Sunday March 13

        Another interesting day in Monrovia. Santiago had 2 colonoscopies lined up for today, but one of them decided she was hungry this morning and had breakfast, so she was cancelled. Then we had scheduled the little girl with the umbilical hernia which I wrote about yesterday; for reasons that remain a mystery, her mother decided she needed food this morning also. So initially she was cancelled, but then anesthesia agreed we could do her later in the day so we did. Mary, the hospital administrator and solver of all problems, had a meltdown over that one because she was understandably frustrated by the failure of the system when everyone had gone out of their way to make this happen. Fortunately she recovered quickly, and was fine later in the day when we saw her again. Then they brought up a woman who had a huge lipoma on her hip that was to be excised...except they brought up the wrong patient ! They brought a woman with a large parotid tumor whom we had seen and were trying to decide whether to operate on her; despite my saying that it was the wrong patient, they brought her into the room and started getting her ready for anesthesia. i pointed out again that it was the wrong patient, and she was brought back downstairs to be traded for the lipoma lady. It's worth noting once again that the patients have no name bands or other form of attached identification; I think this needs to be remedied soon.
       Then we had a 60ish year old woman who was operated on at ELWA Hospital in January for presumed gallbladder disease, but at surgery was found to have a liver nodule. A biopsy was taken and sent to the US where a diagnosis of metastatic adenocarcinoma was made; special stains suggested breast, lung, or gyn origin. She came to see us because she had developed an incisional hernia, and was in pain. We got a chest X-ray yesterday which looked fine, and she had no breast masses, so we thought we would repair her hernia today and explore her abdomen at the same time. Unfortunately we discovered that she had a large pancreatic mass with many liver metastases, so there wasn't much we could do other than to repair the hernia. I realized during the case that what she was calling hernia pain was most likely pain for her pancreatic cancer; regrettably I don't think there is much that anyone can do for her. Sadly there is no facility here for palliative hospice care.
         The best part of the day was having Dr Gbozee on call and with us most of the day. While I had hoped the other residents would show as much interest in actual surgery as he does, I'm happy that we have at least one motivated, intelligent, eager surgical resident. After we finished our cases today we went to the ward with him and reviewed all of the patients. He knew them all without having to ask the nurses, and we were both impressed.
         Tonight we went back to Fuxion for dinner, and I cured myself of a pizza craving. As we walked back to the hotel, members of the Liberian National Police Emergency Reaponse Unit (ERU) pulled up, and two heavily armed members parked themselves inside the gate of the hotel driveway. We think this is a response to the attack in Côte d'Ivoire today by Muslim militants. Liberia has a significant Muslim population, in the range of 30%, and lately they aren't real happy: there is a move afoot in the Legislature to amend the Liberian Constitution to declare that Liberia is a Christian nation. To an outsider (me), it seems that such a move is designed to piss off the Muslim community, and serves no real purpose. Hopefully nothing will come of that, and there will be no further attacks in Côte d'Ivoire or next door in Liberia. Time will tell.