Monday April 11

 A full day to start our second and final week of this trip. We started with breakfast at Madam President’s house and fascinating conversation as usual. Santiago asked her if she missed being President; she responded that while overall she was happy doing what she wanted without harping from adversaries, she missed having the power to fix things immediately. After that we went to JFK and did a variety of operations. The last case was a 38 year old man with a large right inguinal hernia which had been present for years. In the past week it was causing him worsening pain, but he didn’t want to come to the hospital, maybe because of fear of hospitals or fear of the cost. In any case, he finally came in early yesterday morning. He was in the ED most of the day getting IV fluids and making arrangements for his hospital bill. He was carried up the 4 flights to the Operating Suite because none of the elevators are working yet. At surgery he was found to have a perforated colon with extensive fecal contamination; during the operation he had a cardiac arrest and could not be resuscitated. It was a very sad ending to the day,  and a reminder that health issues are often complicated by social and economic factors that are out of our control.

April 9 and 10

 Saturday was a lazy day. We went to JFK and did one case, and then we were back at the Murex by noon. We all napped and relaxed got the afternoon before going to dinner at the Mamba Point Hotel. Our team of eight was joined (and hosted) by Masmina, Adamah, and Theresa Cummings, the Chair of the Board of HEARTT. We had a delicious sushi dinner mixed with lively and fun conversation.

Sunday we went to Libassa, an ecolodge in Marshall out near the airport. There are swimming pools and beaches and huts to stay overnight. It was a great afternoon, and we might go back there before we leave. On the way back to the hotel we stopped at Adamah’s brother Charles house for beer and food. A number of other people were there, many of whom I have met before, and it was great to see them all again.

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.

April 7

 Another good day of variety and interesting cases to learn and teach from. We did a variety of hernias, some adult and a couple of pediatric; the latter included a 10 month old baby who had had a colostomy for imperforate anus which was decommissioned later. She developed an incisional hernia at the colostomy site which was symptomatic, and thus the reason for repair now. She did fine! We also had a breast mass excision(benign), and some endoscopies. At the same time, Dr Ayun Cassell was performing urological procedures including a TURP. He was an excellent general surgery resident who worked with us in that capacity for several years before going to Dakar, Senegal to train in urology. He is now back in Liberia, and I believe he is the only trained urologist in the country. And Dr. Doe was in another room revising the cranial end of a VP shunt in a 2 yr old with hydrocephalus. 

April 6

 This morning JFK has a real crazy busy schedule going in the Operating Suite! As I write this, at the far end of the hall Santiago is working with Liberians doing endoscopy; in another room Sepehr is repairing an incarcerated hernia with Yuk; in another room Becca worked with Dr. Kokulo to repair an incarcerated hernia in an 11 yr old boy; and in another room Dr. Doe is evacuating an epidural hematoma. Dr. Gbozee had some orthopedic cases to do today, but with the crowded situation up here, he decided to do them in the new mini-OR built downstairs next to the newly renovated trauma ward and ICU. The multitude of surgeries and surgeons reflects the progress that has been made at JFK over the past decade, and I feel privileged to have been here to see it. There are still many problems to overcome, but there is movement forward. An aspect that occurred to me is that with the increased number of trained surgeons, there is a pressing need to increase the capacity of the Operating Suite. There are several operating rooms being used for storage now; they will need to be outfitted and converted to active rooms, more staff will need to be trained, etc. Meanwhile, other cases today included removal of a large polyploid growth from the lower back of an older woman by Dr. Kokulo and Becca, and a laparotomy by Sepehr and Yuk and  2 of the Liberian residents on a young man who was shot the previous night. He was stable and it appeared his injuries wouldn’t be too bad, but they found he had a hole in his small bowel and one in his transverse colon. Possession of firearms by private citizens is supposed to be illegal in Liberia, but there appears to be increasing availability of weapons. That seems like a dangerous trend in this country still recovering from the violence of a long civil war. We went back to the hotel and were joined for dinner by Adamah and Masmina. It was a good time!

April 5

 We arrived at JFK to find a number of cases scheduled for us, and that was a surprise. Sepehr and I operated on a man with large bilateral African hernias, and used mesh for the floor repair. Becca and Yuk did a couple of less than African hernias. I removed a fibroadenoma from Precillar’s sister. We ended up doing 7 cases, which was pretty good considering that we weren’t sure we would do any before we arrived at the hospital. Last night Santiago and Samantha arrived to complete the team.

April 4, 2022

 Went to JFK at 8:30 am with our 13 bags of supplies, and found that the elevator was not working. Without too much trouble a group of men was recruited to bring them all up to the Operating Suite on the 4th floor. We then went to Grand Rounds and were warmly greeted by a number of old friends. After the meeting, Dr Gbozee showed us the new ICU as well as the new trauma ward, and the we went back upstairs to unpack our supplies. I think we did well in matching their needs with what we brought! Mary, our Administrator Angel, came up and we reviewed some patient charts for possible surgery: most were routine, and some might be interesting. One is a right colon “mass” for which there is no documented proof, and the other is a “sarcoma of the sacral region”; I asked that both patients be asked to come in so we can see them before committing to surgery. Earlier in the hallway downstairs I saw Miatta; she is a young woman with inflammatory bowel disease who may need yet another operation. I asked her to come back on Wednesday morning when Santiago is here. Masmina came to the hospital to check on us; we decided there wasn’t much more for us to do at JFK today, so we went back to the hotel for lunch. In the afternoon we went out to the 14th Military Hospital which is on the road to the airport. It is quite new and sparkling! There we met Kevin and Nuta Strachy, who I have heard about but never met. She is Liberian and a nurse; he is a retired plastic surgeon. He closed his practice in Florida, and they moved to Liberia where he is essentially CMO of the 14th. We had a wonderful tour and discussion, and I think we will find a way to work together a few times on this trip. After a lovely dinner, we all went to bed early to get ready for the beginning of serious work tomorrow.