Saturday September 14

      With Jonathan and Tom gone, I took the liberty of sleeping in the back bedroom last night where the noise of the generator was less intrusive; yes, it was definitely a better sleep. Dr Mcdonald did assure us the other night that when we come back in March, there will be a much quieter generator in place, and we all look forward to that ! This morning we plan to go to JFK to say our final final goodbyes to patients and staff, and then we will find something to do while waiting to go to the airport this afternoon. We might go to the Post Office and try to buy and mail some postcards; rumor has it that there is a postal service in Liberia, so it might be fun to test it. In fact, now that I think about it, the President once suggested that I should test it at some point !
      With the cases and procedures we did yesterday, we hit a total of 51 which makes us all feel quite proud. It isn't just a matter of doing a lot of operating; to do that number of cases says a lot about better organization by the local staff as well as ourselves. JFK was prepared for us; patients had been screened, and we had a list of them with diagnosis, etc. so we had some choice in who was called. The way the system works is that patients are called and asked if they have the funds available to be admitted; if they do, they pay and get admitted. Our surgical services are free, but the patients are required to pay an admission fee as well as a drug deposit.
      The OR was better organized, so that virtually every day there was enough staff for us to run 2 rooms, and that helped a lot. They were also more malleable than some times in the past about accommodating additions to the OR list as needed.
      We were quite impressed on this visit by the better organization and professionalism shown by the nurses on the surgical ward. One of them always was with us on rounds, and they showed us that they knew their patients better than they have sometimes in the past.
       There is no question in my mind that much of this improvement is due to familiarity: they know us, and they know what we are capable of doing if given the opportunity, while equally we know and respect the excellent care that the JFK staff is able to provide under less than optimal conditions. They are asked to do a lot with minimal support in the way of supplies and support; they are able to improvise very well.
       There are major hurdles to overcome in the rebuilding process for JFK as well as for Liberia as a country. It continues to be exciting for us to be a part of the JFK rebuild; it is definitely frustrating at times, and it will take a lot longer than any of us would like, but there is progress being made. Each time I come here, I leave with more ideas on what we can do to help advance the process, and what members we should include in the next visit. There is general agreement that we should try to bring a biomedical engineer with us next March to help fix what can be fixed, and scavenge parts off those machines which cannot be fixed totally. The engineer might also help make some sense out of the power situation in the OR, where lights, cautery machines, suction, and anesthesia machines are all competing for power strips and transformers in a tangled mass of cords. Some require 220V supply, while others are 110V; there have been times when it seemed that we could have suction or cautery, but not both, and that needs to be fixed. Fortunately, I have someone in mind...he has asked if he could come to help, and I hope now we can make it happen.
      I think that's it for this visit. As Kenna says, Lord willin and if the creek don't rise, we will be back in the USA tomorrow.