Monday March 3

Monday March 3
      After an uneventful but long trip here through Brussels on Brussels Airllnes, we and our 21 bags arrived in Monrovia last night. We have brought an extraordinary amount of supplies, thanks to the generosity of many people, especially including Alyssa at Cook Medical, Jenn and Rose at Ethicon, Mary and Tanya and Donna at Waterbury Hospital, and Brussels Airlines for allowing us to bring an extra bag each at no charge. A further huge thank you to our Waterbury Hospital family who have pitched in so remarkably to help us do this work.
      We drove to JFK Hospital where we were met by Dr Mcdonald; she had arranged to have a meal waiting for us at the Maternity Hospital. We learned that the bungalow is once again out of order, so the 4 of us will be staying at the TGH Apartments, where Jonathan Laryea and I had stayed a couple of years ago. They are very nice, and have hot water and a/c; the only problem is that they are a drive from the hospital, and that can be a long drive in morning traffic. In addition to the issues at the bungalow, apparently there was a transformer fire, and the dormitory is without power, though it is expected to be fixed in a day or two.So in the meantime, the other 3 members of our team had rooms at Bella Casa,a hotel nearby.
      Oh, I forgot to tell you about the team. Besides me, the team includes Dr. Santiago Arruffat, a former resident now colo-rectal surgeon in Indiana making his 4th trip to Liberia; Dr. Philomina Thruthumaly, and anesthesiologist from Indiana; Kenna Besing, an OR Tech from Indiana who came last year; Dr. Yuk Ming Liu, one of the current Chief Residents at Waterbury Hospital who came here with us 3 years ago; Dr. Rakesh Hegde, a junior resident in our program; and John Wasik, a biomedical engineer at Waterbury Hospital.
      After a good night's sleep we all met fro breakfast in the dorm,and the went to Grand Rounds. The presentation was on trauma, and road traffic accidents in particular, presented by 2 doctors from the ED. It was a very well-presented talk, and there was lively discussion afterwards about how to go about involving all interested parties, from medical to law enforcement to government, in the process of forming regulations to decrease preventable deaths from accidents. Not much different than the discussion we have in the US on a regular basis.
       We then went to the OR to greet our friends, and then went on the wards with Dr. Konneh. By early afternoon, we had a list of 14 people who need surgery, and they are just the ones already in the hospital. Several interesting problems: 2 men with malignant melanoma on their heel and palpable inguinal adenopathy; a 4 year old with a recurrent huge mass on her left chest which must be a liposarcoma; an young man with an enterocutaneous fistula after laparotomy last week; a child with a huge umbilical hernia; and a young man with several months of projectile vomiting of bilious material. And at the Maternity Hospital there are two women with wound dehiscence and evisceration which was treated conservatively. There is no doubt that we will be quite busy over the next 2 weeks !!
       Santiago and Yuk operated with Dr. Moses on the young man with the enterocutaneous fistula. He was operated on by Dr. Moses a week ago, and has had a rocky post-op course with renal insufficiency which resolved...but yesterday he started leaking enteric contents through his wound. So they took him back to the OR and found several holes in his small bowel which they repaired; hopefully he will improve now.
       At dinner tonight, we were discussing the electrical problem at the dorm with the burnt out transformer which apparently could not be fixed today. So Dr Mcdonald bought a generator which is in the process of being installed. I asked John Wasik how complicated a procedure the connection might be, and he responded : "After what I have seen today, I couldn't even imagine !" I thought that was a pretty good summation. The Liberian people are able to do a lot with very little, and often what they do defies imagination.
          I was invited to Aunt Jenny's tonight for a small party. I went with Dr. McDonald; I knew more of the  guests than I would have expected, and all in all it was a very good time. Tomorrow we have a busy day, so it's time for bed.