Friday March 24

       This was an interesting and amazing day in many ways. We did 10 operations, including 5 thyroidectomies, and I believe that sets a new single day volume record for the HEARTT surgical team. To be honest, while we are proud to have done 10 cases, what is more significant is that the Liberian OT team was willing to put themselves out so that we could accomplish this. And our team worked extremely well together to make it all happen.
        Goiter is quite common here. Lack of iodine in the diet causes the thyroid gland to enlarge into what is called a goiter, which is typically a mass in the neck. As usual in Liberia, by the time these patients seek medical attention, the goiter is often huge; this was the case with several of our patients today. From a surgical perspective, removing an enlarged thyroid is a challenge because the gland has a big blood supply, and there are several important structures in the neighborhood which you have to take care not to injure. Another aspect of the surgery is that in Liberia we don't take out the entire gland; we want to leave some behind which will produce enough thyroid hormone for the bodies needs since oral thyroid hormone replacement (like Synthroid) is generally not available.
       In addition to the thyroidectomies, we excised a thyroglossal duct cyst in a 4 year old boy, did a hemorrhoidectomy, and a couple of other small cases. We also saw several patients to add to our list of surgeries that need to be done before we leave on Wednesday evening.  The woman I mentioned in yesterday's posting with the huge breast tumor came back to the hospital today apparently ready to have surgery, but then she left again before we could get her done. It's sad that she is so overwhelmed by fear; I wish I knew how to help her conquer it.
         As I said at the beginning, doing as much as we did today was the result of a team effort by a lot of people. Yassah, who runs the OR, encouraged her people to keep going and provided the example by staying till we finished at 8:30pm. Our team meshed with our hosts to keep things moving; in particular our anesthesiologist Philomina made sure there were no unnecessary delays. Aaron Gilson also ran all over getting patients ready and upstairs, as well as operating with us.