Saturday May 17

     Our major case for today was a mastectomy on a 41 year old female who is related to one of the nurse anesthetists. The patient's 40 year old sister is currently in Ghana receiving chemotherapy for breast cancer, and according to the family it isn't working. The main reason my patient wants surgery is to get rid of the smell from the large ulcerated.fungating lesion on the upper part of her left breast. Gbozee and I did her surgery, and maybe we will be surprised that she will do well if she goes to Ghana for chemo treatment. But I'm not optimistic. Unfortunately, in my experience breast cancer in a 41 year old is rarely curable, even with the best chemo and radiation available. But there is certainly a much better chance of longer term survival if it is diagnosed early. One of the great public health tasks for Liberia over the next several years will be public education about the importance of early diagnosis and treatment for all sorts of diseases. People here tend to stay away from hospitals and medical for all sorts of reasons including cost, fear of disease, and fear of hospitals; it will take a concerted effort to change that.
       The rest of the day involved a smattering of cases including a ruptured appendix done by Sandeep and Mike Quaye, biopsy of a strange looking leg mass, and a hernia among others. We kept the OT staff busy from 9 am to 5 pm, and they made no complaints. In fact, the only yelling and complaining was that the pharmacist was not there at 9am, delaying our start.
        The other patients are doing well; in particular the 10 year old girl with the huge renal cyst is recovering nicely. As you can tell, I'm pretty happy about that one !