Thursday

It rained incredibly hard last night; the sound of it on the metal roof woke me, and confused me initially, but then I remembered the cause of the sound. John and Nathan came over to join us for breakfast; as usual they had already been to the hospital and reported that our patients were doing well. They also said that we would have 5 cases today as planned, because the parents of the 2 children on our schedule had come in last night and signed the consents. It is an interesting aspect of life here that nurses always get the consent rather than the surgeon; I will take a look tomorrow, but my guess is that the "consent" they sign is for an operation without particular consideration of the risks, benefits, or alternatives. Our first case was a 5 year old boy burned by hot water a few months ago, primarily on his left side. He developed severe scar contractures of his left shoulder, left elbow, left hip, and left knee. The hip had been released previously; today we released his shoulder and elbow, both of which had major webs. It took quite a while with Santiago, Nathan, and I trying to figure out how to use Z-pasties and the like to release the scars and allow return of normal movement. We were quite happy with the result when we were done; we plan to bring him back next week to do some skin grafting on his hip and thigh, and to release a contracture of his lower leg. While we were doing that, John assisted Dr Muvu with an above-knee amputation. Then John and I excised a breast mass and repaired an inguinal hernia while Santiago and Nathan took down and closed a colostomy. Just before we did the hernia Dr McDonald called to ask us to see a young man in the ED, and to talk about Rita. We went to the ED and saw the patient; he needed emergency surgery for strangulating bowel, so we got that process started through Mary. I went to see Dr McDonald in her office, and told her that I didn't think we could offer Rita anything; Rita is a young woman in her 20s who had a criminal abortion, and then seems to have developed a septic arthritis of her left hip complicated by a pathological fracture of the femoral neck. She was operated on twice by Dr Muvu, but now she needs more expert help than we can offer. While disappointed that we could not help, especially since Rita's father is a politician, I think Dr McDonald understood the rationale for us declining to operate. We then talked a little about the planned development of JFK, and that the re-establishment of JFK as a medical resource and academic center for Liberia was one of the lasting legacies that President Sirleaf would like to leave. Finally she expressed her sincere gratitude to us and all of our donors for the amazing amount of supplies we brought. Our last case was the hernia from the ED which John and I did; he had a loop of ileum stuck in the hernia which remained purple and flaccid after release, so we elected to resect it. It went well, and we finally finished around 7. After a stop at the dorm for our Internet fix, we came back o the bungalow for a great dinner of barracuda, couscous, and fresh salad. We had a wonderful discussion covering everything from JFK to pitstaches ( you really don't want to know about this concept dreamed up by Kenna!), and then off to an early bed after a long day.