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.