Well we did actually make it to Liberia. I’m sorry we haven’t been able to get any info out before now but we don’t have internet or email connections at the guest house we are staying in. First I will give you a brief rundown on getting here and our first few days.

We left Knoxville on Tuesday on what should have been a 1:40 Cont. flight to Newark. Unfortunatly the flight would be delayed at least 2 hours due to storms in Houston (where the flight was coming from). This would cause a missed connection to Brussels, so our flight was changed to Delta to Atlanta to Brussels, making our arrival in plenty of time to connect to Monrovia. This worked out despite the 90 min wait in the plane in Knoxville due to storms in Atlanta. So all went well and our luggage made it with us to Liberia, including the anesthetic drugs. Customs was not a problem, in fact when we told them we were going to ELWA hospital, we bypassed the lines and went right out to the car and met our driver Samuel, a native Liberian working for Samaritans Purse. Samaritan’s Purse, World Medical Missions, is the organization that arranged the trip for us.
We arrived after dark, about 10:15, in the pouring rain. It was a 35 min drive to the ELWA compound were the hospital and our housing is located. Compound is really not the right word, it is a collection of buildings and houses covering about 100 acres along the beach outside of Monrovia’s suburbs. There are no active gates or walls. There is local hired security of sorts which patrol. ELWA stands for Eternal Love Wins Africa. They are staffed by missionaries from SIM (Serving In Missions). The house is run by another organization called the African Bible College or ABC for short. The African Bible College was destroyed during the war and has just recently reopened. Samaritans Purse has essentially funded its rebuilding and is supporting its efforts to become a leading college in Liberia. The ABC guesthouse is very comfortable. We have a bedroom with windows facing the beach, and have our own bathroom. Unfortunatly, no hot water. Im sure in the dry season that is no problem, as it is hot, but the rainy season is cool and the morning shower sure wakes us up.

Our first full day was orientation to both the Samaritans Purse projects and to the hospital. SP has a large presence here and is working with building projects, literacy, agriculture, nutrition and others. There is a group of girls here from South Carolina for the summer, going to several villages “in the bush” doing VBS for a week at a time. They are staying in the villages in tents, doing projects with the children. These girls are tough on the outside, with tender hearts. It is very humbling to be around all these people. At the ELWA hospital, we met Dr. Rick Sacra, a family practitioner, from Mass., that trained at the ETSU program in Bristol from 89 – 92. He has been in Liberia from 94 until now with only minimal breaks. He is one of two full time physicians, the other is Dr. Quayee a Liberian practitioner who does the majority of the surgery currently performed here. They limit most cases to below the waist, so spinal anesthesia can be used.

The hospital at first glance is a mess, it has been in disrepair and needs some basic maintainance, but as you begin to get to know the people working there, you become impressed with what they are doing with so little. It is a 50 bed hospital with small wards of male, female, pediatric, and OB/post partum patients. Since my arrival they have turned their conference room into a surgical ward with six beds. The patients I am seeing are prescreened and referred for evaluation. As I understand it , the path a patient takes is to first go to the nurse/PA clinic where most common things are taken care of, if there is increased complexity or if the patient desires they can then go to the doctors office (D.O.) for evaluation. Dr. Sacra deals with a multitude of medical problems including diabetes, hypertension, any manifestation of TB that you can think of, typhoid, etc, etc. He does this with minimal lab, a fair ultrasound machine, occasional plain x-ray, and a limited pharmacy. The patients must pay for their services, so it is important to keep costs down by carefully choosing what is done and considering what the patient will continue to do after the visit. We have already used and given one of the blood glucose kits that were donated by Allen Britton. We had a 36 yo patient with extreme weight loss over 4 months time that came to the clinic with a blood sugar over 400. He underwent teaching, was started on insulin and given the monitoring device. He will have close follow up, but the kit will keep him from having to make daily visits to the hospital, as his sugar is brought under control.

My second day will mirror most of the remaining time I think. Devotions are at 7:30 at the hospital chapel, followed by patient rounds or surgery. Rounds and clinic evaluations will be done between cases and in the afternoon if cases are completed. I already have several cases scheduled, including prostatectomies (which are going to be my most common case I think), hernia repairs, neck mass biopsy, removal of a baseball sized tumor in the groin area (sarcoma maybe?), and a pelvic mass (cystadenoma I hope). The first 3 cases I saw in clinic were 1. Large unilateral lymphadenopathy (TB?Lymphoma?), 2. Mylomenengiocele on 4 week old girl with spastic paraplegia, 3. Recurrent tumor L groin, baseball sized. This is going to be an interesting 3 weeks.