We arrived in Monrovia at Sunday night around 7:30pm, after the usual long journey from the US. Tired after 20 hours of travel, it was an incredible joy to be greeted so warmly at the Murex Hotel! It's the little touches like smiles and hugs, and being handed the key to room 203 with the words:"Your usual room, Doctor"! We had a lovely dinner; it will come as no surprise to those who have been on these trips that I had the spaghetti bolognese, and it was great!
Monday morning we arrived at JFK to more warm greetings as we brought our 9 supply bags to the surgical Suite. Leaving the bags there we went to Surgical Morning Report to greet friends and then to the Hospital Grand Rounds. The speaker was a urologist from the Royal College of Surgeons in Edinburgh who was discussing the collaboration between them and the Liberian College of Physicians and Surgeons to bring laparoscopy to Liberia. It was a very interesting talk, and brought up a number of issues about introducing technology into less resourced countries.
We went back to the Surgical Suite to see what was the plan for the day. For a variety of reasons, we expected that this trip would have a slow start, but we were very wrong! Dr. Mabenza and Dr. Kukulol had planned to get us operating right away and so we started with hernias, several endoscopies, and a lot more to come. We were also pleasantly surprised to find that several of the OR staff had unpacked all of our supplies, sorted them, and shelved them for easy availability. We ended up having a busy half day of surgery, and then arrived back at the Murex around 8pm for dinner and early bed. Mickey and Sean, the 2 surgical residents from Waterbury Hospital on the trip, were both very pleased with the day !
Today we had another busy day with several more complex cases. After doing a routine hernia this morning, Mickey and I had a patient with a huge incarcerated/strangulated recurrent inguinal hernia who was brought up from the Emergency Department. At surgery he was found to have about 5 feet of dead small bowel in the hernia sac. We were able to resect the dead bowel and perform a handsewn anastomosis thru the incision we had made, and then we found a creative way to repair the hernia defect. I'm expecting him to recover well; time will tell.
Then Dr. Mabenza and Sean and I went to see a 17 year old female with a large breast mass who was waiting in the pre-op area for her anticipated surgery. A previous biopsy of the mass indicated that it is a benign phylloides tumor; it's not cancer, but it has a propensity to recur. I had been told that the tumor was not large and could be easily removed, but it was immediately apparent to me that this would not be a simple surgery. The tumor is huge, and there is very little normal breast tissue. Additionally she told Dr. Mabenza that she does not want a mastectomy, and she wants her nipple preserved. At that point I told Dr. Mabenza that I was not comfortable operating on her today, and we should put her on the schedule for tomorrow so I have some time to consider and plan an approach which would accomplish the goal of removing the tumor while offering her the best chance of an acceptable cosmetic outcome. Fortunately with modern communication being what it is, I was able to send her clinical information and pictures to my colleagues in CT, and they had some good ideas for consideration. Before we left the hospital I asked Dr. Mabenza to speak with her again and see if she would agree to a mastectomy; if not, tomorrow I will do my best to give her a good operation that will get rid of the tumor and have a decent cosmetic outcome.
G0d is a marvelousGod
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