Friday September 15

   Our final day on this trip. We did several biopsies on patients who had an unknown diagnosis, or at least needed pathological examination of their problem. One was a guy with multiple lumps of varying sizes all over his body; another was a man complaining that his left wrist was painful, He had incurred some minor trauma to the wrist a few years ago, but said no bones were broken. It started getting painful in the past year. On examining him, he has a huge node in his left axilla which is not painful.He kept saying that his wrist was the problem while I kept telling him that the enlarged node was a bigger problem. They could be related, or it could be two different things going on. In any case, after consulting with my colleagues, we all agreed that the node biopsy was important to do first since we are leaving. He needs an X-ray of his wrist, but he doesn't have money to pay for it right now. So we did the biopsy.
     We finished around 1 pm, and then ordered pizza from Sajj for the OT staff to thank them for their hard work. We ended up with a total of 78 or 79 procedures done(the final total is still being worked on). On past trips we have done 55-60 most of the time, so this was a substantial increase in volume. This is particularly notable in view of the fact that 1 of the 2 ORs we were using had limited use because there was no surgical lighting other than our headlights, and the ventilator on the anesthesia machine wasn't working. Joshi was reluctant to use that room for anything other than spinals or short cases, so we had to do a lot of juggling with the schedule. I think we had an excellent team pitching in and getting things done and that includes our HEARTT people as well as the Liberian staff. Without question we could not have been that productive without the encouragement and help from Mary, Munah, and Dr. Macdonald as well as Selina in the Admitting Office and many others.
      After lunch we went back to the hotel to change and get ready to depart. Moses was going to take Sandeep, Greg, and Murphy to the mask shops at Mamba Point, but one of the political parties was launching their campaign downtown, and traffic was a total mess, so that didn't happen. Masmina came to the hotel and we had a good debriefing/chat with some ideas for our next trip. Then Murphy, Sandeep, Greg and I went to leave with Morris; Jonathan and Chandra have a later flight going to Amsterdam, so Moses will bring them to the airport in a few hours. Before we left the hotel, Morris couldn't get one of his back doors to latch, so we had a delay while that got fixed. In my usual pre-flight anxiety, I let out some of my frustration...but then the latch got fixed and we left for the airport.
       Robertsfield Airport is about an hour drive from Monrovia under good conditions; Friday afternoon at 5 pm is never a good time to go anywhere ! Getting out of Monrovia was a struggle with traffic, but Morris found some interesting, rutted dirt road shortcuts, and then we seemed to be cruising until about 5 miles from the airport. We found that there was a traffic jam because there was about 18 inches of water on the road due to flooding from recent rains. I had never seen this on any previous trip. Many cars were having trouble getting thru it because they were slung low enough that water got in the exhaust or engine or whatever so people were getting out to push them thru. Fortunately we didn't get stuck, though I certainly had some anxious moments. we arrived at the airport and left on time flying to Brussels and then on to JFK(NY). Aside from having to wait 2 hours while Sandeep went thru the line for non-US passport holders, it was okay. As we walked down the hallway from the plane to Immigration, we separated into 2 lines based on signs saying "US" and "Non-US"; I wondered if they will be changing the signs soon to "US" and "THEM".