santiago, Adamah, and I came back from our visit to JFK with the President, we found a woman with 2 young children sitting in the carport with a policeman standing next to her and the two psychiatrists also staying in the Guest House sitting nearby talking to her. The story was that she was from Nimba County; she is Muslim and had married a Christian who died in a car accident 7 months ago; as a result of the marriage she was ostracized from her family, and had no means of support; and her 3 year old son had a large communicating hydrocele. The policeman had taken pity on her, and had brought her to the Guest House because he knew that Adamah was in town and that HEARTT could possibly take care of her. So anyway, after much discussion, we said that we would take care of her, and that she should come to the hospital in the morning. In fact, Jenn asked her to come at 9:30 AM, but Adamah pointed out that she is illiterate, and actually had no concept of what 9:30 meant.
Anyway, she showed up, and had actually remembered to keep Santa NPO, so there was a good chance we could do his surgery today, if we could get through the necessary hoops. Fortunately we ran into Mary, the Clinical Coordinator, who took charge and made sure that it was all done expeditiously.
We went back up to the OR to learn that the next case was another emergency, but this one had been admitted yesterday with a strangulated right inguinal hernia. Why his surgery wasn't done yesterday by Dr. Muvu remains a mystery. Anyway, he is 33 years old and had a huge recurrent hernia. Yuk and I started the case under spinal, but found on opening the sac that his right colon was in it and dead. We converted to a laparotomy, and after some urging by me, anesthesia converted him to general anesthesia. On opening his abdomen, we found more dead bowel, but some still alive, so I asked Santiago to scrub in. We ended up resecting about half of his small bowel, and his right colon up to mid-transverse colon. At one point I saw his blood pressure was 50, and I was pretty convinced he was not going to survive. We removed his dead bowel quite expeditiously, and also his dead right testicle, and gave him an ileostomy.
After that we learned that the man with the acute abdomen in the ED had expired; I thought he was sick, but I was surprised at the speed of his demise. Moses went to see the man with the scrotal mass, and said that it was filariasis (elephantiasis) and did not require surgery. So Yuk and I did the 3 year old next, and that was uneventful, while Moses and Santiago did an incarcerated umbilical hernia next door.
On post-op rounds, we saw the man with the strangulated hernia and now with an ileostomy. He looked remarkably good for what he had been through. I explained that we had to remove half of his intestines, and that he had a temporary ileostomy which could be reversed in a couple of months. He held out his hand to shake mine, and said "thank you" in a very heartfelt way. As Santiago said, he knew he had been close to death, and he appreciated that his life had been saved; it was quite a memorable moment.
We came back to the Guest House to find Jenn in about the same condition; she said that the staff, especially Catherine and Welke, had been checking on her during the day. Having collected the necessary supplies from the hospital, we then did a little home surgery in the kitchen to remove a 3 cm lipoma from Catherine's upper arm; while conditions were somewhat primitive, the surgery was successful !
Santiago, Catherine the psychiatry resident, and I then went for dinner at Cafe Jamal with Yuk, Melissa, Robyn, and Guy, a visiting medical student from Oxford. We had an interesting conversation on a number of topics, and then back here for bed.
Monday, March 14, 2011
Sunday March 13
Sunday March 13
I was resting comfortably in that netherworld between sleep and awake when my phone rang around 9 AM. It was Adamah who said that Auntie Jennie wanted to speak to me; she then got on the phone to ask if I was up and about. I said of course, and she asked if I would come next door to the President's house as she wanted to speak to me. I got up, put in my contacts, and quickly dressed. I was ushered into the President's house, and upstairs when I met Madame and Auntie Jenny in the hallway so we all went into the dining room together where Adamah and Rob were waiting. Apparently the President was out with people yesterday, and one of the young men she spoke with was later assaulted and stabbed; he was brought to JFK and observed overnight. His hemoglobin was 8.6 and apparently there was some concern that he had lost enough blood to need a transfusion. Dr. Moses had seen him and said that he could be discharged, but apparently someone was worried about that, and by means unknown, had contacted Auntie Jennie, and now the President was concerned. So she wanted to know if I would be willing to go to JFK to provide another surgical opinion, and of course I said yes. Adamah asked if I wanted to bring anyone with me, and I thought that in case it was serious, it would be good to have Santiago along. So he was roused from bed by Dewalt since he wouldn't answer his phone, and soon he was at the table eating breakfast with us.
The President decided she wanted to go to JFK to see this man and his family also on her way to church. So before long, we went downstairs and I was told to ride in the Presidential limousine with herself; Santiago rode in the Secret Service vehicle ahead, with 3 M-16s on the seat next to him. We proceeded the short distance to JFK, and were met by the CMO Dr. Johnson, and then went through the hospital to the Trauma ER where we found the patient. He had a small laceration on his right shoulder, and a superficial laceration of his left upper abdominal wall; he was stable, talking, and in no distress. I assured the President that he was fine. The patient's mother was then brought in, and she talked for several minutes about what had happened to her son, and the fact that she couldn't donate blood last night when he came in because she had been drinking beer, and a whole lot more which I couldn't understand. I was quite astonished that this woman was yammering on so much to the President, but Madame took it all in stride and only commented at the end on how important it was to reduce violence among young people. We all then went outside, where the President said that we should not go back to JFK today, but rather we should take the day off and go to the beach ! She then left for church and we came back here.
In the afternoon we went to RLJ as instructed by the President ! My sister-in-law's friend Sondra Tyler was arriving with her group to stay at RLJ for a few days, so I left a note for her at the desk and also spoke to one of the people from the host organization, but I haven't heard back yet.
We left the beach around 6:30 to go back to the Guest House. Later we went for dinner at Sajj, and then home to get to bed early, at least compared to our last couple of nights.
I was resting comfortably in that netherworld between sleep and awake when my phone rang around 9 AM. It was Adamah who said that Auntie Jennie wanted to speak to me; she then got on the phone to ask if I was up and about. I said of course, and she asked if I would come next door to the President's house as she wanted to speak to me. I got up, put in my contacts, and quickly dressed. I was ushered into the President's house, and upstairs when I met Madame and Auntie Jenny in the hallway so we all went into the dining room together where Adamah and Rob were waiting. Apparently the President was out with people yesterday, and one of the young men she spoke with was later assaulted and stabbed; he was brought to JFK and observed overnight. His hemoglobin was 8.6 and apparently there was some concern that he had lost enough blood to need a transfusion. Dr. Moses had seen him and said that he could be discharged, but apparently someone was worried about that, and by means unknown, had contacted Auntie Jennie, and now the President was concerned. So she wanted to know if I would be willing to go to JFK to provide another surgical opinion, and of course I said yes. Adamah asked if I wanted to bring anyone with me, and I thought that in case it was serious, it would be good to have Santiago along. So he was roused from bed by Dewalt since he wouldn't answer his phone, and soon he was at the table eating breakfast with us.
The President decided she wanted to go to JFK to see this man and his family also on her way to church. So before long, we went downstairs and I was told to ride in the Presidential limousine with herself; Santiago rode in the Secret Service vehicle ahead, with 3 M-16s on the seat next to him. We proceeded the short distance to JFK, and were met by the CMO Dr. Johnson, and then went through the hospital to the Trauma ER where we found the patient. He had a small laceration on his right shoulder, and a superficial laceration of his left upper abdominal wall; he was stable, talking, and in no distress. I assured the President that he was fine. The patient's mother was then brought in, and she talked for several minutes about what had happened to her son, and the fact that she couldn't donate blood last night when he came in because she had been drinking beer, and a whole lot more which I couldn't understand. I was quite astonished that this woman was yammering on so much to the President, but Madame took it all in stride and only commented at the end on how important it was to reduce violence among young people. We all then went outside, where the President said that we should not go back to JFK today, but rather we should take the day off and go to the beach ! She then left for church and we came back here.
In the afternoon we went to RLJ as instructed by the President ! My sister-in-law's friend Sondra Tyler was arriving with her group to stay at RLJ for a few days, so I left a note for her at the desk and also spoke to one of the people from the host organization, but I haven't heard back yet.
We left the beach around 6:30 to go back to the Guest House. Later we went for dinner at Sajj, and then home to get to bed early, at least compared to our last couple of nights.
Sunday, March 13, 2011
Saturday March 12
Saturday March 12
No one really wanted to get up this morning, but we did anyway. I did a hernia repair with Chris Hughes, which was a fun experience for both of us. After the surgery and rounds, we came back to the guest house for a nap.
Late in the afternoon Dr. McDonald came over with Althea and 2 of the Rhode Island Liberian nurses to have lunch. I sat with them, and Dr. McDonald told of the conditions at JFK right after the war. There was no food for patients, or water, or electricity; it is hard to imagine coming back to such circumstances and seeing a way out, but they did.
In the evening we attended the HEARTT Gala fundraiser at City Hall. This was the first time they have tried to raise money in Liberia to support HEARTT, and it was an unqualified success ! The President attended as the Guest of Honor, and I'm sure that was the big draw. They sold all 250 available tickets, and had another 100 people on a waiting list. Several people gave testimonials about their experience; I spoke briefly about the honor and privilege of being part of HEARTT.
After the dinner and speeches, Madame President made the rounds of the room greeting guests while Eric did an amazing and wonderful rendition of Amazing Grace on his trumpet, accompanied by the keyboard player from the band. He started out with the standard tune, and then morphed into a jazz rendition that was awesome. The President then came over and asked Eric to play it again when she was back in her seat so that she could really listen and enjoy it. So he played it again and she clearly loved it, tapping along to the jazzy beat.
As the evening was breaking up and we were all milling about, a young woman came up to me to say that she heard me say I was from Connecticut, and that she had gone to school in Connecticut. I asked her where, and she said "Choate Rosemary Hall" ! Her name is Idella Cooper, CRH '94 , and she is the Deputy Minister for Justice for Economic Affairs . Her fiancé took our picture together, which I will be submitting to the CRH Alumni magazine...who would have guessed that 2 CRH alumni would meet up in Monrovia, Liberia ?!
From the gala at City Hall we all went to Groovie's for more dancing. Eric sat in with the band for several tunes and was awesome; having him with us on this trip has definitely added an unexpected dimension of enjoyment for all of us. The band and the singer were fantastic, and we all had a great time dancing. After Groovie's we went to the Palm Springs Casino; I had a very pleasant chat with the President's social secretary, who invited me to come back next January for the President's inauguration !! Assuming she is re-elected of course, but of that there can be little doubt at this point. One should never overestimate the intelligence of a voting population, but it would seem particularly foolish not to reelect her to keep the very powerful sense of forward momentum going. After a good discussion with Wilfred and Michelle at the bar, we all piled into vehicles and headed home to bed.
Oh I forgot to mention one detail. Santiago dared me to get the phrase "Easy Peasy Lemon Squeezy" into my remarks...and I did so seamlessly ! It was a big hit for those in the know lol
No one really wanted to get up this morning, but we did anyway. I did a hernia repair with Chris Hughes, which was a fun experience for both of us. After the surgery and rounds, we came back to the guest house for a nap.
Late in the afternoon Dr. McDonald came over with Althea and 2 of the Rhode Island Liberian nurses to have lunch. I sat with them, and Dr. McDonald told of the conditions at JFK right after the war. There was no food for patients, or water, or electricity; it is hard to imagine coming back to such circumstances and seeing a way out, but they did.
In the evening we attended the HEARTT Gala fundraiser at City Hall. This was the first time they have tried to raise money in Liberia to support HEARTT, and it was an unqualified success ! The President attended as the Guest of Honor, and I'm sure that was the big draw. They sold all 250 available tickets, and had another 100 people on a waiting list. Several people gave testimonials about their experience; I spoke briefly about the honor and privilege of being part of HEARTT.
After the dinner and speeches, Madame President made the rounds of the room greeting guests while Eric did an amazing and wonderful rendition of Amazing Grace on his trumpet, accompanied by the keyboard player from the band. He started out with the standard tune, and then morphed into a jazz rendition that was awesome. The President then came over and asked Eric to play it again when she was back in her seat so that she could really listen and enjoy it. So he played it again and she clearly loved it, tapping along to the jazzy beat.
As the evening was breaking up and we were all milling about, a young woman came up to me to say that she heard me say I was from Connecticut, and that she had gone to school in Connecticut. I asked her where, and she said "Choate Rosemary Hall" ! Her name is Idella Cooper, CRH '94 , and she is the Deputy Minister for Justice for Economic Affairs . Her fiancé took our picture together, which I will be submitting to the CRH Alumni magazine...who would have guessed that 2 CRH alumni would meet up in Monrovia, Liberia ?!
From the gala at City Hall we all went to Groovie's for more dancing. Eric sat in with the band for several tunes and was awesome; having him with us on this trip has definitely added an unexpected dimension of enjoyment for all of us. The band and the singer were fantastic, and we all had a great time dancing. After Groovie's we went to the Palm Springs Casino; I had a very pleasant chat with the President's social secretary, who invited me to come back next January for the President's inauguration !! Assuming she is re-elected of course, but of that there can be little doubt at this point. One should never overestimate the intelligence of a voting population, but it would seem particularly foolish not to reelect her to keep the very powerful sense of forward momentum going. After a good discussion with Wilfred and Michelle at the bar, we all piled into vehicles and headed home to bed.
Oh I forgot to mention one detail. Santiago dared me to get the phrase "Easy Peasy Lemon Squeezy" into my remarks...and I did so seamlessly ! It was a big hit for those in the know lol
Saturday, March 12, 2011
Friday March 11
Friday, March 11
The first news this morning was that the elevator was broken and therefore surgery was delayed; later in the day they got it working again. Then we learned that the woman with the breast cancer upon whom we operated yesterday did not survive the night. I can't say that it was a huge surprise, given her overall condition, but still it came as something of a shock. And I forgot to mention in yesterday's posting that one of the esophageal dilations from Tuesday had died. Little Marie was terribly malnourished; the feeling is that perhaps there was a perforation with the dilation, but who knows.
When we finally got to the OR, we started the day with me and Yuk doing a 12 year old boy with an inguinal hernia, and found that his appendix was stuck in the hernia sac. This has a name which escapes me at present, but I will look it up when I can. The next case was a boy with a 3 cm mass on his heel, which was advertised as a lipoma, but it wasn't; rather, I think it was some sort of hemangioma which one of us had ever seen before. I took some pieces of it for pathology, and perhaps that will help us figure out what it was and whether further surgery will be needed. Next I did an adult hernia with Dr. Cocola, and that went well; I think he is trainable, but he will need a good teacher.
Between cases I went to the Administration building to meet Mr. Ofora, whose wife has been organizing our meals here at the guest house. He had a neck operation locally many years ago, then more, the last being at Howard University several years ago. He has what appears to me to be a hemangioma in his lower right neck, but it also involves the right half of his tongue. He says his tongue is enlarging and it is starting to make it difficult to eat and talk. He said that with his last surgery he had a trach rather than endo tracheal or nasotracheal intubation. I'm not sure what ICANN do, but I told him that I would research it and see if something can be done with laser or other modern means. How it would get paid for if he had to go to the USA is another problem.
After that Santiago and I did the most massive hernia I have ever done ! We both thought it would be fun to operate together again like we did when he was a resident, and indeed it was a most enjoyable experience. It was a huge inguino-scrotal hernia containing small bowel and cecum, but it all appeared viable,so we reduced it and then repaired the hernia. We both remarked afterwards on how enjoyable it was and that such experiences are an added attraction for former residents who want to come to Liberia.
Tonight we had dinner at the Guest House, and since it is Eric's birthday, they put on a great dinner. There were 25 or 30 people here,and they served wine in addition to the usual beer along was a lovely dinner, and a birthday cake for Eric ! After dinner we went to Tides for a few drinks, and then to Deja Vu for some dancing. We came home around 2:30 AM as we have a hernia to do in the morning, and then the Gala tomorrow night.
The Gala is the first fundraiser for HEARTT held in Monrovia, and it will be a formal affair at City Hall tomorrow night. According to Wilfred, ticket sales were slow until this week when they went through the roof, and currently it is filled to the capacity of 250 with 100 people on a waiting list ! Adamah asked me a few weeks ago if I would say a few words, and I said that I would; now it seems somewhat more daunting a task, especially since it seems like others are interested in hearing what I will say. I'm pretty sure I can pull it off, but it is still a little nerve-wracking to know that I will ve speaking to l the President.
The first news this morning was that the elevator was broken and therefore surgery was delayed; later in the day they got it working again. Then we learned that the woman with the breast cancer upon whom we operated yesterday did not survive the night. I can't say that it was a huge surprise, given her overall condition, but still it came as something of a shock. And I forgot to mention in yesterday's posting that one of the esophageal dilations from Tuesday had died. Little Marie was terribly malnourished; the feeling is that perhaps there was a perforation with the dilation, but who knows.
When we finally got to the OR, we started the day with me and Yuk doing a 12 year old boy with an inguinal hernia, and found that his appendix was stuck in the hernia sac. This has a name which escapes me at present, but I will look it up when I can. The next case was a boy with a 3 cm mass on his heel, which was advertised as a lipoma, but it wasn't; rather, I think it was some sort of hemangioma which one of us had ever seen before. I took some pieces of it for pathology, and perhaps that will help us figure out what it was and whether further surgery will be needed. Next I did an adult hernia with Dr. Cocola, and that went well; I think he is trainable, but he will need a good teacher.
Between cases I went to the Administration building to meet Mr. Ofora, whose wife has been organizing our meals here at the guest house. He had a neck operation locally many years ago, then more, the last being at Howard University several years ago. He has what appears to me to be a hemangioma in his lower right neck, but it also involves the right half of his tongue. He says his tongue is enlarging and it is starting to make it difficult to eat and talk. He said that with his last surgery he had a trach rather than endo tracheal or nasotracheal intubation. I'm not sure what ICANN do, but I told him that I would research it and see if something can be done with laser or other modern means. How it would get paid for if he had to go to the USA is another problem.
After that Santiago and I did the most massive hernia I have ever done ! We both thought it would be fun to operate together again like we did when he was a resident, and indeed it was a most enjoyable experience. It was a huge inguino-scrotal hernia containing small bowel and cecum, but it all appeared viable,so we reduced it and then repaired the hernia. We both remarked afterwards on how enjoyable it was and that such experiences are an added attraction for former residents who want to come to Liberia.
Tonight we had dinner at the Guest House, and since it is Eric's birthday, they put on a great dinner. There were 25 or 30 people here,and they served wine in addition to the usual beer along was a lovely dinner, and a birthday cake for Eric ! After dinner we went to Tides for a few drinks, and then to Deja Vu for some dancing. We came home around 2:30 AM as we have a hernia to do in the morning, and then the Gala tomorrow night.
The Gala is the first fundraiser for HEARTT held in Monrovia, and it will be a formal affair at City Hall tomorrow night. According to Wilfred, ticket sales were slow until this week when they went through the roof, and currently it is filled to the capacity of 250 with 100 people on a waiting list ! Adamah asked me a few weeks ago if I would say a few words, and I said that I would; now it seems somewhat more daunting a task, especially since it seems like others are interested in hearing what I will say. I'm pretty sure I can pull it off, but it is still a little nerve-wracking to know that I will ve speaking to l the President.
Friday, March 11, 2011
Thursday March 10
Thursday March 10
My day in the OR today doing a ventral/umbilical hernia, a breast cancer, and an adult inguinal hernia. I'm not sure why it was so hot in the OR, and maybe it was the new Goretex sterile gowns we were wearing, but especially in the first case I was sweating like it was a steam room.
The 56 year old woman with breast cancer was interesting from several points of view. When I met her in the pre-op area, Moses and Santiago were with me, and without actually looking at her breast, Moses said that this type of patient is the kind that he would delay surgery for a long time, hoping that death would come before he was forced to operate, because the outcome is so dismal. I think there is wisdom in his comments; on the other hand her chest X-ray was normal, and so who knows how long it would take for her to die. The second interesting feature was that her breast cancer was unlike anything I have ever seen. It looked like a small tree trunk growing up from her chest, and it was hollowed out in the middle. She had an axillary ode the size of a lemon. In any case we took her to surgery, and managed to close the would after doing a mastectomy. I don't know how long she will survive, but I hope that what we did for her improves her remaining time.
While Jenn and I were doing the mastectomy, Dr. Jallah was operating on a girl with a recto-vaginal fistula. She sent out a request for help, and Santiago went in to work his magic. He did some kind of fancy advancement flap to close the defect; hopefully it will work ! I am very pleased that he is here with us, providing expertise to us and the other doctors !
This team is working out well, and everyone seems quite happy with their experience to date. It is also interesting and fun to be here with so many other HEARTT people; I think the cross-cultural exchange ( between medicine,pediatrics, and surgery) benefits all of us more than we realize.
Tonight we all went to Taaj, an Indian restaurant on Tubbman Boulevard near Golden Beach. We had an excellent meal, and great conversation. One of the pediatrics residents was telling me that they do have some IV chemotherapy for kids with retinoblastoma and for Burkitt's lymphoma. She showed me before and after pictures of one boy with a Burkitt's, and his response to chemotherapy in 5 weeks was astonishing ! This type of story is that kind of information that will hopefully get people to realize that there is always hope, and that things are looking up for Liberia.
My day in the OR today doing a ventral/umbilical hernia, a breast cancer, and an adult inguinal hernia. I'm not sure why it was so hot in the OR, and maybe it was the new Goretex sterile gowns we were wearing, but especially in the first case I was sweating like it was a steam room.
The 56 year old woman with breast cancer was interesting from several points of view. When I met her in the pre-op area, Moses and Santiago were with me, and without actually looking at her breast, Moses said that this type of patient is the kind that he would delay surgery for a long time, hoping that death would come before he was forced to operate, because the outcome is so dismal. I think there is wisdom in his comments; on the other hand her chest X-ray was normal, and so who knows how long it would take for her to die. The second interesting feature was that her breast cancer was unlike anything I have ever seen. It looked like a small tree trunk growing up from her chest, and it was hollowed out in the middle. She had an axillary ode the size of a lemon. In any case we took her to surgery, and managed to close the would after doing a mastectomy. I don't know how long she will survive, but I hope that what we did for her improves her remaining time.
While Jenn and I were doing the mastectomy, Dr. Jallah was operating on a girl with a recto-vaginal fistula. She sent out a request for help, and Santiago went in to work his magic. He did some kind of fancy advancement flap to close the defect; hopefully it will work ! I am very pleased that he is here with us, providing expertise to us and the other doctors !
This team is working out well, and everyone seems quite happy with their experience to date. It is also interesting and fun to be here with so many other HEARTT people; I think the cross-cultural exchange ( between medicine,pediatrics, and surgery) benefits all of us more than we realize.
Tonight we all went to Taaj, an Indian restaurant on Tubbman Boulevard near Golden Beach. We had an excellent meal, and great conversation. One of the pediatrics residents was telling me that they do have some IV chemotherapy for kids with retinoblastoma and for Burkitt's lymphoma. She showed me before and after pictures of one boy with a Burkitt's, and his response to chemotherapy in 5 weeks was astonishing ! This type of story is that kind of information that will hopefully get people to realize that there is always hope, and that things are looking up for Liberia.
Thursday, March 10, 2011
Wednesday
Wednesday March 9
Today is Decoration Day, sort of like our Memorial Day, and the day on which families go to the graves of loved ones the clean them up and redecorate them. It is a national holiday, so there isn't much going on, except that we are operating. Moses is back from Lofa County, an 11 hour drive, where he went for the funeral of his mother-in-law or sister-in-law or something. He and Yuk did a hernia on a 3 year old, then Cocola and I did a Halstead repair of a recurrent hernia in a 60 year old, and now Santiago and Jenn are doing Trifecta. It appears to me that she had a strangulated Spigelian hernia, which has to be pretty rare. In any case the surgery went well and was not as difficult as expected, so that was all good.
After the usual HEARTT lunch in the cafeteria at the Maternity Hospital, we were walking back when we met a group including Cynthia Nash, the Liberian Consul in Atlanta; I had met her before on the trip in September. She was leading a group of interested church people and others from Atlanta. A group of us then went sightseeing to Mamba Point and the Hotel Ducor, and then to the Capitol grounds. Following that we came back to the Guest House to wait for everyone else coming for dinner.
Around 7:30 Catherine came into the living room to say that we (Santiago, Jenn, Eric, and me) were wanted next door at the President's house. We went over there to find that all of the other HEARTT people were there, and had just said hello to Madame President, who had just arrived home from the office. Adamah sent the others to the Guest House, while we were escorted to the gazebo to meet the President. She was very gracious and warm, greeting us each individually; we also met the Minister of Labor and the Minister of Health. Santiago noted afterwards that he couldn't remember the last time he was nervous meeting someone, but he was this time.
We then went back to the Guest House for a wonderful dinner and excellent company including the Dean of the UMass Medical school and a group with him including a librarian. We talked about books and Internet and knowledge etc.
At the end of the evening I spent some time chatting with Chris Hughes, who has finished his PGY-2 at Hartford, and is now a Global Surgery fellow at Childrens Hospital in Boston. He is also engaged to Amy, a daughter of Jock Lawrason who is my friend and boss as he is Chief Medical Officer of Alliance. Yes, indeed it is a small world !! they are interested in seeing what sort of program they could set up to help in Liberia, and he is here on a scouting mission.
Today is Decoration Day, sort of like our Memorial Day, and the day on which families go to the graves of loved ones the clean them up and redecorate them. It is a national holiday, so there isn't much going on, except that we are operating. Moses is back from Lofa County, an 11 hour drive, where he went for the funeral of his mother-in-law or sister-in-law or something. He and Yuk did a hernia on a 3 year old, then Cocola and I did a Halstead repair of a recurrent hernia in a 60 year old, and now Santiago and Jenn are doing Trifecta. It appears to me that she had a strangulated Spigelian hernia, which has to be pretty rare. In any case the surgery went well and was not as difficult as expected, so that was all good.
After the usual HEARTT lunch in the cafeteria at the Maternity Hospital, we were walking back when we met a group including Cynthia Nash, the Liberian Consul in Atlanta; I had met her before on the trip in September. She was leading a group of interested church people and others from Atlanta. A group of us then went sightseeing to Mamba Point and the Hotel Ducor, and then to the Capitol grounds. Following that we came back to the Guest House to wait for everyone else coming for dinner.
Around 7:30 Catherine came into the living room to say that we (Santiago, Jenn, Eric, and me) were wanted next door at the President's house. We went over there to find that all of the other HEARTT people were there, and had just said hello to Madame President, who had just arrived home from the office. Adamah sent the others to the Guest House, while we were escorted to the gazebo to meet the President. She was very gracious and warm, greeting us each individually; we also met the Minister of Labor and the Minister of Health. Santiago noted afterwards that he couldn't remember the last time he was nervous meeting someone, but he was this time.
We then went back to the Guest House for a wonderful dinner and excellent company including the Dean of the UMass Medical school and a group with him including a librarian. We talked about books and Internet and knowledge etc.
At the end of the evening I spent some time chatting with Chris Hughes, who has finished his PGY-2 at Hartford, and is now a Global Surgery fellow at Childrens Hospital in Boston. He is also engaged to Amy, a daughter of Jock Lawrason who is my friend and boss as he is Chief Medical Officer of Alliance. Yes, indeed it is a small world !! they are interested in seeing what sort of program they could set up to help in Liberia, and he is here on a scouting mission.
Wednesday, March 9, 2011
Tuesday March 8
Tuesday March 8
Yuk messaged us while we were waiting for our ride to the hospital that the man with the enterocutaneous fistula was a go, but the woman with the 3 enterocutaneous fistulae( we have given her the nickname of "Trifecta") was refusing to have surgery till she saw her family. On the good side, however, 3 children who had swallowed caustic chemicals and had esophageal strictures were given the go-ahead for today. So Santiago and Jenn started on the man, and Yuk and Konneh started on the kids, as we had been allowed to have 2 rooms. Soon after that Yuk and went down to start clinic...oh, before we started Dr. McDonald came up to the OR to ask us to come down to evaluate a man with a bad leg who was outside the ED. In fact he was sitting in the bed of a police pickup truck,mandate had what has to be oneof the grossest things I have ever seen. He has filariasis (elephantiasis) with secondary ulceration and infection. And it really was enough to make one gag! I told her that I couldnt think of any surgical procedure that would be likely to improve things.
In clinic we saw a number of interesting cases including a recurrent large goiter which Santiago and I decided would be more of a surgical challenge than we wanted to accept on this visit; a man with advanced anal cancer; a possible Kaposi's sarcoma of the leg; and the usual variety of hernias.
Konneh has malaria, and son he will be taking tomorrow's holiday (Decoration Day) off to rest. Most people living in malaria-endemic areas develop malaria occasionally during their adult life, but it is generally mild and short lived.
After clinic we chatted with Señora for a while about patient financial issues, and then went back to make afternoon rounds. Everyone is looking good, and we took a number of photos.
After going back to the Guest House we went out to Sajj again for dinner, mostly because they have a big screen TV so that Santiago could watch Arsenal playing Barcelona. The place was packed with similar fans, and a good time was had by all, especially since Barcelona won !
Yuk messaged us while we were waiting for our ride to the hospital that the man with the enterocutaneous fistula was a go, but the woman with the 3 enterocutaneous fistulae( we have given her the nickname of "Trifecta") was refusing to have surgery till she saw her family. On the good side, however, 3 children who had swallowed caustic chemicals and had esophageal strictures were given the go-ahead for today. So Santiago and Jenn started on the man, and Yuk and Konneh started on the kids, as we had been allowed to have 2 rooms. Soon after that Yuk and went down to start clinic...oh, before we started Dr. McDonald came up to the OR to ask us to come down to evaluate a man with a bad leg who was outside the ED. In fact he was sitting in the bed of a police pickup truck,mandate had what has to be oneof the grossest things I have ever seen. He has filariasis (elephantiasis) with secondary ulceration and infection. And it really was enough to make one gag! I told her that I couldnt think of any surgical procedure that would be likely to improve things.
In clinic we saw a number of interesting cases including a recurrent large goiter which Santiago and I decided would be more of a surgical challenge than we wanted to accept on this visit; a man with advanced anal cancer; a possible Kaposi's sarcoma of the leg; and the usual variety of hernias.
Konneh has malaria, and son he will be taking tomorrow's holiday (Decoration Day) off to rest. Most people living in malaria-endemic areas develop malaria occasionally during their adult life, but it is generally mild and short lived.
After clinic we chatted with Señora for a while about patient financial issues, and then went back to make afternoon rounds. Everyone is looking good, and we took a number of photos.
After going back to the Guest House we went out to Sajj again for dinner, mostly because they have a big screen TV so that Santiago could watch Arsenal playing Barcelona. The place was packed with similar fans, and a good time was had by all, especially since Barcelona won !
Tuesday, March 8, 2011
Monday March 7
Monday March 7
After breakfast we went to the hospital with the expectation of doing 3 cases, but to no ones surprise there were complications : the older man with the left groin enterocutaneous fistula said he didn't want surgery until he saw his son, and his son hadn't visited in 5 days; the parents of the 14 year old boy scheduled for colostomy decommissioning hadn't shown up to sign the consent; and the 16 year old girl scheduled for an ileostomy decommissioning had not yet put money down for the second surgery. So it was looking rather bleak, but then the parents came so Santiago, Konneh, and Yuk were able to go ahead with the boy. They took down his colostomy, resected his sigmoid, and did an EEA anastomosis. I took a pice of his colon for pathology to see if indeed he does have a lack of ganglion cells. I then spoke to Señora, who spoke to Lisa, the social worker, and we were allowed to proceed with the ileostomy decommissioning because the fees were waved for our patient. That is a very nice thing that happens for us here : if there are patients we feel we should operate upon because we have a particular skill set, then Dr McDonald is very generous in making it happen through waving the usual fees, or getting extra OR staff, or whatever.
After finishing we saw some consults in the ED; one in particular was heartbreaking. A 9 year old girl who had surgery at another hospital in November for what was suspected to be an intussusception now comes in with a severely distended abdomen, serious malnutrition, fevers, and weight loss. She has several masses in her abdomen, and looks like she has some malignant process going on, most likely lymphoma. But I'm not sure if we will ever know the exact diagnosis.
Later we went back to the guest house and I took a short nap, and then we joined the dorm people at Cafe Jamal for pizza and beer. After returning to the guest house, Santiago, Eric, and I stayed up talking to Emmanuel and Catherine about Liberia, and the war mostly. It seems like the wounds of the war may have healed on e surface, but there are scars which run deep.
After breakfast we went to the hospital with the expectation of doing 3 cases, but to no ones surprise there were complications : the older man with the left groin enterocutaneous fistula said he didn't want surgery until he saw his son, and his son hadn't visited in 5 days; the parents of the 14 year old boy scheduled for colostomy decommissioning hadn't shown up to sign the consent; and the 16 year old girl scheduled for an ileostomy decommissioning had not yet put money down for the second surgery. So it was looking rather bleak, but then the parents came so Santiago, Konneh, and Yuk were able to go ahead with the boy. They took down his colostomy, resected his sigmoid, and did an EEA anastomosis. I took a pice of his colon for pathology to see if indeed he does have a lack of ganglion cells. I then spoke to Señora, who spoke to Lisa, the social worker, and we were allowed to proceed with the ileostomy decommissioning because the fees were waved for our patient. That is a very nice thing that happens for us here : if there are patients we feel we should operate upon because we have a particular skill set, then Dr McDonald is very generous in making it happen through waving the usual fees, or getting extra OR staff, or whatever.
After finishing we saw some consults in the ED; one in particular was heartbreaking. A 9 year old girl who had surgery at another hospital in November for what was suspected to be an intussusception now comes in with a severely distended abdomen, serious malnutrition, fevers, and weight loss. She has several masses in her abdomen, and looks like she has some malignant process going on, most likely lymphoma. But I'm not sure if we will ever know the exact diagnosis.
Later we went back to the guest house and I took a short nap, and then we joined the dorm people at Cafe Jamal for pizza and beer. After returning to the guest house, Santiago, Eric, and I stayed up talking to Emmanuel and Catherine about Liberia, and the war mostly. It seems like the wounds of the war may have healed on e surface, but there are scars which run deep.
Monday, March 7, 2011
Sunday
Sunday March 6
We all slept late this morning...I needed it after a night of Tubman's Revenge !! I haven't been hit by traveler's trots on previous trips here, but during the night it seemed like my intestines had decided the third time was the charm, or not so charming. Anyway, I started Cipro just in case, but it got better by this evening, so I doubt that it was anything needing Cipro.
This afternoon we went to the RLJ Kendeja Resort for some R & R, and it was very pleasant. Sat on the beach, walked on the beach, had some drinks and some food...we left around 7 to come back to meet Señora and 3 psychiatrists from Mt Sinai in NYC who are here to investigate the possibility of setting up a program in child psychiatry for the country. They will be here for a week, and at this point anyway they are staying in the guesthouse with us. We went to The Royal with them for dinner, and then back here for an early evening.
We all slept late this morning...I needed it after a night of Tubman's Revenge !! I haven't been hit by traveler's trots on previous trips here, but during the night it seemed like my intestines had decided the third time was the charm, or not so charming. Anyway, I started Cipro just in case, but it got better by this evening, so I doubt that it was anything needing Cipro.
This afternoon we went to the RLJ Kendeja Resort for some R & R, and it was very pleasant. Sat on the beach, walked on the beach, had some drinks and some food...we left around 7 to come back to meet Señora and 3 psychiatrists from Mt Sinai in NYC who are here to investigate the possibility of setting up a program in child psychiatry for the country. They will be here for a week, and at this point anyway they are staying in the guesthouse with us. We went to The Royal with them for dinner, and then back here for an early evening.
Sunday, March 6, 2011
Saturday
Saturday March 5
The administration at JFK wants us to be as busy as possible, so they arranged with the OR to have staff available for us to work today. Originally we were goingto do just one case, but we were convinced to do three. So we started this morning with a hypospadius repair on a 4 year old boy; it was likely a traumatic hypospadius from his circumcision. Konneh did it with Yuk and I was quite impressed with his technique; afterwards I asked him if he would like a pair of loupes, and he was really quite excited about that !, so I will arrange for a HEARTT volunteer to bring them over to him when we get back. The next case was an unfortunate 37 year old woman who was thought to have a recto vaginal fistula from childbirth 2 years ago, but she turns out to have a huge cancer which has destroyed her recto vaginal septum. Dr Jallah asked us to see her, and we recommended a palliative colostomy just to make hygiene a bit easier. We also biopsies to mass to see if it is rectal, cervical, or cloacogenic. The final case was an inguinal hernia which we finished around 3.
We then went to the dorm for lunch, which was brought over by the staff from the Guest House. We had a nice lunch, and I had the opportunity to chat for a long time with Dr. McDonald about a variety of subjects. One of the ladies on staff at the Guest House asked Dr McDonald if she could arrange for her husband to see me about a growth on his face/neck; I will see him on Monday. She also said that JFK could advertise our presence on the radio, but I think we have plenty to do as it is, so I don't think we need an advertising campaign !
After that we came back to the Guest House and had a nap. Later on we decided that we would meet some of the other HEARTT people for dinner at Sajj, a Lebanese restaurant near the hospital. Since Dewalt is driving Adamah to Freetown, we needed to find a way to get to Sajj. I called Señora, who said that Adamah had told her that a guy named Alfred would be our driver while Dewalt was away. She tried to contact Alfred, but was not able to get a response; she thought his phone was turned off. So, at her suggestion, we decided to walk up to the end of the lane and ask the security guards to get us a taxi. Outside the President's house, we told one of the Special Security Service agents of this plan, which she nixed immediately. She explained that we were guests of the President, and as such they would take care of us. So within a few minutes we had a vehicle, a driver, and another agent who sat in the restaurant (at a discrete distance) while we ate. It seemed like they made a much bigger deal out of it than was really necessary, but then again it is not unreasonable that they don't want to take chances. It was a good meal and good company, so it all worked out in the end.
The administration at JFK wants us to be as busy as possible, so they arranged with the OR to have staff available for us to work today. Originally we were goingto do just one case, but we were convinced to do three. So we started this morning with a hypospadius repair on a 4 year old boy; it was likely a traumatic hypospadius from his circumcision. Konneh did it with Yuk and I was quite impressed with his technique; afterwards I asked him if he would like a pair of loupes, and he was really quite excited about that !, so I will arrange for a HEARTT volunteer to bring them over to him when we get back. The next case was an unfortunate 37 year old woman who was thought to have a recto vaginal fistula from childbirth 2 years ago, but she turns out to have a huge cancer which has destroyed her recto vaginal septum. Dr Jallah asked us to see her, and we recommended a palliative colostomy just to make hygiene a bit easier. We also biopsies to mass to see if it is rectal, cervical, or cloacogenic. The final case was an inguinal hernia which we finished around 3.
We then went to the dorm for lunch, which was brought over by the staff from the Guest House. We had a nice lunch, and I had the opportunity to chat for a long time with Dr. McDonald about a variety of subjects. One of the ladies on staff at the Guest House asked Dr McDonald if she could arrange for her husband to see me about a growth on his face/neck; I will see him on Monday. She also said that JFK could advertise our presence on the radio, but I think we have plenty to do as it is, so I don't think we need an advertising campaign !
After that we came back to the Guest House and had a nap. Later on we decided that we would meet some of the other HEARTT people for dinner at Sajj, a Lebanese restaurant near the hospital. Since Dewalt is driving Adamah to Freetown, we needed to find a way to get to Sajj. I called Señora, who said that Adamah had told her that a guy named Alfred would be our driver while Dewalt was away. She tried to contact Alfred, but was not able to get a response; she thought his phone was turned off. So, at her suggestion, we decided to walk up to the end of the lane and ask the security guards to get us a taxi. Outside the President's house, we told one of the Special Security Service agents of this plan, which she nixed immediately. She explained that we were guests of the President, and as such they would take care of us. So within a few minutes we had a vehicle, a driver, and another agent who sat in the restaurant (at a discrete distance) while we ate. It seemed like they made a much bigger deal out of it than was really necessary, but then again it is not unreasonable that they don't want to take chances. It was a good meal and good company, so it all worked out in the end.
Saturday, March 5, 2011
March 4
Friday March 4
After a restful sleep, we had a busy day in the OR. The first case was a 4 year old boy with a hernia/hydrocele. Jenn and I did the operation in about 25 minutes, but then it took about 90 minutes for him to wake up. Jenn stayed with him as they bagged him in the PACU, feeling not unreasonably that if she left they would stop, and the outcome would be a disaster. Eventually he did wake up, but the experience brought up some of the issues and problems with anesthesia in this setting. There is no anesthesiologist since Dr. Gouma went back to Nigeria, and the nurse anesthetists are of varying quality. Some are quite good, but others are less competent, and they seem to be the ones who don't provide much supervision or feedback to the nurse anesthetist students. Jenn wondered about bringing our own anesthesia team over when we come but there are major issues with that approach. It will be worth some discussion.
After that case we did some more hernias, and Konneh and Jenn did a gastrostomy on a 14 year old boy who swallowed lye. Konneh was unable to dilate his esophagus either antegrade or retrograde. When I asked him what the future held for the boy, Konneh said "hopefully he will be lucky and be able to go to another country where he could be cared for."
We finished our last case around 5 PM, and then made rounds on our post-op patients. All of them, including the 4 year old boy, were doing very well. One of the hernia patients, who had a huge African incarcerated hernia, smiled when I said "How are you doing?" and then replied "I'm doing fine...how are you doing?" it was really quite gratifying to see all of then doing well after so many worries in the morning. We went back to the Guest House to shower and change, and the we all went out to Senator Edmonde Snow's house for drinks and dinner. He has a lovely and rather palatial house on the ocean, and he was a wonderful host with his girlfriend Peggy. We were joined there by Lydia, and a group of Liberian nurses from Rhode Island who have come over to help in whatever way they can. There were some toasts and thanks from a variety of people for the work we are doing through HEARTT. After that, we went to Lydia's house for some wine and chat; The Honorable (aka Senator Snow) personally drove some of us over in his Nissan SUV. At Lydia's, we were also entertained by a trumpet recital by Eric...it was awesome !
After Lydia's, we went to Groovie's for some dancing till 1:30 AM.
After a restful sleep, we had a busy day in the OR. The first case was a 4 year old boy with a hernia/hydrocele. Jenn and I did the operation in about 25 minutes, but then it took about 90 minutes for him to wake up. Jenn stayed with him as they bagged him in the PACU, feeling not unreasonably that if she left they would stop, and the outcome would be a disaster. Eventually he did wake up, but the experience brought up some of the issues and problems with anesthesia in this setting. There is no anesthesiologist since Dr. Gouma went back to Nigeria, and the nurse anesthetists are of varying quality. Some are quite good, but others are less competent, and they seem to be the ones who don't provide much supervision or feedback to the nurse anesthetist students. Jenn wondered about bringing our own anesthesia team over when we come but there are major issues with that approach. It will be worth some discussion.
After that case we did some more hernias, and Konneh and Jenn did a gastrostomy on a 14 year old boy who swallowed lye. Konneh was unable to dilate his esophagus either antegrade or retrograde. When I asked him what the future held for the boy, Konneh said "hopefully he will be lucky and be able to go to another country where he could be cared for."
We finished our last case around 5 PM, and then made rounds on our post-op patients. All of them, including the 4 year old boy, were doing very well. One of the hernia patients, who had a huge African incarcerated hernia, smiled when I said "How are you doing?" and then replied "I'm doing fine...how are you doing?" it was really quite gratifying to see all of then doing well after so many worries in the morning. We went back to the Guest House to shower and change, and the we all went out to Senator Edmonde Snow's house for drinks and dinner. He has a lovely and rather palatial house on the ocean, and he was a wonderful host with his girlfriend Peggy. We were joined there by Lydia, and a group of Liberian nurses from Rhode Island who have come over to help in whatever way they can. There were some toasts and thanks from a variety of people for the work we are doing through HEARTT. After that, we went to Lydia's house for some wine and chat; The Honorable (aka Senator Snow) personally drove some of us over in his Nissan SUV. At Lydia's, we were also entertained by a trumpet recital by Eric...it was awesome !
After Lydia's, we went to Groovie's for some dancing till 1:30 AM.
Thursday, March 3, 2011
March 3
Back to Liberia....March 1/2/3
Yesterday we ( Jenn Malsbury, Eric Lucero, Yuk Ming Liu, Adamah Sirleaf, and I ) flew from Westchester Airport to Atlanta, where we met up with Santiago Arruffat, We then left Atlanta at 7:30PM for for 10 1/2 hour flight to Accra, Ghana. After a couple of hour stopover where we had to stay on the plane, we left for Monrovia, and arrived mid-afternoon.
Our first stop coming in from the airport was JFK, where I saw a lot of familiar faces. One of the things which is most gratifying for me is the joyful reception by people who appear to be genuinely pleased that I have returned. After that we went to he bungalow to drop off our luggage, and then to the Presidential Guest House for dinner. We had about 15 people at the house, and it was good fun. I then retired early as I was pooped!
Today was our first clinical day, and it was very busy. We met up with Konneh and went onto the wards to see some patients, several of whom have been waiting for us to arrive. There is a man with an enterocutaneous fistula probably due to a strangulated left inguinal hernia; a woman with at least 3 enterocutaneous fistulae and an open abdominal wall; and a 14 year old boy with a colostomy because he was thought or maybe have Hirshsprung's, but maybe just has chronic constipation. We will be operating on al of them as well as others next week. We also saw a 30 year old albino man who had a typhoid bowel perforation and resection 2 days ago. When we saw him he looked very ill, and was having trouble breathing; a half hour later we came back to see him and the nurse told us he had expired. We also saw a woman in the Trauma ED who apparently was beaten up by her boyfriend last night, and then came to the ED complaining of abdominal pain. Complicating matters is the fact that she is HIV+. While being observed in the ED she was getting worse clinically, so she went to the OR is afternoon, Santiago and Dr. Cocola, a family practitioner/surgeon from the Congo, explored her and found some blood and contusions but no source. She had a cardiac arrest on e table, but they resuscitated her and got her closed and off the table. Unfortunately she was never able to breathe on her own, and passed away. I have no idea what caused her demise, but i think anesthetic hypoxia is the leading candidate.
We saw about 40 people in the clinic, with an amazing variety of pathology; actually I should point out that Jenn and Yuk saw virtually all of them, and Santiago, Konneh, and I were consultants. We will operate on many of them in the coming days.
Late this afternoon we met up with Dr. Jallah who took us to the new maternity unit to see a baby born today with an amputated foot; it looks to me like maybe he had a hair or congenital band around it. Then we saw a 37 year old woman with a probable rectal cancer and a recto-vaginal fistula. She will need a colostomy for palliation, as there is no treatment available to her. Very sad.
Yesterday we ( Jenn Malsbury, Eric Lucero, Yuk Ming Liu, Adamah Sirleaf, and I ) flew from Westchester Airport to Atlanta, where we met up with Santiago Arruffat, We then left Atlanta at 7:30PM for for 10 1/2 hour flight to Accra, Ghana. After a couple of hour stopover where we had to stay on the plane, we left for Monrovia, and arrived mid-afternoon.
Our first stop coming in from the airport was JFK, where I saw a lot of familiar faces. One of the things which is most gratifying for me is the joyful reception by people who appear to be genuinely pleased that I have returned. After that we went to he bungalow to drop off our luggage, and then to the Presidential Guest House for dinner. We had about 15 people at the house, and it was good fun. I then retired early as I was pooped!
Today was our first clinical day, and it was very busy. We met up with Konneh and went onto the wards to see some patients, several of whom have been waiting for us to arrive. There is a man with an enterocutaneous fistula probably due to a strangulated left inguinal hernia; a woman with at least 3 enterocutaneous fistulae and an open abdominal wall; and a 14 year old boy with a colostomy because he was thought or maybe have Hirshsprung's, but maybe just has chronic constipation. We will be operating on al of them as well as others next week. We also saw a 30 year old albino man who had a typhoid bowel perforation and resection 2 days ago. When we saw him he looked very ill, and was having trouble breathing; a half hour later we came back to see him and the nurse told us he had expired. We also saw a woman in the Trauma ED who apparently was beaten up by her boyfriend last night, and then came to the ED complaining of abdominal pain. Complicating matters is the fact that she is HIV+. While being observed in the ED she was getting worse clinically, so she went to the OR is afternoon, Santiago and Dr. Cocola, a family practitioner/surgeon from the Congo, explored her and found some blood and contusions but no source. She had a cardiac arrest on e table, but they resuscitated her and got her closed and off the table. Unfortunately she was never able to breathe on her own, and passed away. I have no idea what caused her demise, but i think anesthetic hypoxia is the leading candidate.
We saw about 40 people in the clinic, with an amazing variety of pathology; actually I should point out that Jenn and Yuk saw virtually all of them, and Santiago, Konneh, and I were consultants. We will operate on many of them in the coming days.
Late this afternoon we met up with Dr. Jallah who took us to the new maternity unit to see a baby born today with an amputated foot; it looks to me like maybe he had a hair or congenital band around it. Then we saw a 37 year old woman with a probable rectal cancer and a recto-vaginal fistula. She will need a colostomy for palliation, as there is no treatment available to her. Very sad.
Subscribe to:
Posts (Atom)