March 29

     Busy days on the 26th and 27th, ending with the biggest inguino-scrotal hernia I have ever seen. It extended to below his knee when standing.Emery, Dr. Mabanza, and one of the Liberian surgeons found a way to return all of the bowels to his abdomen, and then create a repair combined with a scrotoplasty. It was quite a surgical tour de force!

     Thursday night there was a birthday celebration for me as well as a recognition of my last trip. Masmina organized everything, and it was quite a special event for me. Many people spoke of the contributions we have made of the past 15 years, and several who couldn't be present provided comments that were read by Masmina. The guest of honor was former President Sirleaf who was very generous in her praise. She surprised me by saying that while it was nice to have this celebration by our medical colleagues, she thinks that a lot of people in Liberia would like a proper celebration of my contributions, and she proposed that there should be a planned public occasion in September celebrating our work which I would obviously be expected to attend! Someone asked me afterwards if I would come back for such an event; my response was that when Madam commands, I do what I'm told!

Professor Coleman, Chairman of Surgery, then said that there are plans to make me an Honorary Fellow of the Liberian College of Physicians and Surgeons at their annual meeting in September. HEARTT gave me a quilt with the names of all the residents who have come to Liberia with us since we started coming in 2010 which is beautiful and a moving memento; JFK presented me with a plaque and a stunning ceremonial robe; and Dr. Gbozee told me that I now have a new name added to mine recognizing me as a warrior of Lofa County or something !

On Friday we went to JFK to say goodbye, and then went to Madam Sirleaf's house to say goodbye and to each receive an inscribed copy of her autobiography. We then had one of those amazing drives to the airport by Richard, a driver for Madam and a tiger on the road. Equipped with a full set of sirens and horns, and the ability to aggressively navigate narrow corridors between lines of cars and trucks, he went thru traffic like a knife thru butter ! And now we are in Brussels awaiting our flight to the US.

As a final working trip, it could not have been better for me. It's gratifying to see the progress that has been made in Liberia in general and in surgical services at JFK in particular in the past 15 years. I know that we have helped with our provision of supplies and our teaching, but I think perhaps our biggest contribution has been our reliability and consistency. We made a commitment and we kept it over 15 years and 26 trips, and we have created new leadership to insure it will continue as long as they want us to come. 

March 25

 I have no good excuse for not writing every day, except that we have been very busy working and I have been very tired at night. We have had some interesting cases, and some real challenges which have made the trip interesting and fun. We have been challenged by a number of abdominal cases in particular: one last week was a 19 year old with abdominal pain which progressed to an acute abdomen. His abdomen with distended and very tender; Emery and I had no clue what to expect, other than he needed surgery sooner rather than later.On opening his abdomen he had bowel twisted around itself; this is called a volvulus. What made him unusual was the part of his colon (sigmoid) was twisted, and we think that process brought in small intesting which also twisted. Twisting cuts off the blood supply to the affected bowel and it dies; we ended up removing about half of his small bowel and 1/3 of his colon. He is doing well at this point, so I continue to be optimistic.

Saturday night Masmina took us to the Mamba Point Hotel for sushi. We had a great time! Then Sunday we went to Libassa, the eco-resort about an hour drive from Monrovia that we have visited on previous trips. It is situated in jungle next to the ocean, has a lazy river as well as several pools, and  it provided a most pleasant day off.

This week we have been busy, and we are running up against the usual difficulty of have more to do than we can do in the tome available.

March17-18-19 2025

    We arrived in Liberia on Sunday night March 15 after a long pair of flights from NYC. We were greeted by thunderstorms and torrential rains on the drive from the airport to the Murex hotel. After s short but solid sleep we brought our 12 bags of supplies to the JFK Operating Suite and greeted many old friends. We then went to Grand Rounds and listened to a talk on HIV Care in Liberia presented by the Infectious Disease physicians. They noted that the HIV medications which they receive for patients comes from WHO so they still have access to them, but a USAID  grant provided the funding for computers and staff tor their surveillance and contact tracing. Without that USAID funding, they are not able to continue that work. After that talk, Dr. Tamba, the CMO, invited me to introduce the team which I did, and then I informed them that this would be my last trip. I was moved by their expressions of sadness and thanks.

     On Monday and Tuesday we did about 15 cases, and almost every one involved a member of our team and a Liberian resident. Our previous experience has been that the Liberian residents were reluctant to operate with us, perhaps somewhat out of fear but  the Liberian surgeons told me often that their residents seemed to think they could learn all that the needed to know from  books rather than operative experience. I think finally the message has gotten thru that there is no substitute for operating  if you want to learn surgery!

    Yesterday the best news was speaking to Dr. Williefrank Benson, a Liberian surgeon who trained here and then went to Nairobi to learn pediatric surgery. I have talked in previous blogs about the problem of caustic ingestion in children. Women buy crystalline sodium hydroxide and mix it with water to make lye which they use for making soap. They store the lye in any convenient container, such as a coke bottle; the children see a bottle of clear tasteless liquid and think it’s water. The lye can cause serious injury to the esophagus leading to stricture and inability to swallow food. Sometimes we have been able to dilate the stricture, but they often recur.the only longterm solution is to replace the esophagus but moving a length of colon into the chest to bypass the strictured esophagus. This is a big operation on a child requiring combined abdominal and chest surgery;  it’s not something a general surgeon would want to do, and until Dr. Benson came back from his fellowship, there was no pediatric surgeon in Liberia. But now he is here and he has done several successfully! This is yet another milestone for Liberian surgery!

     Looking back over 15 years I am impressed by the progress Liberia has made in healthcare. The are still a lot of problems, but overall I’m thrilled to have been here to witness the improvements.

    I’m going to stop now. I wrote the above during the day today, but there was bad internet. Now its 10pm and we have just finished dinner. And we have a long day ahead tomorrow.