Monday was yesterday; I wrote half the post yesterday before collapsing in sweet sleep last night. I then wrote the other half this evening, but for some reason it has all been lost. I'm tempted to blame a temperamental Internet connection between Liberia and the rest of the world, and I actually do think that might be at the root of it. There is a fiberoptic sea cable which comes from France down the west coast of Africa, and countries join to that cable. My understanding is that Liberia has just the one connection, so it can be a problem. Right now it is rainy season in this part of Africa, and today there were frequent deluges, so roofs were leaking, roads were bad, and it was generally not pleasant to be outside. Maybe water got into the cable? who knows...
So yesterday we started with Grand Rounds, which was a celebration of the tenure of Dr. Billy Johnson as Chief Medical Officer at JFK from 2010 till now. It was also a gathering of lots of people across the hospital, and thus a great way to greet friends once again.The rest of the day was spent in the clinic seeing patients who thought they might need surgery; apparently there was an announcement on the radio that we are here, and as a result fees for surgery are reduced or waived. From what we saw yesterday, these two weeks will involve a lot of thyroid surgery. We also saw Dr. Brown and had the chance to talk to him about his vision for the future of JFK. There are many challenges ahead, but he seems to be moving ahead with determination and clear ideas on how to accomplish the possible. I think this is going to be another very good trip.
Today was a great first day of surgery for this trip. We started around 9:30, and did 9 cases including a mastectomy, 2 thyroids, some hernias, and a couple of other things. Throughout the day, Dr. Albertha Clark was in a room next to the OR screening patients for surgery. I would stop in to see her and patients from time to time, and I really enjoyed most of it.
We saw several women with operable breast cancer whom we will schedule for surgery while we are here. By "operable" I mean that there is a reasonable chance that surgery will prolong their lives significantly. In general, breast cancer treatment involves removing the cancer itself and then reducing the risk of the patient developing another cancer in the same breast by either radiating the remaining breast tissue or removing it by means of a mastectomy. Unfortunately, for women in Liberia, radiation is not an option because there are no radiation therapy facilities here; the nearest is in Ghana. So we offer the women a mastectomy because that is really all we have to offer.
I saw a 14 year old boy with a large mass in his left axilla, and then lumps several cm in diameter going down his arm. We biopsied one of the lumps when we saw him in March, the path showed it was a schwannoma. Now it seems to be growing and causing his left hand to be numb and unable to grasp. Schwannomas are generally benign tumors of the nerve sheath, but this is acting much more like a malignancy. I have no idea what if anything can be offered to this boy; I told him I would do some research, and he will come back to see us on Friday.
I also saw a 5 year old boy on Pediatrics with some sort of orbital tumor which appears small on the surface but must be large inside. They asked us to do a biopsy, and we likely will, but first we are going to collect further information from skull X-rays, and an opinion from a pediatric oncologist who apparently is here. I don't have high hopes for this boy.
After we finished operating, Adamah and Masmina took up on a tour of the city, including a stop at the Snapper Clinic (started by his uncle and Masmina's father). We stopped at the Capitol Bar for a drink, and then back here for sleep. The power has been going on and off all evening; hopefully I can publish this before it gets lost !
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