Tuesday September 6.

     We did 4 cases today, which is quite an accomplishment considering everything that has happened. Back in June, they were forced to evacuate several of the Operating Rooms because of a leaky roof; in fact, for several months they have only done emergency operations at the Maternity Hospital next door. This meant that they had to transport equipment and patients over there to do the surgery, and then bring everything back to the main hospital in the rain. Repairing the roof during an unusually heavy rainy season presents its own set of difficulties, and work is ongoing. In the meantime, to accommodate us, we are using the Eye surgery room and the half of the Recovery Room has been turned into a temporary OR.
     The first case was a 10 month old child with an unusual growth on her left shoulder. It might be just a pyogenic granuloma ( benign) but it could also be a sarcoma. Deirdre and I did a wide excision, and we will check the pathology when we get home. Jonathan and Deirdre then closed a loop ileostomy in a young woman who have a perforated appendix with damage to her cecum last May. Her cecum was repaired, and appropriately to protect the repair the ileostomy was performed. Next Daniel and I debrided a burn on a 4 year old. The clinical story was peculiar, as was the burn which extends over most of his left buttock up onto his back. It is quite deep with gluteus muscle exposed. The story was that his mother brought him to her sister in Sierra Leone, and then went to get him a month later at which time she discovered he was sick and had this burn.There are some pieces missing to this puzzle. The final case was another loop ileostomy decommissioning by Daniel and Jonathan which went well.
       In between these cases, Konneh brought up several patients from the Outpatient Clinic for me to see and consider for admission and surgery. As usual, the pathology here is quite amazing: a huge parotid tumor, massive neck adenopathy which almost certainly is lymphoma in a 30 year old, several hernias of various shapes, sizes, and locations, and some friends from years past. Ophelia came to see us: she had an abdominoperineal resection for recurrent rectal cancer a couple of years ago. She is feeling well, and has no evidence of recurrence, but she is worried and thinks that she " needs a little cancer medicine". I tried to reassure her that she didn't need it, and she said okay. For those of you who have seen the photo of me wearing my Liberian garb at the Resident Graduation Party in June, that outfit was made by Ophelia !
     Miata also came to see us: she is a 17 year old female who met Jonathan at Phoebe Hospital several years ago. She has Crohn's disease, and has suffered mightily as a result. Last March Saniago repaired her rectovaginal fistula, and created a diverting loop ileostomy to protect the repair. She has done very well and is feeling great; she also looks fantastic. She is not having an perineal problems, and Jonathan thinks it will be reasonable to decommission her ileostomy during this trip.
      It took a long time to get started this morning, and I felt my frustration building, but it all turned out pretty well, thanks to cooperation from everyone involved. Hopefully after this start we will pick up steam over the next several days !