Saturday March 9

It's hard to believe that we are halfway through this trip. I think we have done well so far, and that we are making progress in terms of organization and planning. It isn't perfect by any means, but each time it seems better than the last, and I think that is the definition of progress. Santiago, John, and I are particularly excited today because we are planning to see Harriett, the 4 year old whom we operated on last March and removed the 9 lb. duplication cyst. As it turns out, one of the HEARTT pediatricians, Camille, has been in contact with Harriet's father (who wanted photos of what we removed) so we had a phone number. Wilfred called them the other day to say that we would like to see her perhaps on Saturday, and apparently they didn't understand because they showed up here at JFK the next day. The address we had for her was about 30 min away, but it turns out she has moved with her mother much further away, like a days drive. But they said they would stay in Monrovia until Saturday night or Sunday morning so they could see us, and hopefully that will be what happens. Santiago and John did an advancement flap on a lady with anal stenosis this morning. She had presented last year with rectal cancer, and Santiago did a local excision. Apparently she received some form of chemotherapy in the past year, and he was very excited to see her in the clinic last week since none of us expected she would still be alive. The stenosis appeared to be benign scarring rather than recurrent cancer, and here's hoping she will see us next year , After a quick lunch we got in the van with Wilfred and Camille, and went to see Harriet ! She is living with her grandmother quite close to the Executive Mansion, and we had no trouble finding the house. It was quite a celebration when we got out of the van, and Harriet looks beautiful ! I admit that I needed to pull up her shirt and look at the scar to be sure it was the same child, and it was! We attracted a gaggle of kids and others, and it really was fun and satisfying. As we headed back to the hospital, Santiago and discussed how we want to make a point of seeing patients from previous trips, because it is really a wonderful feeling to see that we have made a difference. We then came back to the hospital to operate on a 50 year old man with an acute abdomen who came to the hospital this morning. John and Nathan and I opened him to find the biggest sigmoid volvulus I have ever seen; I'm pleased to note that a sigmoid volvulus was out pre-op diagnosis also ! We resected his sigmoid, and tried to do a primary anastomosis, but it became clear that wasn't going to work so we did a Hartmann's. He is very slow waking up...we think in large part because of hypothermia...so I was able to get the Gaymar warming blanket working and we are warming him up. Because there is no ventilator available at JFK, we are staying him with him until he is awake enough to go back to the floor. Unfortunately it is Saturday night and we had plans for dinner at the Mamba Point Hotel followed by an expedition to Groovie's and possibly Deja Vu, but as I write it is 8:30pm and we are still here. We will do something tonight, but I'm not sure what ! As it turned out, our patient finally woke up enough to be transferred downstairs, and we went back to the bungalow around 11. In the meantime, John and Nathan went to Sajj with Moses the hospital driver to pick up some pizzas and other food; they arrived back shortly after we arrived, and we all had an excellent meal. After that no one was interested in going out, so we all went to bed.