Kwendin #13 | February 28, 2017
Last night I typed up my letter and sent it off, then looked around for the team. Bob was sitting at the table reading but the othe 3 were somewhere else. And there was loud music coming from Sammy's house across the field.
Turns out they had persuaded our driver Mohammed to bring the car over there, and put on some radio music, and they were dancing. Apparently Spencer declined to dance. But he was there in the crowd. they came back here an hour or so later and were very happy. And we all went to bed eventually.
OK today was busy. My first full day in the clinic since last Wednesday, and we ended up seeing 92 patients apparently. I did not see them all--Spencer and Kate certainly did their share. But I saw a lot.
I had some surgical type patients to look at first thing. I knew I needed to see the fellow with the stitch abscess from yesterday. And indeed he needed his drssing changed. Turns out he had been oozing blood all night so there was a litte bleeder that I had to oversew. We'll have to look at that again tomorrow.
Maybe you remember the fellow with the machete cut to his finger frmo last week. I was hoping that by today it might be clean enough to sew up the stump. But it was still stinky and with lots of dead tissue. I had brought a small pair of wiire cutters along on purpose and I had them soaking in alcohol, so i used them to trim off the dead bone that was giving us trouble. And I cleaned it up once more and re-dressed it. We'll see him tomorrow too.
Then there was the lady with the cancer on her nose. I simply changed the dressing and arranged for her to meet me in Tappita next week so I can show her to Dr Sherman. We'll change the dressing again before that.
I had actually booked a lady to come for repair of an epigastric hernia--a small lump just above her belly button. She eventually showed up around 10 when we were well into seeing the long line of patients, so we asked her to wait till the end of the day.
And a fellow came in with a swolllen painful knee that had been draining pus. He had had a pin put in in 2009 for a fracture, and clearly it is now infected. I asked him to wait till the end of the day too.
Spencer and Kristie went off to Tappita right away to discharge our patients. Apparently they were all doing well and that was pretty straightforward. The challenge was guiding our 15 year old diabetic through the system. It actually went very nicely but took quite a lot of time. Kristie has a long story to tell about it, amazingly positive. The internist there was very kind, and even paid for some of her tests out of his own pocket. He went personally to the lab to see that things were done right, and also to the pharmacy when it was time to buy insulin.
So Spencer and Kristie came back to the clinic about 2 pm. By which time Kate and I had stopped for lunch, then resumed and seen most but not all of the patients. We put Kristie to work with her little lab machine (she had taken it to tappita to show the internist and had run some lab work for free for a couple of his patients--he was delighted).
Once there were only about a dozen more patients to see, I left them all to Spencer and Kate while Kristie and I started on the afternoon surgical list. The epigastric hernia went very nicely under local anaesthetic. Kristie had to take a break half way through to sit down--turns out she never got any lunch today. She had something to drink and perked right up and carried on.
The infected knee was worse than I had thought--really no pus collection, just lots of scarring and a draining sinus alll the way down to bone. He will need some major surgery and weeks of iv antibiotics. Which he will likely not get. We will give him what we can.
We saw some other interesting patients today as well. A young fellow with a huge swelling of his jaw that was growing slowly. Hard and bony, not like a typical jaw tumour in Kenya called burkitt's lymphoma. I will try and get an xray of it to know what is going on.
Another fellow with long standing discomfort in his abdomen--and a palpable lump there. He'll need an ultrasound once the technician returns at the end of March. And maybe he'll be on my surgical list next year.
Still more people with hernias to put on the list. Probably they are going to get done in 2019. So I have a 2 year waiting list for my surgery patients!
Bob went to Tappita with Spencer and Kristie and did some grocery shopping while they were in the hospital. Our cookie supply is running low--terrible situation to be in. And we needed more crackers and sardines. Lunch in the clinic iis always crackers and sardines. If that doesn't sound appetizing, you would be surprised how appetizing they are after 4 hours of seeing patients in a hot room.
Ice cream? No.
Lots of bananas!
Bob's been working on fixing up the house next door where he lived in 1980. Lots of cleaning and scrubbing, and some walls are now painted. he got his team to chisel out a plugged drain in the shower room so water can escape if someone washes themselves there. There are some beds where various Liberian staff sleep (including George our liaison fellow). It will be a place where people can stay when they come from Monrovia to visit Kwendin--makes the idea of a visit more palatable and maybe it will happen more often.
Already tomorrow we admit the next batch of surgical patients. On we go!
Dr. John Potts