Sunday March 17

As planned, we were at the hospital a bit earlier than usual, and we were able to use both OR rooms to do our cases. John and I did the mastectomy so that we can bring tissue back for pathology, and Santiago and Nathan did the 2 year old with a hernia. The OR staff was very kind and accommodating in not only making it easy for us to do these last cases on a Sunday morning, but even having people come in so that we could use both rooms and be done sooner. After the cases, we went downstairs to say goodbye to patients and staff, and as always that wasn't easy. We hope that our patients continue to make progress; I know that we will see some of them again, but hopefully not as patients at JFK. We went back to the bungalow to shower and change for our flight. Moses came early, so we decided to go to Sajj one more time for chicken bread and pizza (I think that was Nathan's idea !) Then we went off to the airport for our flight to Accra and then JFK in NYC. I think this was perhaps our most successful trip for a number of reasons. There is no doubt that our familiarity with the people at JFK, and their familiarity with us after many trips makes the relationship easier for everyone. We all have a reasonable idea about what to expect from the others; even though I do let my frustrations reach a boiling point, I do know in my heart that they are trying, and that they are improving each time. Another key reason for our success was having Dimple with us. Her presence is what allowed us to do more complex, riskier surgery, mainly because the anesthetists knew they had back-up. The other day I was talking with Mr. Hne about the splenectomy we brought back for bleeding. He told me that when the patients of Liberian surgeons have problems, the surgeons tend to stand there and not do much; he was impressed that with the splenectomy all of the members of our team pitched in to try to find equipment and solutions to the critical problems we were facing. I think that part of what we do is to display that sort of teamwork, and perhaps others see how effective it can be. Finally, without doubt, much of our success on this trip reflects the fact that we all got along very well, and there were absolutely no personality issues at all between us. Everyone contributed to the success of the trip by not only doing their job well, but by helping others do the same. Kenna is a spark of joy and laughter, whether entertaining us at the table or in the OR, or getting into a soccer game with the neighborhood kids as we walked home; in addition, she is an incredibly good Surgical Tech! Dimple was a rock: steady, determined, flexible when she needed to be, but she would not accept "we can't do that" for an answer to anesthesia issues. She is also witty, and fun, and a great team player. John and Nathan were wonderful about keeping us organized. I told them at the beginning that I wanted to stress organization and information on this trip, and they did a good job at it, given the limitations of the system. John's full-blooded enthusiasm for everything he does, and his desire to learn everything he can from each case, was an inspiration; Nathan settled right in to this new experience, and seemed right at home within a few days doing complicated cases and learning how to care for patients without any of our usual tools such as labs, xrays, etc. And he loved that chicken bread at Sajj ! Finally, Santiago is an exceptional surgeon, a superb physician, a warm and engaging personality, and a great friend; he is an amazing resource for this work, and I am honored that we can work as partners in Liberia. I will return in September with a different team, and then many of this team will be back next March.