Tuesday March 5

There was some confusion this morning about what cases we were going to do, but it settled out when we learned that the woman with the cauliflower growth on her leg didn't get a bed apparently, so she won't be done today. Nathan and I did an orchidopexy on Jonathan which went well, and then we went down to the outpatient clinic. The. clinic is an amazing experience, in large part because it is ever clear why many of the patients have been referred to Surgery, if in fact they have. Many of them appear because they have aches and pains which they relate to a trauma; our standard for them is an X-ray and pain relief. This year Santiago brought a plastic bag filled with samples of Tylenol which he was giving out by the fistful ! He went up to do an EUA on a 10 year old boy with rectal trauma who had a diverting colostomy and now has a fistula. He might be ready for a decommissioning next week. When Santiago left, I took his place in the clinic and saw all sorts of interesting pathology including a woman with a spleen down to her pelvis; hopefully we will get her in soon for surgery. I also saw an older woman with chronic cholecystitis, which was interesting because I have never seen gallbladder disease here before, and today there were 2 in clinic. And I saw a 32 year old woman with several liver masses by ultrasound; I talked to Konneh and we sent her to the Chinese hospital for a CT scan. The problem is the the new Chinese hospital is about an 8 hour drive from here; they have spanking new facilities, including a CT scanner, but they have no specialist medical staff as of yet. After clinic and lunch, we came back to the OR for an emergency laparotomy on a 20 year old man. It seems he had been sick at home for 2 or 3 weeks; he saw an herbalist,to no avail. Apparently some of his friends told him he was being poisoned; they had no idea how right they were ! Santiago, John, and Nathan o Erased on him, and found a HUGE abscess, the contents of which virtually shot in the air when they got into it. They spent several hours peeling bowel apart, and eventually found the perforation, which they brought out as an ostomy. We have our fingers crossed. It really is astonishing that he could stay home for 2 weeks, unable to eat, virtually unable to move because of pain, before finally deciding to seek medical help. Raising awareness and expectations for the public is yet another hurdle in rebuilding the Liberian healthcare system. We came bak to the bungalow, showered, and then went to Sajj for a pleasant dinner. I never was able to connect to the Internet, so I will post this and yesterday tomorrow.