Tuesday March 15

       Today is a holiday in Liberia celebrating the birthday of the first President. We had hoped to do some skin grafts, but the lack of a dermatome precludes that. Santiago saw a woman yesterday that Jonathan Laryea had operated on last September. She had several operations in the past including a colostomy for unclear reasons, mostly at Phoebe Hospital, and then was referred to Jonathan for further work. After studying her situation, he thought it was safe to put her colon back together and decommission her ostomy. Apparently she had some problems immediately post-op, but was discharged home after a short stay. Out of respect for my readers, I will avoid a gross discussion of what was going on; suffice it to say it wasn't pretty. So we brought her to the OT to explore her abdomen, and give her another colostomy. It will take a brave soul to want to put her back together again.
        During the course of the morning, Ophelia came by to wish us goodbye. Santiago has done several operations on her, most recently in 2014 she had an abdominoperineal resection for recurrent rectal cancer. She is feeling great now, and there is no gross evidence of the cancer coming back. She gave us each a suit of African garb which is quite handsome, and she got the sizes right just by guessing ! Well, almost right...my cap is too small because I seem to have a large head, but I think the hat can be retailored to fit me.
        A woman was brought to me yesterday for evaluation of her breast. She is 50 years old, and has an obvious locally advanced breast cancer with a very deep ulcer above the breast. There is nothing to do for her surgically, but I offered to biopsy the tumor to see if it is receptor positive; if it is, then it might be reasonable for her to buy Tamoxifen to retard the growth rate of the tumor. More to the point, if it not receptor positive, there is no point in her wasting her money on a medication that will do her no good.
      After finishing the cases we went back to the hotel to shower and check out. We then went to a lunch on our honor put on by one of Santiago's colonoscopy patients. She is a nurse, a lawyer, and a judge, and she invited a number of guests several of whom had also had cololonoscopies on this trip. It was a fun occasion with real Liberian food including Fufu !
       We returned to JFK to say our goodbyes, and then off to the airport.
       We did a total of 42 cases during our 8 days of operating, which is quite an accomplishment. More than the number, I am particularly pleased that 32 of the cases were done with a resident, and that is a fantastic change from previous experience. Another positive note on this trip was that while Ebola has caused changes in practice, and clearly had a major effect on the delivery of healthcare while the epidemic raged, they have recovered from it better than I had anticipated. I think we will be able to resume bringing residents and others when we come again in September.