April 8

 Today is National Fasting and Prayer Day in Liberia, a national holiday, so we were expecting a limited schedule today. When we arrived at 9AM, it seemed like we had 2 cases and would be finished quickly. To no one’s great surprise, we ended up doing 7 cases and finishing at the hospital around 4:30pm. The final case was complicated: a 22 year old female with abdominal pain and distension for several days, but her abdomen was soft. The major logistical issue was getting her from the Trauma ED on the ground floor to the Operating Theater on the 4th floor. Because it was a holiday, it wasn’t easy to find strong men to carry her up; eventually it happened thanks to intervention by Dr Mbasa. On exploration by Santiago, Sepehr, and Becca, she was found to have 900cc of bilious ascites, cirrhosis, and a probable retroperitoneal duodenal perforation. Based on the tissue reaction, it looked like the perforation occurred days ago; it seemed like the best course of action was to wash out her abdominal cavity, place drains, and hope for the best. It’s not clear why she has cirrhosis, but a reference in her chart to asthma made us wonder if she has alpha-1 antitrypsin deficiency. After dinner we went to the rooftop terrace and had a nice time chatting with Joe Morris, Clarence, and Adamah.