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


It is very difficult to be an albino in the tropics. These patients often develop lethal skin cancers. It has been hypothesized that skin cancer prompted the evolution of dark skin.  On every trip to Nigeria, I see albinos with terrible skin cancers. Some patients come early enough that simple cauterization can solve the problem. However, they must come often since new cancers are always developing. This unfortunate patient came in very late. Soon we will perform a big surgery to remove the cancer and cover the site with new tissue.
Albino patients that frequently come for surgery



Making a world class motorcycle is similar to surgery. Every detail must be perfect to get the desired result. Patrick Godet in France makes a beautiful motorcycle that is as beautiful as any surgery I have seen. Every detail is thought out and executed to perfection. What a surgeon he could have been.


This past trip in September, We made a trip to Abuja to do some surgery at Dr. Uche Nkeonye's new hospital. This was Eric Oje's (best nurse anesthetist I have ever worked with) first flight. The surgeries went well and we had a grand time.
Dr. Uche's Hospital

Eric Oje (nurse anesthetist), Ifeanyi Chiekwe (urologist),
and Uche Nkeonye (general surgeon)


This poor lady was involved in a fire and had severe burn contractures, especially from her chin to her chest. She could barely move her head. We excised the scar tissue and placed a pectorals myocutaneous flap. After healing she had normal mobility of her neck. However, we did have to sacrifice most of the right breast. Vicki Jones from the Women's Health Boutique in Longview, TX, kindly supplied her with a bra and silicone breast prosthesis. She is very happy.

Servere burn contracture of the neck
Right pectoralis flap (head to left)

Raising the flap (Head toward bottom)

Postop day 7

Appearance after 3 months


I have been quiet on the Blog recently since I have been so busy. I spent 3 months this year in Nigeria doing surgery-January, May, and September. I am returning for a shorter trip in November. We have done over 600 cases this year and taught numerous resident surgeons and attendings. The Blog will start again soon.

BTW-my suspicious mole was benign!



In January, Dr. Jombo performed surgery on Dr. Camazine to remove a suspicious mole. The pathology is pending.



I get my supplies wherever I can, whenever I can. An amazing array of wonderful people contribute supplies to the effort. Today we had a huge donation from Fred and Mary Kay Posey (Walking in Love Ministries) in conjunction with the Texas Baptist men (Disaster Relief). The Poseys' had the supplies and they were stored with the Texas Baptist Men. We rented a U-Haul cargo van and drove down to Dallas. Everyone helped pack up the van. Now the trick will be to get all the supplies to Nigeria. That will be another story.

Mary Kay Posey, Brian Camazine, Susan Camazine, Fred Posey
Texas Baptist Men



Kingsley came for surgery in September,  2013. He had a large parotid mass that we resected. The pathology  epithelial-myoepithelial carcinoma. He is doing well and our temporal is flap has epithelialized in the mouth. He will be getting radiation.

Add caption



The other day we went to Palmer Hospital (sister hospital to NCH) located in Akwa Ibom State. The team consisted of NCH personel- Drs. Camazine, Jombo, Oje; Nurse Anesthetists Eric Oje and Wilson Anyanwu; surgical technician Chimobi Micah; and nurses Angela, Joy, Favor, Kelechi and Vincent. Dr. Anekan and nurse Glory from Palmer assisted, as well.  Sixteen surgeries were performed in one day. This was an incredible effort by everyone involved and resulted in a very productive trip.
NCH team members (minus Dr. Oje)

Palmer Hospital

Operating room

Dr. Jombo-CMO at NCH

Angela, RN

Joy, RN and wound care nurse

Wilson, nurse anesthetist

Dr. Oje, Eric Oje, nurse anesthetist and Vincent, RN

Dr. Anelem, Staff physician at Palmer



This lady came to NCH with a large parotid tumor. The resection was difficult but we removed the tumor. She developed a pulmonary embolus after surgery but is doing well now. She will need adjuvant radiation treatment. Postop pictures to follow!

Radical neck dissection


This poor lady developed an esophageal stricture after swallowing a denture. She waited 3 months for me to come and dilate her esophagus. We are dilating her weekly-up to 60 F. She is eating without problem now.