When we are out in the field, we occasionally need help when we are faced with a problem out of our area of expertise. Recently, I was dealing with a thumb problem. While investigating this problem on the internet, I came across the name Louis Carter, MD, an orthopedic surgeon. I contacted Dr. Carter and he was amazingly helpful. He has also written a book on Reconstructive Surgery called Principles of Reconstructive Surgery. this book is available online FREE as a download. I would recommend every surgeon read this book.

Dr. Carter and his wife Anne

Operation Giving Back


Louis L. Carter, Jr., MD, FACS, of Chattanooga, TN, is presented the 2011 Surgical Humanitarian Award in recognition of a veritable lifetime of service to the underserved spanning nearly five decades, 20 countries, and 74 mission trips. Following his 1964 medical school graduation, he and his new bride, Anne, spent five months at a mission hospital in Tanzania. After residency and two years of military service including a tour in Vietnam, Dr. Carter returned to Africa in 1974 as a board-certified general surgeon. Accompanied by his wife and two children, he served as a full-time medical missionary at Egbe Hospital in Nigeria for seven years. In the early 1980s, Dr. Carter became board certified in plastic surgery to address the reconstructive surgical needs he encountered abroad and was later also certified in hand surgery. He returned to missionary service in Jos, Nigeria, from 1985 to 1987 at Evangel Hospital. From 1987 to 1996, he continued to make frequent visits to remote mission hospitals in Africa and other underserved regions while practicing and serving as a faculty member at the University of Tennessee in Chattanooga. In 1996, Dr. Carter returned to full-time medical missionary service with Serving In Mission U.S.A. as the sole American full-time missionary plastic and hand surgeon. As part of their “Home Schooling for National and Missionary Doctors” program, he and his wife teach local national and missionary doctors basic techniques in plastic and hand surgery to raise the skill levels of local providers, as well as provide donations of needed books, equipment, and supplies. Dr. Carter has left a legacy of surgeons, nurses, and other medical professionals who are equipped with the knowledge and skills to care for hand injuries, burn contractures, cleft lips and palates, and other correctable debilitating conditions.


Readers may remember a girl we treated in the past who had necrosis of her nose  and necrotizing fasciitis of the face. We thought she had mucormycosis, so we treated her with antifungals as well as antibiotics. A recent article that I read read makes it clear that she had NOMA-also called cancrum oris- a necrotizing stomatitis that affects the face and is associated with aerobic organisms. Unfortunately, this girl died, despite our efforts. With more aggressive antibiotic treatment and debridement , she may have survived.



Its about 3 weeks until my next trip to Nigeria. There are already more than 50 patients waiting for surgery. I have 210 lbs of luggage! Hopefully the internet will be good enough to blog in real time.



I was recognizably human; I had at least the usual complement of legs and arms; but I might have been some shameful piece of garbage. There was something indecent about the way in which I was being furtively shuffled out of life-Peter Greaves, leprosy patient 

She came to see me completely covered by a scarf. I knew immediately that there was something dark and terrible hidden away. She was subdued and timid from years of being shunned in her village. I removed the scarf and told her she did not need it at the hospital and would not need it  anymore. We would help her.

She arrived the day before I was leaving Nigeria so I promised that I would do her surgery on the next trip,  but I doubt she believed me. I showed her pictures of another unfortunate soul with a similar problem that I had repaired. I think I could see a glimmer of hope in her eyes.

She will have her surgery soon.



Ebola is a terrible disease. Fortunately, Nigeria did a splendid job of eradicating the recent epidemic. Nigeria had 20 cases of ebola with 8 deaths-better mortality than any other country. The last diagnosed case was August 31, 2014.  All people in Nigeria who were sick with Ebola have now either died or recovered. Contacts of these patients have completed their 21-day monitoring period and are no longer at risk for getting sick with Ebola. The country is safe (at least as concerns ebola)

Common misconceptions:

1. There is active ebola in Nigeria.

2. West Africa is one country! Most people I speak with believe this! West Africa, also called Western Africa and the West of Africa, is the westernmost subregion of the African continent. West Africa has been defined in Africa as including the 17 countries Benin, Burkina Faso, island of Cape Verde, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, island of Saint Helena, Senegal, Sierra Leone, Sao Tome and Principe and Togo.

Therefore, it is meaningless to discuss "ebola in West Africa". It would be similar to referring to ebola in Southwestern USA. In fact, there is only ebola in Dallas.

3. Obviously, since there is no ebola in Nigeria, restricting travel to this area will do nothing to help the current epidemics.

4. Rejecting Nigerian students from American colleges will not stop ebola



Ameloblastoma is common in Nigeria and West Africa. Despite what you might think, patients tolerate having half their mandible removed  quite well. They can eat and speak normally. This lady had a large ameloblastoma that had destroyed her right jaw. We performed a hemimandibulectomy and pectorals flap reconstruction in 2006. She came to visit us this past September. She is very happy.

Resected jaw

Postop day 3

Postop 1 year

Postop 8 years
Postop 8 years


This lady has a big problem, yet, amazingly, like most of my Nigerian patients, she is happy because she is finally getting some care. She has had 3 cycles of chemotherapy and soon we will remove her necrotic, fungating breast. She will probably die relatively soon (who knows?) but at least she will not die with the smell of rotten flesh around her. For an investment of a few weeks, she will be happier for the rest of her life, however long that may be.

Unfortunately, fungating breast cancer is common in Nigeria. For many reasons, such as economics and fear, the ladies come in late. With educational programs, we are trying to change this trend