Friday March 15

   This day is another national holiday, honoring the birthday of J J Roberts, first President of the Republic of Liberia. Nonetheless, with the critical and uncomplaining assistance of the staff at JFK, we worked. We did 9 cases spanning the variety of surgery that we are called on to do on theses trips. A couple of hernias, two thyroids, endoscopies, closure of a colostomy in a baby who was born with imperforate anus. removal of a large benign salivary gland tumor in a 10 year old boy, and a bowel resection for cancer.
      The 19 year old boy has had this mass growing just under his jaw for several years. He lives in the southern part of the country, and had been to several hospitals, but apparently no surgeon felt comfortable removing it. He was then admitted to Pediatrics here at JFK, I believe the plan was to wait for our arrival. The tumor extended from the angle of the mandible near the ear to his chin; it was mobile and nodular, and had the physical characteristics of a pleomorphic adenoma arising from the submandibular gland. I think is is quite unusual to see such things in a 10 year old, but this is Liberia and we have become used to seeing unusual things! Rob Kimmel Jr, Arthur Wouh ( a PGY-1 Liberian surgery resident), and I did the surgery; I think it went very well. One of the joys of removing benign tumors is that there is little attachment to the surrounding tissue so it can be peeled off.At the end of the operation I felt that we had changed the course of this boy's life, and that is pretty cool; at the same time, there was a lot of teaching and learning for Arthur and Rob, and that was great.
      We heard in the morning that a woman had been admitted with a bowel obstruction, and she might need surgery later in the day. By late afternoon it was clear that she was getting worse, and that surgical relief of her obstruction was needed. The only problem was that there had been problems with the elevators and the electricity supply all day, and now the elevators weren't working. The HEARTT Surgery team along with several OT staff members then went down to the second floor, strapped  this significantly sized, very ill, 250 pound woman to a backboard, and carried her upstairs to the 4th floor Operating Theater! Santiago and Albertha Clark, and Samantha, then proceed to explore this woman and find an obstructing transverse colon cancer. They removed it and did a primary anastomosis. It was an interesting scene in the OT with them doing surgery with no light other than their headlights and the glow of the anesthesia machine monitors powered by reserve battery, and with Santiago's techno beat music playing in the background! We had sent the other members of our team back to the hotel, and we joined them in the restaurant around 10 pm.
      I write this a 7:30am on Saturday. Usually we would work on Saturday, but we have received a special invitation to go to Tubmanburg to visit former President Sirleaf at "The Farm". I had some reservations about skipping one of our normal working days, but in the end I decided it was an opportunity for the members of this team that was too good to pass up. We have worked hard this week, and have done 32 cases in 4 days under difficult conditions, and next week we will do a lot more. Time to take a little time to enjoy Liberia !