Monday and Tuesday

Yes, My apologies to readers: we are having internet problems and as a result my Monday-Tuesday post has been lost into space or someplace. I will try to recreate it.

Monday was a busy day: we arrived at the hospital at 8:45sm and returned to the hotel at 9pm. We did a variety of cases including hernias and thyroids and lumps of various types, but I want to tell you about one patient in particular. She is a 39 yo woman with a large but operable breast cancer. Ominously she had several large palpable axillary lymph nodes. Several aspects of her treatment were and will be dictated by what is available here. There is no radiation facility in Liberia; patients who need it must go to Ghana or India, and that obviously involves significant expense. Because of her circumstances she chose to have a mastectomy instead, and perhaps avoid the need for radiation. She would have probably benefited from a course of neo-adjuvant chemotherapy given before surgery, but without the ability to assess her for metastatic disease, it would be hard to advocate for that. Furthermore, an essential element in decisions about breast cancer treatment is the presence or absence of tumor hormone receptors; the pathology department here often lacks the solutions necessary to do those tests. So she was scheduled for a modified radical mastectomy(removal and f the breast and the axillary contents), and Dr. Mabanza asked me to take Dr. Kempe,one of the senior registrars, thru the procedure. Gaspar and Dr. Kempe did the first part of the procedure by removing the breast, and then I helped show them how to do an axillary dissection. As a side note, axillary dissection is disappearing from the common surgical procedure list due to improvements in technology, understanding of cancer behavior, and improved chemotherapy. I expect that in the next decade any surgery for breast cancer will become rare in well-resourced countries 

Tuesday we did more hernias: Gaspar and Paul did several inguinal hernias, and I did a large incisional hernia with Gaspar and Kempe. There are an increasing number of Liberian residents who are eager to scrub with us, and that is very gratifying. I’m