Monday September 5

      We went to Grand Rounds this morning, held in the cafeteria rather than in the amphitheater because of some leakage problems, I believe. It rained all day today, and was torrential at times; even for a country with a rainy season, I think this year they have had more than usual. We spent the day getting organized, and I think it went quite well. Mrs. Cooper, from Admitting, found us early on so she could show us the list of potential patients and we could start thinking about what surgeries we want to do. There are a number on the list who will clearly benefit from pathological examination of tissue, so they move to the top of the list. Others are interesting operations to do from a surgical perspective, so we will likely do them also. There is a large list of hernia patients, both pediatric and adult, which we will fill in the schedule with. When I suggested that we didn't need to do a lot of adult hernias, Dr. Konneh pointed out that there are 1st and 2nd year residents who would benefit from operating with us, and I think his point is valid. We are here to teach, and that is what we will do !
     We sat in for their chart rounds, and then made walk rounds through Pediatrics with Dr. Konneh and others. The level of knowledge and discourse is clearly improving among the postgraduate trainees, and that is a wonderful thing to see. The patient stories remain heartbreaking; today we saw a 2 year old who drank caustic material a couple of days ago. It's the same story we have heard before: mother is making soap, so she takes the crystalline caustic(like Drano), mixes it with water in any available container, and then sets it aside. Young patient comes along, and thinks the liquid is in a cup ( or a Coke bottle or whatever) so it's ok to drink. Unfortunately it causes a deep alkali burn to the esophagus, which most of the time leads to a stricture, and that prevents the child from eating or drinking. There is no medical solution to this problem. The surgical solution is far too complex to be carried out in these surroundings. It is really a public health issue, and the solution will come from prevention.
       Dr. Jonathan Laryea arrived from Little Rock, AK vis Accra, Ghana this afternoon so out team is complete. We came back to our apartment where we had dinner and then we are all retiring early, partially in response to jet lag but also in anticipation of a busy day in surgery tomorrow.