Wednesday September 14

      The first item on the docket today was to see if the equipment was working which would allow the 3 GI bleed patients to have endoscopy this morning. It seemed to be working, but during the first case, the video monitor froze which brought everything to a halt. Various attempts by Jonathan and others to switch things around didn't get it working....and then I remembered something similar had happened last March with Santiago. Thank heavens for modern communication ! I texted him in Indiana, and after some thinking he remembered that we had a problem when the endoscopy equipment was plugged into a transformer plugged into a 220volt socket, but it worked when we switched it to plug it into a 110volt socket directly. It is one of the peculiar aspects of JFK that it is wired with both 220V and 110V sockets; this, as you might imagine, causes confusion and the occasional mishap when something is plugged into the wrong voltage. In any case, we switched things around and the equipment was working, and the scopes got done.

      The most interesting was the 16 or 19 year old female. The 2 middle-aged men could easily have had peptic ulcers to account for their bleeding, but it's hard to come up with a reason for repeated GI bleeding at her age. It turned out on endoscopy that she has large esophageal varices ( veins) just under the lining of the esophagus. They can bleed easily, and the bleeding can be torrential. Most of the time esophageal varices are related to cirrhosis of the liver, but this patient had no other evidence of liver disease. In looking on the Internet, it turns out that this could be caused by schistosomiasis ( infestation by an amoeba), in which case it is treatable and reversible. We spoke to the medicine people who will investigate further. Schistosomiasis is not common in Liberia, so maybe they will identify some other cause; in any case, hopefully it was be a treatable entity, in which case the  availability of endoscopy will have saved her life.

      Jonathan had to leave at 12:30 to catch a plane to Accra,Ghana where he has some meetings at the medical school on Thursday and Friday before heading back to Little Rock on Saturday. Once again it was a great pleasure for us to work together on this trip; he is smart, and skilled, and has a wonderful dry sense of humor. He has also taken a real interest in educating the Liberian residents, and I know this means a lot to them. Additionally, for this trip, it was a stroke of genius for him to bring Deidre Wyrick along on the team: she is smart and funny, and an excellent team player. On top of that, her interest and expertise in pediatric surgery paid huge dividends for our young patient yesterday in particular as well as many others. I have really enjoyed working with her, and I intend to remind her frequently about her stated desire to return to Liberia in the future ! Another very pleasant aspect of this trip has been the interaction between Deidre and Daniel, and knowing how much they have enjoyed working with each other, exchanging stories about residency, and helping each other get things done. Daniel has set up an Excel spreadsheet for all of our patient data, which will allow us to follow up patients a lot more efficiently than we have been able to do in the past. both of them have taken a strong interest in working with the Liberian residents, and that will have lasting positive effects I know.

      After we repaired a hernia in a 12 year old boy under spinal anesthesia, we walked around to check on out post-op patients, all of whom are doing well. We met up with Bola, the daughter of our patient Ophelia; Bola runs a clothing business, and she very kindly made beautiful African shirts for all of us. We also saw Robert Dolo, who runs the New Sight Eye Center; I had hoped to get out to visit his newly built clinic, but I don't think we will have time on this trip. 

       I think tomorrow will be busy, and then we plan to operate on Friday morning, leaving the afternoon to go souvenir shopping before we get on the plane on Friday night.