BRAVERY

We have it easy in the USA. Education is highly accessible. Travel abroad is easy. Not so in Nigeria. Eseose (God's Gift) is a very interesting woman I met in Nigeria. She is 27 years-old; newly wed to Dr. Kelechi Eguzo, administrator of the Nigerian Christian Hospital. Since her marriage, she has become pregnant for the first time and is due in September 2012. 

She attained a Bachelor of Science in microbiology at the Ambrose Alli University,  Ekpoma. She applied for training in Food Science and Technology in Belgium to begin September 2011 and was accepted-a prestigious but expensive school. She applied for her visa in May but the visa did not come through until this week.  Now she leaves for Belgium today, to start the course of study almost 2 months late.   

Think of the obstacles this young woman faces! She has never left Nigeria, She has little money. She is traveling to a foreign country to start school 2 months late. She is pregnant for the first time and will have her baby in a foreign country with no husband or relatives with her. She is as brave as they come! She is a hero!

This story is unusual but not unique. All over Nigeria, people are battling against all odds to inprove their situation. While we in the USA are living, Nigerians, and billions in the third world, are just struggling to survive. Kudos to these brave people who accept these challenges.

Addendum: Eseose made it to Belgium. She is struggling to catch up on studies and having some money problems but surviving!

HOME

I arrived home today. I'll rest tonight then start making plans for the next trip tomorrow !

SURGERY DAY 22-FINISHING UP

Liver mets

Yesterday was the mother of all surgery days. We started with 2 pediatric hernias. Next we operated on a lady with a right lower quadrant mass and an enlarged liver. We suspected a cecal cancer with liver mets and, unfortunately, we were exactly correct. We did a right hemicolectomy as the tumor was near obstructing. 

The next patient was an older lady with a large flank bulge. She had a previous surgery and most of her intestines were in a hernia that tracked posteriorly. We repaired this with mesh. Next a submandibular mass which I am sure will be an adenoid cystic carcinoma. The mass was hard as a rock. Then, a woman came in with a fibroid which was prolapsing through the cervix and bleeding. We resected it without a problem.

Next,  a 13 year-old with a large jaw mass. On palpation, the jaw was crackly from the bone being thinned out in areas to less than 1 mm. In other areas, there was no bone! This is probably an ameloblastoma. We had to perform a total right hemimandibulectomy. 

We then placed a chest tube in a man with a pleural effusion. Next we operated on a 21 year-old female who previously had a resection of an ovarian endodermal sinus tumor. She failed to get her followup chemo and now has a recurrence. We found a tumor mass above the bladder. We were able to remove all visible tumor and she will get chemo. 

Finally, we operated on a 25 year-old female with a scalp mass that has been growing for 24 years! We suspected a dermoid cyst. We were correct, as we found, when we accidentally entered the cyst and yellow mush squirted all over the field. There were three of us working on the case and I'm sure each was praying it would be the others that entered the cyst first-LOL!

This is it. I am leaving for Lagos today and then to the USA. We completed 133 cases in 22 days.  Most patients are heading home. There are a few who will be in the hospital for awhile. There is already a list of patients growing for ths next trip. 

Addendum (10/27/11) : Our lady with the dermoid cyst is doing well and discharged. I can't wait for her hair to grow out!

HAPPY 55TH BIRTHDAY

Many doctors, nurses, employees and patients came out to wish me a happy 55th. It was.

After surgery, we had a birthday party with cake!

SURGERY DAY 21-LATE NIGHT

Surgery was busy today. The word is out that the trip is almost over so many people are coming at the last minute, hoping to get their surgery done.  For tomorrow we have a mandibular tumor, a giant ventral hernia, a submandibular mass, a cecal cancer,  2 pediatric hernias and a recurrent ovarian tumor in a 21 year-old female. More will becoming,  as well. Tomorrow is the last day of operating so we plan to finish all comers, even if we stay up all night. We have done 122 surgeries.

Sister Mary Joseph Nodule

The clinic was also busy. One old man came with an umbilical tumor, a Sister Mary Joseph Nodule. The tumor was fungating and bleeding so we resected it-not expecting a cure but a slight improvement in the quality of life for the patients final days. He has carcinomatosis from an unknown source.

A patient from two years back also came today. She is 40 years old. In 2009, she came in with a rectal cancer. I performed an abdominoperineal resection which involves removal of the anus and formation of a colostomy. She was wealthy enough to get chemo and radiation after surgery and is doing quite well now. She was wearing a standard appearing colostomy appliance, which surprised me. She was able to purchase it in the market for 350 Naira, about $2.33. She uses a bag about every 5 days so she will spend about $150 /year on ostomy appliances-not much unless your monthly salary is $100!

It is 845 PM. We just got called for an obstructed hernia so we are returning to the hospital. Don't wait up.

CHIEF ENGINEER

Jerry Nwosu used to be the assistant cook. Then the hospital electrician was electrocuted and he became the Chief Engineer. He is fantastic! He is trained as an electrician but he can fix anything. He is the one that set up the emergency light system for the operating room. He even fixed my hair trimmer.  We are lucky to have him.

SURGERY DAY 20-GAS-GANGENE

Today I was called for an emergency-a woman with an injection abscess of the buttock. The patient had the abscess for several weeks after an injection for malaria. She looked terrible-wasted, pale, diaphoretic and tachycardic-a true emergency. Her buttock was grossly swollen, red and full of pus. 

Wound 1 day after I&D

When the patient was asleep I could examine the wound better. I could feel crepitus (air) in the tissues. When I cut the wound open, pus and air bubbled out-gas gangrene-a clostridial infection. This patient is critically ill and the situation is complicated by her being HIV positive. Even in the USA, this would be a challenging case.

We will see if she can survive.