Our final day on this trip, and I found myself more anxious than I had expected. We usually have last minute operations to do, but today we had none, in large part because we were caught up in thinking about what we should expect on our way home and asked that our schedule remain free. The Corona issue is looming large, and will clearly have an impact on our journey.
We went to the hospital around 9, and said our goodbyes to patients and staff. We packed up those things we were bringing back(path specimens, our supply bags, etc); I picked up some slides from JFK Pathology for review and further study in Waterbury, and then we left around noon to go back to the hotel. We had lunch and a couple of Club beers, showered, and packed. Masmina came to see us off when the shuttle bus came at 4 for our trip to the airport.
The process at the airport starts with a security check, then baggage check in, then Liberian immigration check, then the metal detector etc. I knew we had a problem when Sepehr stepped up to the security check and they had him stand to the side. This was Friday evening; the Trump travel ban was going into effect at midnight. Sepehr is a Canadian citizen in the US to work at Waterbury Hospital on a J-1 visa; they determined that he was not eligible to fly to the US from Brussels because he didn't meet the criteria set out under the travel ban. After what seemed like an eternity to us sitting in the lounge upstairs, he finally emerged to say that he would fly with us to Brussels, but then would have to wait there till Monday when he will fly to Toronto, his hometown. Once there, he will contact the American Embassy to find out when he will be allowed back into the US to resume his residency; my guess is that they will say he must stay in Canada for 14 days from the date he leaves Belgium before he can come in. Having to stay in Brussels isn't the worst thing in the world, but it seems quite absurd to deny him entry while we are allowed to return.
We arrived in Brussels around 5am, and then departed for Newark around 10:30am ( Brussels Airlines had cancelled their flight to JFK(NY) and put us on a United flight to Newark instead. We arrived at 1:20pm, and once the plane stopped at the gate, we got up to deplane. They then announced that we needed to sit down because the CDC had forms we needed to fill out, but they hadn't brought the forms to the plane yet. After a few minutes the forms arrived and were distributed; then they said we need to wait until some of the people from other flights had cleared before they would let us deplane. Around 1:45pm they said we could get off, and join the line of people waiting to be screened with questions and a temperature check. After that there was Immigration; I was directed to the back room for more questions about where I was coning from, how long I had been in Belgium, etc.; interestingly, Mohammad gave them the same information that I did and was cleared without being called into the back room. Today I read that people in other airports like Chicago and Dallas were spending up to 8 hours in line awaiting clearance, so I guess I shouldn't complain.
All in all, it was another excellent trip. We did a total of 61 cases with good variety, and some very interesting cases for which we will rely on pathology to give us the diagnosis. Our team worked well together, and meshed very well with the Liberian staff. I think for Sepehr and Mohammad, it was a wonderful trip in which they learned a lot about their knowledge and abilities, and began to understand the responsibility of being a surgeon.
I found it fascinating that while people in the US often think about Liberia as a very poor, conflicted country full of hazards for us, on this trip with all of the hullabaloo over Corona and the financial market free fall, Liberia was a peaceful oasis for us. Until the end, we were able to focus on the task at hand and not think too much about the wailing voices far away bemoaning the end of the world. I found that I couldn't ignore those voices because the internet is ubiquitous, but being in Liberia allowed me to put them in perspective and feel a little more certain that we will all survive this crisis.
Sunday, March 15, 2020
Friday, March 13, 2020
Thursday March 12
The world is going crazy. We spent the day operating, but honestly I'm more concerned about getting everyone home safely. We learned this morning from a TV interview with Vice President Pence, that all US citizens return from Europe (except the UK and Ireland) would be expected to go into self-quarantine for 14 days. Our exposure to Corona is quite limited: there have been no reported cases in Liberia or neighboring countries, but will will be passing thru Brussels Airport for 5 hours so apparently that counts.
We had some interesting cases, and got thru the day. Then we had our usual farewell dinner put on by the owner of the hotel on the rooftop. It was a lot of fun, and the thanks from all sides were quite sincere.
To bed, and then tomorrow evening we start the trip home. Oh what fun to be traveling at this time !
We had some interesting cases, and got thru the day. Then we had our usual farewell dinner put on by the owner of the hotel on the rooftop. It was a lot of fun, and the thanks from all sides were quite sincere.
To bed, and then tomorrow evening we start the trip home. Oh what fun to be traveling at this time !
Thursday, March 12, 2020
Tuesday March 10 and Wednesday March 11
Another busy day using rooms as they became available and taking a noon break to go see Madame President. We did some hernias and small cases in the morning; I have confidence in Sepehr and Mohammed doing hernias together with my supervision. They understand the anatomy and the principles of repair much better thru their experience here, and it shows. They have both been a great asset on this trip.
At the event on Sunday Ethel told me about a brunch at Madame President's house on Tuesday, and I responded that it would likely be very difficult for us to break free of operating in the middle of the day. This morning Adamah made it clear that we were expected, and that Madame wanted to meet the team, so around 1pm Sepehr and I were picked up at JFK by Adamah's driver and taken to Madame President's house...in our OR scrubs since that is what we wear to the hospital each day. There were lots of other people there including many friends from over the years. We had some lunch, and then Santiago, Sam, and Mohammed came with Mary and other Sam, at which point Sepehr and I went back to the hospital to keep the operative ball rolling. He and I did a thyroid with minimal problems other than a very light level of anesthesia. Finally Santiago and Mohammed did a 14 year old girl with a huge cystic mass in her abdomen. We were hoping she would be another Harriet, but alas that was not the case; she had a big cyst filled with a thin, whitish yellow fluid with some debris. The cyst wall was thickened, and very adherent to the abdominal wall as well as to small bowel. The thought on CT was a mesenteric cyst; the contents looked like chyle. but the capsule was very thick and adherent. Santiago eventually decided that he had done what he could do, and that further attempts to remove the capsule would likely result in injury to her bowel. We will await pathology before suggesting further moves.
Wednesday was Decoration Day, a national holiday during which people clean and decorate the graves of their departed relatives. We had the day off, so we slept in, and then met for lunch. Dami Harper, a former HEARTT guy at JFK, had lunch with us and then we took the shuttle bus to Mamba Point to visit the mask and carving shops. Several of the vendors recognized us from past trips, and we had an enjoyable time viewing the wares and bargaining on prices. We then went up to the Ducor Hotel, but it seems the Libyan owners are serious about renovating it finally, and no one is allowed on the grounds. We visited the statue next to it of JJ Roberts, first President of Liberia, and talked with some of the locals.
Then we went to a new, Liberian-owned hotel/bar on the lagoon in Congotown called D Callabash where we sat on the outdoor porch and had a few beers. It was very pleasant!
Back to the hotel, then dinner and bed.
Awoken at 3 am by Santiago pounding on my door to tell me that Trump has put a travel ban in effect for anyone coming from Europe. Since we leave here tomorrow night for Brussels, and then Brussels to NY on Saturday, this could affect us. With clarifications, the ban doesn't affect US citizens who have been screened, so I think most of us will be okay. It remains unclear how this will affect Sepehr who is a Canadian citizen working at Waterbury Hospital on a J-1 visa. Some reports say that visa holders are okay, others don't mention it. The uncertainty is casting a pall over the end of this trip.
At the event on Sunday Ethel told me about a brunch at Madame President's house on Tuesday, and I responded that it would likely be very difficult for us to break free of operating in the middle of the day. This morning Adamah made it clear that we were expected, and that Madame wanted to meet the team, so around 1pm Sepehr and I were picked up at JFK by Adamah's driver and taken to Madame President's house...in our OR scrubs since that is what we wear to the hospital each day. There were lots of other people there including many friends from over the years. We had some lunch, and then Santiago, Sam, and Mohammed came with Mary and other Sam, at which point Sepehr and I went back to the hospital to keep the operative ball rolling. He and I did a thyroid with minimal problems other than a very light level of anesthesia. Finally Santiago and Mohammed did a 14 year old girl with a huge cystic mass in her abdomen. We were hoping she would be another Harriet, but alas that was not the case; she had a big cyst filled with a thin, whitish yellow fluid with some debris. The cyst wall was thickened, and very adherent to the abdominal wall as well as to small bowel. The thought on CT was a mesenteric cyst; the contents looked like chyle. but the capsule was very thick and adherent. Santiago eventually decided that he had done what he could do, and that further attempts to remove the capsule would likely result in injury to her bowel. We will await pathology before suggesting further moves.
Wednesday was Decoration Day, a national holiday during which people clean and decorate the graves of their departed relatives. We had the day off, so we slept in, and then met for lunch. Dami Harper, a former HEARTT guy at JFK, had lunch with us and then we took the shuttle bus to Mamba Point to visit the mask and carving shops. Several of the vendors recognized us from past trips, and we had an enjoyable time viewing the wares and bargaining on prices. We then went up to the Ducor Hotel, but it seems the Libyan owners are serious about renovating it finally, and no one is allowed on the grounds. We visited the statue next to it of JJ Roberts, first President of Liberia, and talked with some of the locals.
Then we went to a new, Liberian-owned hotel/bar on the lagoon in Congotown called D Callabash where we sat on the outdoor porch and had a few beers. It was very pleasant!
Back to the hotel, then dinner and bed.
Awoken at 3 am by Santiago pounding on my door to tell me that Trump has put a travel ban in effect for anyone coming from Europe. Since we leave here tomorrow night for Brussels, and then Brussels to NY on Saturday, this could affect us. With clarifications, the ban doesn't affect US citizens who have been screened, so I think most of us will be okay. It remains unclear how this will affect Sepehr who is a Canadian citizen working at Waterbury Hospital on a J-1 visa. Some reports say that visa holders are okay, others don't mention it. The uncertainty is casting a pall over the end of this trip.
Tuesday, March 10, 2020
Monday March 9
Monday morning begins our second and last week of this trip. We arrived in the Operating Suite at JFK at 8:30 to learn disappointing news: one of our incisional hernia patients who seemed to be doing well on Saturday and almost ready to go home passed away on Sunday. It's not clear what happened, except her eyes looked pale and her blood count was low, and then there was difficulty getting her a blood transfusion and getting an IV restarted. The other piece of bad news was Ama telling us that there was no gauze available, and therefore there would be no surgery. Santiago and I each gave Adiola $20 to go buy some rolls of gauze from the pharmacy, and then Adamah went and bought more, so we were able to carry out our expected schedule of 8 cases.
Prior to our surgical day, we attended Grand Rounds where the presentation was by the Department of Internal Medicine on Chronic Kidney Disease. They presented some of their data, including the fact that there is a 98% mortality in patients admitted with renal failure because there is no hemodialysis or peritoneal dialysis currently available in Liberia. Most of the patients had loosely-defined "glomerulonephritis", but a significant percentage also had diabetes and/or hypertension. There was much talk about the need for a dialysis facility in Liberia, and the difficulties they will have maintaining a supply chain. Prof. Ikpi and others made the strong point that it will be much more cost-effective to focus on prevention of kidney failure thru treatment of diabetes and hypertension, and education of the public of the need for BP checks etc. This is a public health issue, and that should be a prime focus.
Then we went to operate. Sepehr and I operated on a 46 year woman with an abdominal wall mass which had been growing for several years. It was now the size of my hand, and I guess she decided something should be done about it.We thought it was going to be an unusual tumor called a dermatofibrosarcoma protuberans, but were surprised to find that intra-abdominal structures were involved; we had to resect a piece of small bowel which was caught up in the mass as well as part of the wall of her uterus. We were able to take out what needed to be removed, and close her abdomen with some difficulty. One aspect of surgery here that is makes it most interesting is the possibility of surprise findings: in the US, this patient would have had a CT and other imaging studies which would have made operative surprise much less likely.
Mo and I did a 71 year old man with a large mass on his back which surgeons elsewhere had tried to remove it 4 times previously. He presented to us with a large 20cm mass which was ulcerated and odiferous. My initial impression was that this was an elastofibroma based on its characteristic location at the lower end of the scapula. There was no way that we would be able to remove it and close the skin, so our goal was to remove it and later he can have it closed with skin grafts. The surgery went pretty much as expected, but then there was much activity from the head of the table; on questioning, the anesthetists indicated they were having trouble hearing a heart beat. With alacrity, we removed the mass so that we could move him from his side onto his back, and felt a weak femoral pulse. After making sure he was okay, we bandaged his wound and he is okay. Close call.
We had dinner on the rooftop of the Murex Hotel last night, and it was delightful as usual. Adamah and Mary and Sam came over, and then Joe and Abraham joined us, so it was a lot of fun.
Prior to our surgical day, we attended Grand Rounds where the presentation was by the Department of Internal Medicine on Chronic Kidney Disease. They presented some of their data, including the fact that there is a 98% mortality in patients admitted with renal failure because there is no hemodialysis or peritoneal dialysis currently available in Liberia. Most of the patients had loosely-defined "glomerulonephritis", but a significant percentage also had diabetes and/or hypertension. There was much talk about the need for a dialysis facility in Liberia, and the difficulties they will have maintaining a supply chain. Prof. Ikpi and others made the strong point that it will be much more cost-effective to focus on prevention of kidney failure thru treatment of diabetes and hypertension, and education of the public of the need for BP checks etc. This is a public health issue, and that should be a prime focus.
Then we went to operate. Sepehr and I operated on a 46 year woman with an abdominal wall mass which had been growing for several years. It was now the size of my hand, and I guess she decided something should be done about it.We thought it was going to be an unusual tumor called a dermatofibrosarcoma protuberans, but were surprised to find that intra-abdominal structures were involved; we had to resect a piece of small bowel which was caught up in the mass as well as part of the wall of her uterus. We were able to take out what needed to be removed, and close her abdomen with some difficulty. One aspect of surgery here that is makes it most interesting is the possibility of surprise findings: in the US, this patient would have had a CT and other imaging studies which would have made operative surprise much less likely.
Mo and I did a 71 year old man with a large mass on his back which surgeons elsewhere had tried to remove it 4 times previously. He presented to us with a large 20cm mass which was ulcerated and odiferous. My initial impression was that this was an elastofibroma based on its characteristic location at the lower end of the scapula. There was no way that we would be able to remove it and close the skin, so our goal was to remove it and later he can have it closed with skin grafts. The surgery went pretty much as expected, but then there was much activity from the head of the table; on questioning, the anesthetists indicated they were having trouble hearing a heart beat. With alacrity, we removed the mass so that we could move him from his side onto his back, and felt a weak femoral pulse. After making sure he was okay, we bandaged his wound and he is okay. Close call.
We had dinner on the rooftop of the Murex Hotel last night, and it was delightful as usual. Adamah and Mary and Sam came over, and then Joe and Abraham joined us, so it was a lot of fun.
Monday, March 9, 2020
Saturday March 7 and Sunday March 8
On Saturday we worked in the morning doing a variety of cases. One of them was a young girl with a fun gating tumor on her thigh. Apparently excision had been attempted elsewhere twice, but it had come back again. It was sent to us as "malignant melanoma", but I think that diagnosis is quite unlikely. I removed it with a decent margin, so we shall see what the pathologist says.
We finished 6 cases by 3pm; as we were preparing to leave for the day, I asked Ama if we would need to scale back our operating plans for next week because of a shortage of supplies. She rather emphatically said yes, and explained that there were more shortages than I had thought. We shall see.
Saturday evening Teresa Cummings invited us to join her for dinner. Originally we were going to go to Mamba Point, but all day there have been a lot of people in the streets because the governing party(CDC) is having a gathering this weekend. So we switched and decided to dine on the roof of the Royal instead. It was a very pleasant gathering and a lot of fun!
Sunday we were up early to leave the hotel at 8 am for a drive to the Farmington Hotel near the airport where we attended the launch of the Ellen Johnson Sirleaf Presidential Center for Women and Development. It was planned to coincide with International Women's Day! There were 200-300 people there, including the current President George Weah, the current Vice President Jewel Taylor, and a variety of retired Presidents and others from neighboring countries. There were a lot of speeches, some of which were quite interesting. Madame President has already started a program called Amujae, which is a Liberian dialect word for "We're moving up". 15 or so young women from all over Africa have been selected to come to Monrovia 4 times during the next year to attend an intense 3 day course of education, coaching, and mentoring by Madame and several of her friends. The first Amujae class was there, and included a number of impressive young women including the first female minister of Finance from Ghana, the first female Mayor of Freetown Sierra Leone, and others of similar accomplishment. Over the next couple of years the physical Center will be built, and will contain a library, an exhibition area to display her achievements, and a conference center.
I had a nice conversation with Madame President in which we talked about her travel plans including a likely trip to Dublin once the corona virus scare has abated. Seated next to her was Linda Thomas-Greenfield, former US Ambassador to Liberia and then Assistant Secretary of State for African Affairs in the Obama administration. She introduced herself and we had a pleasant chat.
Then back to the hotel where we rested, had dinner, and crashed for the night.
We finished 6 cases by 3pm; as we were preparing to leave for the day, I asked Ama if we would need to scale back our operating plans for next week because of a shortage of supplies. She rather emphatically said yes, and explained that there were more shortages than I had thought. We shall see.
Saturday evening Teresa Cummings invited us to join her for dinner. Originally we were going to go to Mamba Point, but all day there have been a lot of people in the streets because the governing party(CDC) is having a gathering this weekend. So we switched and decided to dine on the roof of the Royal instead. It was a very pleasant gathering and a lot of fun!
Sunday we were up early to leave the hotel at 8 am for a drive to the Farmington Hotel near the airport where we attended the launch of the Ellen Johnson Sirleaf Presidential Center for Women and Development. It was planned to coincide with International Women's Day! There were 200-300 people there, including the current President George Weah, the current Vice President Jewel Taylor, and a variety of retired Presidents and others from neighboring countries. There were a lot of speeches, some of which were quite interesting. Madame President has already started a program called Amujae, which is a Liberian dialect word for "We're moving up". 15 or so young women from all over Africa have been selected to come to Monrovia 4 times during the next year to attend an intense 3 day course of education, coaching, and mentoring by Madame and several of her friends. The first Amujae class was there, and included a number of impressive young women including the first female minister of Finance from Ghana, the first female Mayor of Freetown Sierra Leone, and others of similar accomplishment. Over the next couple of years the physical Center will be built, and will contain a library, an exhibition area to display her achievements, and a conference center.
I had a nice conversation with Madame President in which we talked about her travel plans including a likely trip to Dublin once the corona virus scare has abated. Seated next to her was Linda Thomas-Greenfield, former US Ambassador to Liberia and then Assistant Secretary of State for African Affairs in the Obama administration. She introduced herself and we had a pleasant chat.
Then back to the hotel where we rested, had dinner, and crashed for the night.
Friday, March 6, 2020
Friday March 6
Yesterday was a good day with a number of challenging cases. Sepehr and I did a parotid tumor which was quite a bit larger and more involved than we expected. It was supposed to be a benign pleomorphic adenoma; these typically shell out easily. However it turned out to be quite involved surgically, invading or compressing the internal carotid artery up to its entrance into the skull. We opted to back out, and just remove the 90% of the tumor we could, rather than risk an uncontrollable disaster to try to remove it completely. As surgeons, it’s in our nature to be aggressive in surgery for cancer, but particularly here we need to recognize our limitations.
We arrived back at the hotel around 9:30. Adamah was there with Ben, Matt, Mary, and Sam; we had a fun dinner then off to bed.
Today was another long, but good day. I started with a thyroid which I did with Dr Albertha Clark, and it was quite fun. The patient is an older woman with a monstrous unilateral goiter, the size of it made the dissection difficult but we got thru it well. Later on Santiago and I did a young woman (27 yo) with a parotid tumor. It was another difficult dissection in an area fraught with hazard because of the risk of damage to the facial nerve. After Santiago expressed his misgivings about our decision to do the surgery, everything came easier and we completed the surgery successfully. And her smile in Recovery showed eat her facial nerve was intact !
While we were doing the parotid, Sepehr and Mohammad did a hernia. It was a very good feeling to know that after 5 days of assisted and supervised work, these 2 residents were ready to do a hernia repair on their own with minimal supervision! They were rightfully proud. So we had them do another! We ended up finishing the day with 4 hernia repairs, and a total of 11cases for the day. We got back to the hotel around 10:15, had dinner, and then to bed. We will work again tomorrow.
We arrived back at the hotel around 9:30. Adamah was there with Ben, Matt, Mary, and Sam; we had a fun dinner then off to bed.
Today was another long, but good day. I started with a thyroid which I did with Dr Albertha Clark, and it was quite fun. The patient is an older woman with a monstrous unilateral goiter, the size of it made the dissection difficult but we got thru it well. Later on Santiago and I did a young woman (27 yo) with a parotid tumor. It was another difficult dissection in an area fraught with hazard because of the risk of damage to the facial nerve. After Santiago expressed his misgivings about our decision to do the surgery, everything came easier and we completed the surgery successfully. And her smile in Recovery showed eat her facial nerve was intact !
While we were doing the parotid, Sepehr and Mohammad did a hernia. It was a very good feeling to know that after 5 days of assisted and supervised work, these 2 residents were ready to do a hernia repair on their own with minimal supervision! They were rightfully proud. So we had them do another! We ended up finishing the day with 4 hernia repairs, and a total of 11cases for the day. We got back to the hotel around 10:15, had dinner, and then to bed. We will work again tomorrow.
Wednesday, March 4, 2020
Wednesday March 4, 2020
I didn't write yesterday partly because I was tired, and partly because I was feeling frustrated. Happily today I feel much more optimistic !
Yesterday we started late (1st case around 11:15am) and that was the highlight of a frustrating day. Elizabeth Kubler-Ross wrote some years ago about the 5 stages of the grieving process: Denial, Anger, Bargaining, Depression, and Acceptance. I have told people before that I go thru similar stages each time I come to Liberia tho I put Frustration in there before Bargaining. It usually takes me about a week to feel like I have passed thru those stages; yesterday I set a personal best by going thru all of the phases in a single day! By the end of the day I was feeling totally frustrated by the pace and by our inability to accomplish what we set out to do.
Today, on the other hand, was an excellent day and we are back on track. I had an excellent chat with Professor Ikpi this morning, and then we did a bunch of cases. I felt there was some good teaching as well as interesting surgery which required some outside-the-box thinking. Tonight we came back to the hotel around 7:30 and had dinner after cleaning up. Adamah came to the hotel and Mary and Sam, and Ben was with them along with Masmina, so we had a good evening. Tomorrow is going to be another busy day with a schedule that we are unlikely to complete, but we will try. But I need sleep first.
Yesterday we started late (1st case around 11:15am) and that was the highlight of a frustrating day. Elizabeth Kubler-Ross wrote some years ago about the 5 stages of the grieving process: Denial, Anger, Bargaining, Depression, and Acceptance. I have told people before that I go thru similar stages each time I come to Liberia tho I put Frustration in there before Bargaining. It usually takes me about a week to feel like I have passed thru those stages; yesterday I set a personal best by going thru all of the phases in a single day! By the end of the day I was feeling totally frustrated by the pace and by our inability to accomplish what we set out to do.
Today, on the other hand, was an excellent day and we are back on track. I had an excellent chat with Professor Ikpi this morning, and then we did a bunch of cases. I felt there was some good teaching as well as interesting surgery which required some outside-the-box thinking. Tonight we came back to the hotel around 7:30 and had dinner after cleaning up. Adamah came to the hotel and Mary and Sam, and Ben was with them along with Masmina, so we had a good evening. Tomorrow is going to be another busy day with a schedule that we are unlikely to complete, but we will try. But I need sleep first.
Tuesday, March 3, 2020
Monday March 2, 2020
Back at JFK Hospital for another visit; others on the team include Dr Santiago Arruffat, Ms Samantha Shoultz. Dr Sepehr Karimi, and Dr Mohammad Ali. We arrived last night after meeting Santiago and Sam at the airport in Brussels; we will once again stay at our home away from home, the Murex Plaza Hotel. There is something very comforting about arriving at a hotel after 20 hours of traveling to be greeted as friends for whom the ritual registration and filling out of paperwork are a formality which can be avoided!
This morning we went to JFK to see our friends once again We delivered our 400 pounds(8 duffel bags) of supplies to the Operating Theater, and then went to Grand Rounds where I was honored to introduce our team. Later on we went to meet the pathologist and see the lab. Then we went to OPD and saw about 30 patients with Dr Clark including a variety of hernias, several thyroids, a parotid tumor, and 2 patients with suspected dermato fibrosarcoma protuberans.
I’m not sure how this is all going to work out on this trip. We have very limited availability of general anesthesia because there is only one anesthesia machine in service, and that one has issues. Today we are going to develop a system to try to maximize productivity in the OT. My experience from past trips allows me to be optimistic that we will overcome the roadblocks that right now seem unpassable; we shall see.
This morning we went to JFK to see our friends once again We delivered our 400 pounds(8 duffel bags) of supplies to the Operating Theater, and then went to Grand Rounds where I was honored to introduce our team. Later on we went to meet the pathologist and see the lab. Then we went to OPD and saw about 30 patients with Dr Clark including a variety of hernias, several thyroids, a parotid tumor, and 2 patients with suspected dermato fibrosarcoma protuberans.
I’m not sure how this is all going to work out on this trip. We have very limited availability of general anesthesia because there is only one anesthesia machine in service, and that one has issues. Today we are going to develop a system to try to maximize productivity in the OT. My experience from past trips allows me to be optimistic that we will overcome the roadblocks that right now seem unpassable; we shall see.
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