Tuesday March 8s

After a more fitful nights sleep than I prefer, we had our breakfast downstairs and then Moses(our assigned driver) picked us up and took us to the hospital. We participated in morning rounds with the residents and faculty, enjoying the lively and pointed questions particularly by Dr. Ate and Senator Dr. Coleman. Following chart rounds on new patients and the ward rounds, we went to the OT to begin our day. I should note that the practice here is to refer to it as the Operating Theater or OT rather the the Operating Room or OR, so when in Rome we do like the Romans ! The first case was the guy with a bad perineal injury following a motorbike accident. They had done a colostomy and placed a supra pubic tube immediately after the accident several months ago, but they weren't sure how to proceed further. Santiago discovered that his anode fm had been denuded and then everything fused together in healing, leaving him with something like an imperforate anus. He broke thru the fusion, and then did a flexible sigmoidoscopy; the question remains as to how to proceed from here. An assessment of his sphincter function is vital before making any decisions.
     The next case was a youngish woman  who had been sodomized by her husband several times, and subsequently developed a painful anal mass. On examination under anesthesia, it appears that she has a hard mass extending from the anus several centimeters into her rectum; Santiago is suspicious of malignancy.mhe took a biopsy which we will bring back to the US for analysis, and he did a diverting colostomy.
     For much of the morning I was in the OPD Surgical clinic seeing a variety of patients, many of whom had no surgical issues so I'm not sur why they were there. There were also several referrals to me of one sort and another: a benign breast mass in a young woman, several patients with keloids, a couple of hernias, etc. Already it is unclear to me how we will have time to do all the work being offered, but better too much than too little I suppose.
       Dr. Gbozee and Dr. Moses did a recurrent hernia while I was in the OPD, and then I cam up and did another recurrent hernia wth Dr. Gbozee. While we were doing those in the Orthopedic room, Santiago and Dr. Cassell did an ileostomy dcommisioning. So we did 6 cases that day, finishing at 6 pm, and that was a good days work !