Sunday, July 26, 2009

Mary with hysterectomy patient. She had a huge ovarian tumor.


Deaf ministry.

Large thyroid Goiter.

Today is Independence Day in Liberia, so today and tomorrow will be slow at the hospital. I have a full house in the surgical ward, with 9 patients. Six of them are post op prostate cases, and all are doing reasonably well. I have been a little stressed the last couple of days. Unfortunately, after a long and difficult operation to repair a large arteriovenous fistula and 20 cm pseudoaneurism, Mark William died about 4 hours post op. I could go into the many reasons this happened, but the bottom line is the case was too complex and long for the very limited resources that this small hospital or, for that matter, this country has available. Thanks for all the prayers; his family and I are grateful.

There are more challenging patients yet to come. The first is a young man I wrote about previously. He was born with a urinary bladder exstrophy (open to the skin). He has had a constant urine leak since his birth. I was able to consult with Dr. Bob Strimer and he contacted a pediatric urologist at Vanderbilt who recommended implanting the ureters into the sigmoid colon. Ideally this will keep him dry and continent. I am going to do this on Tuesday. The second it the 7 month old with the huge meningiocele arising from the back of the head at the base of the scull. To remove it, the baby will need general anesthesia and to be placed face down. The cyst will need to be removed and the dura (watertight covering for the nervous system) closed with meticulous sterile technique. If the baby gets an infection it will be difficult to survive.

Sterility, as in the lack of bacteria, is almost laughable if it were not so serious a problem here. Today, for instance, there was no sterile gauze in the hospital for dressing changes, a common problem. The techs in surgery have to cut and fold from rolls of gauze, package and then sterilize them in an autoclave that must be supervised and nursed along. They have had a new autoclave for 2 – 3 years, but it needs a triple phase circuit to power it and no one has wired it.

Mary scrubbing in...

The third patient is the lady with the large sarcoma on the back of her leg, who will also need general anesthesia, a wide excision and a skin graft. I am supposed to do this on Thursday and of course we are leaving on Friday. The fourth patient concern is a 37 year old I saw today, complaining of passing blood with her stool. On exam she has a large rectal cancer. In the states, she would receive chemo and radiation prior to surgery. It does not exist here. Surgically she would need removal of her anus and rectum, with placement of a permanent colostomy. I don’t think that is an option, even if I could pull it off surgically, which is possible, there are no colostomy devices (bags and such) available. I need to discuss this case with the local MDs to see what options there are at the two other hospitals. The larger one is JFK Hospital in Monrovia; it was built with funding from the US during Kennedy’s administration. The other is a small but better equipped hospital at the Firestone Rubber plant – the largest employer in Liberia, other than the UN. Both hospitals suffer from similar lack of supplies, personnel and equipment.

On a lighter note, we were able to borrow a car yesterday and had dinner at a local restaurant called Sajj. We had Hummus and fresh hot pita bread which was excellent, followed by a veggie pizza. Driving the streets of Monrovia is a challenge, there are no working traffic signals and the streets are crowded with people and vehicles. The drivers are really very courteous when you learn the local etiquette. When you need to enter traffic, just nose out and someone will stop for you. You should watch out for and stop for the pedestrians. We have found Liberia to be relatively safe and secure as long as you use common sense and don’t put yourself in areas known to have problems.

The sun was out for several hours today which is unusual and nice during rainy season. We went to Dan and Cheryl’s house for a wonderful lunch. They are here with Samaritan’s purse and plan to be here for 5 years. They have 4 young children. He is a helicopter pilot, flying the SP copter all over the country taking teams and supplies to remote areas. He also has to sling load supplies in and out (that’s when the load is carried under the aircraft in a net or basket). There are several other committed missionaries here, several we met work with the African Bible College and others with SIM based in Charlotte, North Carolina. Samaritan’s Purse has a large presence in Liberia; it is the second largest active project country. There is a wonderful staff here, led by Kendell and Bev Kauffeldt. Please check the Samaritan’s Purse website for info, it is impressive.

Keep up the prayers. We will be leaving Friday for home.
Mark and Mary