Just when you think you've seen it all...



One of my first pictures in Liberia

 One of the most interesting things about this job is that you never know what you're going to get when you walk through the door every morning.  As I made my way through the Trauma ER this morning on rounds I noticed this patient who was lying on a stretcher in a dark recessed area not moving much, but moaning alot.  I went over to assess him and get the story, but he couldn't really articulate that well b/c he was in so much pain and had a nasogastric tube down his throat.  He was sweating profusely and he had a splint on his arm which was soiled with blood.  Turned out that he had an RTA (review your Liberian acronyms...) and sustained a really bad open fracture of his forearm and an associated elbow dislocation.  His injury was one week ago and he initially had come in to the ER for treatment, but left before he was registered-not sure if it was another financial issue or not.  Anyway, the guy ended up coming back to the hospital with worsened pain and over the course of the evening was complaining of an inability to swallow as well as neck pain.  When I looked closer I noticed that his neck was hyperextended and he never could bring his neck down to communicate with me b/c he was in so much spasm.  The guy had tetanus!!  I've never seen that before!  It rarely gets to that point in states.  It was crazy-it was like he was getting more and more spastic right before my eyes!  The staff in the ER told me that it is quite common here and they actually jumped on top of it rather quickly overnight with appropriate management.  He's currently in the intensive care unit and seemed to be stabilizing later this afternoon.  Wild...



Back view of the hospital on my way to work

  People in the community are beginning to recognize me more and more.  On my way to work today and as I make my way up and down the hosptial halls I can hear people calling my name and greeting me as I pass.  It's actually a nice feeling.  Some of the peoples' names I don't remember so I just hit them up with the usual "how is it?!" to which they always seem to reply "alright doc" or "thank God."

Clinic was a mad house today.  I swear it's getting more and more busy as word continues to spread that I'm here.  It seems sometimes like word has already made it down to South Africa! LOL! It's all good though-I'm seeing so much pathology.  There's so much variety too-some of which I don't have to means to treat unfortunately.  The next stop is Ghana, and if they can't get treatment there, then some even have means to get to the states.  Can you imaging having to travel to another continent just to get healthcare?!!!  Feeling blessed yet??  As always, you know I have a story or two to share with you from the clinic.  I did another finger amputation today after a guy came in following a severe crush injury to his finger.  It was about as bad as the other one I did last week.  My clinic room is very small and the ventilation isn't very good, so when someone comes in with an infection or something of the sort, it becomes quite memorable.  When I saw the bandage on his hand I immediately started writing up the prescription for him to go to the pharmacy and pickup supplies for an amputation (I have very limited supplies in the office, so if someone needs a minor procedure I have to give them a prescription to pickup the supplies from the pharmacy-even gauze, iodine, needles, lidocaine, bandages, etc..).   

Another shot taken from the Liberian-Japanese Maternity Hospital

I had another guy come in after a fall 2 weeks ago out in the bush.  He was down for 3 days with an open fracture of his forearm before someone came to his aid.  As soon as this guy walked in the room, the medical assistant Massa broke out the aerosol spray!  It's actually pretty funny when he does that-he has no shame!  If something comes in funky, Massa is like quick draw Mcgraw with the spray!! This guys entire forearm and hand was all necrotic and malodorous.  It's hard to believe that people will allow their condition to get to this point.  I'm still trying to get a pulse into culture tenets that are embedded in these patient's lives.  In New York it seems like everyone runs to the hospital for every little boo-boo, but here the ER is a last resort.  I knew immediately that he had been to "country doc" b/c his bandages had this blue dye on it-I've noticed that the herbalist uses this ointment or bluish iodine type solution that he puts on everyone.  I swear I've got to meet one of these guys...
Anyway, I sent this guy to the ER and admission to the Orthopaedic Service.  He's going to need an amputation unfortunately-but of course he's going to have to pay first...



Making the OR schedule for the following day

  The day ended with a bang.  After clinic I walk into the trauma bay to scope things out and then walks in the dean of the medical school along with the head of general surgery with another one of the surgeons.  The chief medical officer just so happened to be in the ER at the time too.  Long story short, the Dean-who is also a doctor-was trying to move a patient into the Trauma ER and was told that there was no room b/c no beds were available.  Remember how I told you patients just sit around in the ER b/c they haven't paid their bills so they end up like prisoners and are unable to be discharged-but as they're staying in the hospital waiting for someone to bring money to pay the bill, they're accruing more charges!  What ends up happening is that you have a stable patient waiting to be discharged holding up beds for really sick patients that need them!  The Dean ran blindfolded smack into this problem and asked what the deal was with all of this.  There was a big hoopla in the middle of the ER with all of the most influential people in the hospital who have the ability to try and do something about the system.  I watched as everyone kinda said their piece and even put in my 2 cents only being here for 2 weeks already.  Supposedly some "meetings are going to be held" as a result of all of this-I'll let you know how it turns out...politics man. 

I was rather tired at the end of the day.  The last kid I saw was an 11yo boy who was hit by a car and has bilateral femur fractures.  I had a long talk with the family about the options of surgery vs. nonoperative management.  I'm going to take him to surgery on Friday.


Gettin' tore off in the barber hut...notice how he's the one smiling!

 The family system is very important in the culture here.  Many times it's not the patient who is making a decision to undergo surgery or treatment, it's the family.  They are all very supportive of one another-it's nice to see.  While some are in the hospital for months at a time and have been shunned by everyone, many of the patients have great family support.  Visiting hours can look like a block party sometimes-HEEEYYYYYYY!!!! LOL!  It makes for some lengthy conversations when you get caught up in a patient's room though...usually I just try and pick out one person and make sure they understand everything then they can pass it along to everyone else.                                                                                     

The Market in Red Light-an area in Monrovia

I'm just trucking along taking it day by day.  You guys keep me in your prayers-especially with all these dang mosquitos!!  Goodnite.

"There is no road too long to the man who advances deliberately and without undue haste; there are no honors too distant to the man who prepares himself for them with patience."
-Jean De La Bruyere