Monday September 3

We arrived at JFK around 8:30 this morning, and soon ran into Dr. Moses who greeted us very warmly. We went up to the surgical floor with him, and found Konneh with a large group of medical students. This is a wonderful development; I think we can offer a lot to medical students, so I am very pleased to see that they are at JFK doing surgical rotations. We also met Dr. Michael Kiiza, a surgeon from Uganda who is a fellow of the West African College of Surgeons, and a delightful man with a great smile and a very friendly demeanor. He was hired by JFK in May, and appears to be settling in well. The first patient we saw is a 50 something year old man who came in with a strangulated right inguinal hernia, and strangulation of his tests also. They resected the strangulated parts, and gave him an ileostomy. The surgery was 3 weeks ago. Unfortunately he looks badly nourished and is losing weight despite eating; his right groin wound is open and clean, but his ileostomy is pouring out. The skin around the ileostomy is excoriated due to ill-fitting stoma appliances, and apparently he is now developing decubitus ulcers. The question is when should we operate to restore his intestinal continuity; my feeling is that he will not get better till we do, so we may operate on him later this week. The second patient, in the bed next to him, is a z12 year old yo admitted with a bowel obstruction. He apparently was operated on at Redemption for typhoid perforation several months ago. His bowel obstruction was ought to be due to adhesions, and has resolved, but he has a large incisional hernia. I think we will probably fix that soon. We then went to Grand Rounds, and greeted a number of friends. The discussion was about postgraduate education; apparently the President has declared it to be an important step to take in restoring the health care system, so there is a lot of a tivity currently trying to figure out what is needed etc. there was a group from Baylor Resnt; they at placing a pediatrician and an Ob-Gyn here for at least a year. After Grand Rounds we went to the OR, and it was like a school reunion with lots of joy and hugs ! Then Jonathan and I did a man with bilateral inguinal hernias, another man with a right inguinal hernia, and a young woman with keloids on her earlobes. One of the process improvements is the development of a computer printed list of surgical patients for us, divided into 3 categories: patients already "on bed"( admitted to the hospital), patients who are Category 1 for admission, and patients who are Category 2 for admission. We still have the issue that they need to pay to get admitted, so the priority for admission is not just their medical condition, but also their financial circumstances; at least it is a bit more organized. I learned that the bungalow has a leaky roof and other repairs are needed,Mao ats why we aren't staying there. Apparently there are other occupying the Presidential Guest House, and that is why we are being housed in these apartments. I feel bad that they are costing JFK some serious money to rent for us, but I'm not sure there was much other choice. After a short nap we went to Jamal's for dinner to meet Jonathan Ryan. I was put in touch with him by a patient of mine in Waterbury, Dr. Peggy Sheehan, who taught him English when he attended Post University in Waterbury. He grew up on Willow St in Waterbury before the family moved to North St. In Watertown; he graduated in 1994 from Watertown High School. he is a lieutenant in the US Navy, currently on assignment as the Information Officer in a UN Peacekeeping Force unit in Ginta,about 6 hours from Monrovia. We had an interesting evening learning his take on Liberia and sharing experiences.