Friday March 23

     Our last day at JFK on this trip, and it was filled with the joys of doing the work we do, and the occasional frustration of trying to get things done. We planned to have a short operating day so we could go to the souvenir shop to get carved masks etc., but it didn't work out that way. When we arrived at JFK we learned that they had forgotten we were leaving, and thought we would be available to staff more cases. After resolving that issue, and emphasizing to the OT staff that we needed to be out by 12 or 1pm, we discovered that the Pharmacy tech for the OT had not arrived yet; he has the key to the drug room, and he keeps track of which patient is charged for what drugs. After multiple phone calls from me and others, he strolled in at 10 am to some icy stares. We then did our 2 cases, the second one being a 6 yr old girl with an inguinal hernia. I had Dr. Quaye with me, and we did what needed to be done in about 30 min; it then took at least an hour and a rocky emergence from anesthesia before she could be taken to the Recovery Room. The final case I was involved in was a 4 year old girl with what was thought to be vaginal mass with bleeding, and Dr. Konneh wanted to get it done in case there was tissue to be sent for pathology. Upon examination under anesthesia, we were not able to see any mass; it turned out later that the real story was quite different from what I was told, and that I had been subjected to some false advertising.
      After saying our goodbyes to everyone, we were driven back to the hotel around 1pm by the JFK driver, and I confirmed with him that he would be back at 4 pm to take us to the airport. We showered and packed, and around 2:30 I went to leave my luggage in the lobby and check out. Upon speaking to the receptionist, I learned that she knew of no arrangement with Masmina to pay the bill, and therefore they were expecting me to pay the charges for the three of us. I then had a half hour of panic as we tried my American Express as well as other cards, and all of them were denied. I knew they would be: the credit card processors are naturally suspect of any charges emanating from West Africa, which is why I have never used a credit card to pay for anything in Liberia. The receptionist suggested I could go to an ATM; I told her that no ATM would allow me to withdraw that much money. She then suggested that I could go to several ATMs; it seemed pointless to explain how that would look to the computers at the Bank of America !! I asked the receptionist to contact the owner of the hotel, who had hosted our rooftop dinner the other night, but she couldn't reach him. I was in something of a panic over this, and I knew that at that moment Masmina was over the Atlantic flying to the US, so I called Adamah to ask for help. He said he would call me back; just then the manager returned from outside business, and took care of everything once I explained. She knows Masmina well, and knows that the bill will be settled up when Masmina returns from her short trip to the US.
       After a couple of Club beers in the hotel restaurant we went to the lobby at 4pm to await the hospital driver. By 4:10 he hadn't arrived so I called him; he said he was on his way. By 4:40pm he still wasn't there, so I called him again and he said traffic was heavy. At 4:45 Mrs. Cooper called to say goodbye, and said that she assumed we were in the car on the way to the airport. When I told her that we were still waiting, she said that she would take care of it and call me back. She did, and shortly before 5pm  Mrs. Koffa, the new Acting Deputy Administrator, came in her car to personally drive us to the airport. My mother always used to say that every cloud has a silver lining, and it was certainly true in this case as we had an hour drive to talk about her impressions of JFK and her plans and hopes for the future. We arrived at the airport in plenty of time for our flight home!
       This was a great trip with many accomplishments that everyone involved can be proud of. As a HEARTT Surgery team, I believe we have at last made the transition into a true collaboration with the JFK Surgery Department including consultants as well as the postgraduate trainees. This has always been the the goal of these visits, but in the past it was difficult to accomplish for a multitude of reasons. This time we were able to do it because of strong leadership from Professor Ikpi as well as strong support from the new JFK Administration, and a group of postgraduate trainees who are eager to develop and refine their clinical surgical skills. I think that we have moved to a new level with this program, and this collaboration can help JFK accomplish a lot for Liberia over the next several years. On top of all that, we once again had many memorable clinical experiences which will be remembered and cherished for years to come.