Liberia 2017

Kwendin #15 | March 2, 2017

It's after 8 and the evening has been hotter and stickier than usual--with sweat drops running down my back starting during supper. A cold shower helps but the heat does not let up. Different from yesterday after the rain. The mercury thermometer on the desk beside me reads 97 F. That would be 36 C I think.

First thing this morning I had a fellow waiting for me that I had booked to take a lump out of the palm of his hand. I commented that I couldn't figure out what kind of lump it was, and the RN Luah said he had injured it in 1998 with a thorn.

I filled it full of freezing and got Kate to put a BP cuff on his forearm for a tourniquet to control bleeding while I was working--I know hands bleed a lot. It was a good thing to have done and really helped. I slowly dissected down to the lump and found it was hard and scarred. As I worked around it I exposed a small black thorn and took it out and gave it to the patient to keep. I took out the lump of scar and sewed him up. It went very nicely but took almost an hour. The sort of thing one really can't do well unless there is an assistant like Kate to hold things and expose the area nicely.

I saw a couple of other recheck patients but basically left them for Spencer to check on. I'll see them all tomorrow.

Meanwhile Kristie had been gobbled up by the delivery room. There was a lady in labour there and she spent much of the morning until that baby finally delivered. it did well and Kristie was delighted.

Kate and Kristie had arranged the night before that Kristie would stay in the clinic today, and Kate would come to the OR with me. She was made very welcome by the staff that remembered her from last year.

Two surprises for us when we got there. First, patient number 6 was waiting for us. this time we already knew what to do. I found Dr Asaye and asked if he would do the surgery for us tomorrow, and he readily agreed. So between cases Kate got him admitted and paid his fees.

The second surprise was that we only had one anaesthetist for two ORs which were both booked. Now, anaesthetists in Africa are a clever lot but there is a limit to the magic they can do. He basically said that he could manage cases that could be done under spinal, simultaneously in two rooms. But not kids. Both our pediatric cases were put off to tomorrow as well. I got in touch with Dr Nuanh who does surgery on kids, and he readily agreed to do those two kids.

That left us with three cases to do. And it started pretty smoothly--once the hysterctomy in the other OR was under way, our patient got his spinal and Kate and I could work away on him. It was a huge hydrocoele and was slow and tedious but went well.

Between cases there was a certain amount of sitting around while the various OR's got cleaned and re-set, so there was time for Kate to do the admission and time to have a visit with the Obstetrician who works there. A fine fellow from Ethiopia and very capable.

Our second case was a big hernia with some technical challenges but again went well.

Then a caesarian case arrived in the OR. So Kate got to watch a caesarian while I looked at an outpatient. The fellow from yesterday with the huge jaw swelling finally had his x-rays done. I looked at them with Dr. Asaye and we puzzled over the best approach. He has a huge bony tumour that does not look malignant. But if we chisel the bone away, there will be little jaw left on that side. We decided to bring it to Dr. Sherman when he is back next week, to try and figure out the best approach in this country.

Finally we got started on the last hernia patient after 4 pm. It was not so huge but still took me till 5 to do it. And it went well too.

I was very glad to get home.

Spencer worked hard all day seeing patients in the clinic, finished about 5. Kristie joined in and saw patients too once the delivery was over. They saw about 90today. Some are coming back tomorrow for me to look at.  

One of the meetings Bob had today was with 6 of the teachers at the local school here. They essentially have no salary. They received about $10 each in the past year. They survive by growing crops in the property around the school. Bob doubled their annual salary by giving them each $10 today. There is considerable turmoil in the management of the school, which is all being handled by the Liberian Baptist organization except that the people in authority are all in Monrovia which is far away. There seems to be slow progress and all we can do is watch and wait.  

Kate and Kristie have had the little girls braid their hair tonight. They look great. The kids climb all over them and love them to pieces. And the feeling is very mutual.  

Time to send this off.

Dr. John Potts