Liberia 2017

Kwendin #9 | February 24, 2017

Ahh, Friday night. Wanna go out for dinner? Catch a flick? Go to the Dairy Queen? Uhh...not in Kwendin!

I got a text from Ladysmith at 4 pm today "Snowing here!"  

Not here! Today was our first surgery day. I spent a little time going over what is in my backpack to cover for possible events in Tappita. Lunch (always crackers and sardines, yum) and 1.5L of water. A light in case we are stranded after dark. Medications for post op pain for our patients. Some money--now how much? I don't expect to buy anything, quite different from admission days when I put down USD$50 for every patient. I took a small sheaf of Liberian dollars (less than USD$20 worth) and there was a few US bills including a $50. I put them in.

Kristie and I were in Tappita Hospital before 9 and checked in with the OR. Actually...the generator does not get switched on until 10 am so there is some time to put in before we actually start operating.

But then a fellow showed up at the OR to see me. Lo and behold, it was patient #5 for the surgery list. He had come on Friday instead of on Thursday. Too late, my friend. I talked with the OR staff and tried to think of a way to make it work. But I remember a similar episode last year and the anaesthetists flatly refused to do a case if the patient has not been in the hospital admitted overnight. They just do not believe that the patient is fasting if he has not been under observation.  

Eventually the suggestion was made by one of the staff, to see if Dr Nuanh would do the case tomorrow. So Kristie and I went off to see him--we knew he was around because he was booked to operate today on a few cases. We found him in his office. He readily agreed (even though it will be Saturday) so Kristie and I started on the process of getting him admitted.

Was I ever glad I had the USD$50 bill! Thank you, God. We got him settled in the ward just in time to head to the OR for our list of patients.

We worked through our list. Three kids with hernias, and they went well. They took time--or I should say, I took time. I'm not a fast surgeon and I am out of practice. But I think I am a careful surgeon and the kids should do well.

The last case was a lady with a swelling on her calf. We thought it was a lipoma at first but it was too firm. And it has been growing very slowly, and is smooth so was not a cancer. I asked the local surgeon to look at it and he shook his head, not sure what it is, just go ahead and take it out.

So I started in on it. At first I dissected around it--it was very stuck down to everything. Finally I decided to take the suggestion of the (very capable) scrub nurse and slice it open. It was full of pus! But no smell to it--a sterile abscess. We poured all the pus out and then I dissected out the sac that was left, and sewed her up.

So (I'm not supposed to start so many sentences with "so." So I'll avoid that.)

We asked her if she had ever had any accident to that leg. She clearly remembers being poked with a stick in 1979 and the lump has been growing ever since! Nearly 40 years! That is a record for me operating on lumps that should have been dealt with years ago.

In the meantime two of our patients from yesterday arrived in the OR with xrays and lab work results for me to see. I talked with them between cases. One of them has HIV and we will get her connected to the HIV clinic on Monday.

By then it was after 4 and that's when the news of snow at home arrived! I had been pouring sweat all day (the air conditioning in the OR was not working) so the idea of snow is almost inconceivable. We got in the car and started for home, with a brief stop for a cold pop on the way.

Meanwhile back here in Kwendin we had left them with a difficult task--get the word out that the next 3 surgery days have been moved. Already the informal network is spreading the word, but some of the patients are from distant villages. Eventually the consensus was that a message needed to go out on the local radio. So Bob got all the correct dates and all the names, and wrote out an announcement, and gave it to our liaison worker George to take to the radio station in Tappita. He did. The agreement is to read it out several times tomorrow and Sunday, and then a few more times through next week. Hopefully everyone will hear. And I am guessing that there will be a few no-shows on our surgical lists. We will see.

Spencer and Kate worked away at the clinic without us. Kate helped with a delivery! A beautiful little girl. And at the end of the day when they walked home, someone showed them a small owl which they had caught, and offered to sell it to them. Spencer got a picture of it but didn't buy it.

Which reminds me that on our way home driving from Tappita, we passed a couple of memorable sights. First was a motorbike, carrying a broken down motorbike on the back! And second was a boy carrying a couple of dead opossums which his dog had caught. No, thanks, don't want to buy them. But both sights made for pictures for Kristie. Yep, this is Africa.

Bob spent much of his day visiting the local school here and the government school in the town itself. He talked to various teachers and town people. There's lots that could and should be done to make each of those schools better. There are baby steps being taken but there are gatekeepers blocking some of the baby steps as well. That is too complex a story for this kind of email.

One other project Bob is working on is repairing the house next to ours. It is structurally sound but needs lots done and he is doing small things with a team of workers. He told me tonight that it really feels good because it is the exact house he lived in back in 1980 when he was here for 4 months. Unfortunately the team has burned out our Skil Saw trimming lumber.

We have finished our first week in Kwendin. Now for the weekend. I will send spencer and Kristie to Tappita to discharge our patients tomorrow, and then on Sunday afternoon Kristie and I will go back to tappita to admit the next batch of patients. Monday is another surgery day. Tuesday Spencer and Kristie will go to discharge that batch, then Wednesday we admit the next batch of patients, Thursday surgery and Friday discharge. Some of us go to Tappita every day for the next week!  

Dr. John Potts