Liberia 2017

Kwendin #24 | March 10, 2017

Now this is a different evening. Kate and I have just come back from the clinic where there is a lady in labour. It is her first baby and she is progressing very slowly. I do think that she will deliver but it is going to be quite a few hours yet, so we have come home to wait instead of putting in hours sitting at the clinic.  

Yes, we are finished seeing patients at the Kwendin clinic for another year. Unless there is an emergency this weekend, and maybe the lady in labour qualifies as an emergency. Through the day today the clinic was very busy, and I worked with Kate taking out lumps and bumps. Spencer and Kristie were the ones seeing most of the patients. Spencer counted 51 that he saw not counting about a dozen dressing changes, and Kristie saw quite a few, and after our lumps and bumps were done Kate and I saw a dozen or so. I'm sure there were close to 100 again today.  

The lumps and bumps went well. Always a bit unpredictable. the first lady had an egg sized lump at the corner of her jaw. Kate rolled her eyes at me when she saw it, remembering the neck lump we took out last year which was a bit beyond what we should have taken on. We made a point of praying with the lady before we started.  

Once I managed to dissect down to the surface of the lump, it was plain even to me that I should not continue. I was expecting a smooth surface like a lipoma or a cyst or an old lymph node. This one was covered with large blood vessels. Nope. That one needs a proper OR and maybe Dr Asaye standing beside me. We sewed her up and promised to do it next year. I offered to send her to Tappita in the meanwhile but she declined. She is a widow and says I am the only one who can help her. She will wait for next year.  

We also had a lady with a large lipoma on her inner upper arm. That one sounded easy but it turned out to be about twice as big as I had thought, penetrating down to the layer right against the major blood vessels and nerves of the arm. One smaller nerve actually went right through the lipoma. We worked away at it for over an hour and it came out nicely. The lady was so grateful that she was almost in tears.  

One of the down sides of that large case was that we used up more local anaesthetic than expected. We started to watch our supply very carefully and ration it out. I saved one larger lump to the end, thinking I could do the smaller ones for sure. And while I was waiting for the next patient, I remembered that Luah had mentioned some sterile water for injection on the shelf. I found 10ml and used it to dilute the local anaesthetic, giving up considerably more volume, which turned out to be just enough to do that last case. Actually I wished I had a little more--one corner of our dissection caused her pain. But we managed it OK. And the patient was stoic and grateful.  

So half way through the day our lady came into the delivery room in labour. Kate and kristie had turns checking on her, and at the end of the day I went to see her as well. Like I mentioned at the start, it is her first baby and she is going slowly. Kate and I will go back and check on her about 10 I think.  

We walked home but didn't get here till about 5. It was a long, hot sweaty day.  

Part way through one of the lump surgeries I heard a drip. I knew the patient wasn't bleeding so I looked around to see what was dripping. It was the sweat running out of the cuff of my surgical glove and dripping on the floor. I was so hot that my hands were running with sweat. Every case when I finished, my hands were wrinkled from being under water for half an hour or more.  

Now, I need to tell you that last night Kate asked to be taught how to suture. We got an extra packet of suture material and a needle driver, and she proceeded to suture the skin back onto a banana. She learned fast. But banana skin is not the same as people skin.  

It meant that I could get her started on suturing some of the wounds today. She worked away at it slowly and did a fine job. And took pictures of her handiwork--maybe they will show up on Facebook someday. She was very pleased to be able to work on something completely new and I was happy with her workk.

Today after lunch Bob and the team slaughtered a small goat for us all to share. He had the pressure cooker going when we got home--goat meat is very tough in Liberia and a pressure cooker is a wonderful tool for such things. Lots of the neat was shared with the Liberian staff so I think everybody has had a good meal with lots of protein for a change. The goat stew that Bob cooked up was just wonderful.  

Our Liberian host John Karmo has arrived as planned. He just got here a few minutes before the medical team arrived walking home. He has a bunch of different people to talk to about how things might develop here in Kwendin. He has a lot of grand plans for developing the school and they sound to me very practical and well paced. He is expecting to visit here once or twice a month to keep an eye on how things are going--that would be a wonderful change and would make a huge difference to the activity level here in the school and in the church. We are supposed to have a talk with him tomorrow morning for a little while. He has to be back in Monrovia tomorrow night so he will leave here before noon tomorrow.  

We are well into the process of leaving things behind. All of the drugs and supplies have been delivered to the clinic, except for a small pile that I will deliver in Boyee on Sunday. We have our solar panels and batteries allocated already--one will supplement the clinic solar panels, and one will go to the local motorbike mechanic. I think that last one might get installed tomorrow afternoon.   This evening after supper when we went to check on our maternity patient in the clinic, it was dusk and the room was quite dark. I re connected the lights I installed 5 years ago, and they helped a bit. But within a few minutes, it got dark enough that the clinic's own solar lighting system came on. Suddenly there was light, much better than the little ones from my system. I switched mine off. And then while I was examining the lady, yet another, brighter light came on. That is powered by the biomass electric generator in Kwendin town, that is supplying electricity to all the people for USD$6 a month each. Wonderful! Three different light sources for a clinic that used to have none.  

The generator for the town burns wood chips and the like. It seems to be working well. I know last year the generator was in place and the light poles were up but the project had run out of money before the wires were strung. That apprently has been rectified. The town of Kwendin now has lights from about 6 pm to 10 pm.  

Yes, every time we come here there is something new, some development, some noticeable and measurable improvement here in Liberia. It is such a treat to see things come up year by year. I'll send this and have a shower and probably by then it will be time to go back to the clinic.

Dr. John Potts