I returned to Nigeria September and October and saw my little patient. She is doing VERY well. Unfortunately, she has rhabdomyosarcoma. We have started chemotherapy and hope to reconstruct her face in the future. However, this is an advanced case with a poor prognosis.
Last trip on Aug 1, 2015, I encountered an incredible case. A poor little girl with a horrific tumor of the face. I do not know why it was not treated earlier. She came on the last day of the trip and I decided to just examiner her under anesthesia in order to plan to do the surgery the following trip, September 17, 2015. We gave her a small does of Ketamine and after examining her, I immediately realized the surgery was possible-so we did it!.
Eric our nurse anesthetist (probably the best in the world), cautiously intubated her and the surgery began. Then miraculously, it was over. I must have been in in a trance or the "zone" because I do not remember doing the surgery. It went very well.
I have consulted with several specialists in nasal reconstruction. As you can see, she has many problems in order to reconstruct her face-missing nasal skin, missing cheek skin, open maxilla with loss of bulk and cheek support and missing upper lip. reconstruction is possible but will tax my skills. We will let her heal and improve her nutrition before we do more surgery. the pathology is pending.
|One week following surgery|
|Aseptico Portable Dental Unit|
It has been awhile since I have posted but the Humanitarian work in Nigeria has continue full speed. i am now going 4 times per year for a total of 4 months. We have progressed at the Nigerian Christian Hospital by adding consultants in Urology (Dr. Achor), Orthopedic Surgery (Dr. Nottidge), Plastic Surgery (Dr. Akunikwe), and Dentistry (Dr. Nyerovwo). Specialties already present are Pediatric Surgery (Dr. Emem), OBGYN (Dr. Oje), General/Thoracic/Head and Neck (Dr. Camazine) and Oncology (Dr. Jombo).
I recently purchased a portable dental unit which is now in Lagos waiting to be carried to NCH. In addition, I purchased a beautiful portable bronchoscope from Pentax which will be invaluable
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|
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.
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.