Wednesday September 6

      This was a very good day ! Our first case was the 4 year old boy with an esophageal stricture from caustic ingestion 2 years ago. He has been unable treat, and looks obviously malnourished with stunted growth. We planned to place a gastrostomy tube to allow direct placement of food into his stomach; since we now have to ability to look at his esophagus with a scope, we decided to do that also. Jonathan looked with the scope and we could see the stricture at mid-esophagus, but there was no clear lumen. So we opened his abdomen and made a hole in his stomach wall for the gastrostomy, and then Jonathan used the scope to look from the stomach back up the distal esophagus in retrograde fashion. He was then able to pass a balloon through the stricture, and blow that up to dilate it. After doing that twice, he looked again with the scope from the mouth down, and then dilate the stricture with another balloon catheter. When he passed that catheter further in(with the balloon deflated, I was able to feel it with my finger in the stomach, so we knew we had an open passage. We then placed the gastrostomy tube button and closed him up.We will get a barium swallow X-ray in a couple of days to see what his esophagus looks like now, and then probably scope him again before we leave. If this works, we have made his future much brighter!
      We then did a variety of cases throughout the day including a couple of hernias, a partial thyroidectomy, biopsy of a neck mass (adenopathy), a colonoscopy, and an upper endoscopy on a man who has an air-filled mass in his neck which is probably a laryngocele. We also saw a large number of consultations during the day including 2 kids with esophageal strictures, more thyroids, hernias, and a neck mass extending into the floor of the mouth (which Sandeep diagnosed as a plunging ranula!)(more on that later). Apparently there was an announcement on the radio that we were in town, so a fair number of people came to the hospital to see us as a result. They are brought to a room near the Operating Rooms, and we go out between cases to see what they have and if there is anything we can offer. There is a ER doc (Dr.Sally) from Mass General here teaching the residents how to do ultrasound, and she has a radiologist/ultrasonographer (Dr. Rao) with her for 2 weeks; they spent time this afternoon doing ultrasounds on several of these patients which is very helpful in guiding our surgery.
     Throughout the day we had Liberian residents with us in the OR and evaluating the many patients; Dr.Gbozee, Dr. Cassell, and Dr. Konneh were particularly involved in the operations. During the morning Dr.Gbozee's mother came to the hospital to say hello to us, and it was a great honor for me to meet her.
     We had some mechanical/electrical issues with the newest endoscopy equipment, but through a concerted effort by the biomedical engineers as well as Mary, Munah, and Dr. Macdonald, the issues were resolved and by afternoon everything was working. There are still significant hurdles to overcome in returning JFK to its place as a referral hospital, but there is definitely progress. Today we saw a glimpse of that progress, and it felt good.