Christmas 2008 in Tamale, Ghana

These photos are of a two year, four month old malnourished child with canker oris. In a malnourished child, an oral infection can quickly destroy tissue and the resulting defect is seen. His facial tissue was normal four months ago. The treatment is nutrition over several months (the hospital is feeding him six times a day) then trying to close the defect.
With the beginning of the Christmas holiday, a patient presented who had an upper airway obstruction. He needed an airway, i.e. a tracheostomy. However, the nurse anesthesist was tired and refused to assist. Although I thought of doing the tracheostomy without help, there is no oxygen and suction on the ward and that has a higher complication rate. The patient was given large doses of dextromethasone and ceftriaxone. I checked him on the ward the next day and was relieved and surprised to see that he was still alive. After six days of large doses of medications, the patient is partially improved. His left arytenoid and pyriform sinus are edematous and I believe he has a carcinoma. We will try to convince him of a tracheostomy, a biopsy and referral for radiation to the larger city of Kumasi. Unfortunately, he is poor and most likely will not be able to make the two hundred mile trip in addition to paying $500 for radiation and the extra costs for travel, food and housing. Never got to church on Christmas day.

Another week with a small step forward

Young man with a submaxillary gland tumor (pleomorphic adenoma or mixed tumor)


Ten year old with necrotic cystic lymph node. Pathology pending.

After seventeen months here, has it been worth it? Has the health of this society improved?

On the accomplishment side, several lives have been saved by treating severe or chronic infections either medically or surgically and some patients are more comfortable having been treated for their minor infections or having foreign bodies removed from their ears and noses. Yesterday we successfully removed two large cysts from young people. One cyst located on the neck, as seen in the photo, was the size of the boy's head. Both patients are very appreciative. The morale of hospital physicians and administrators has improved through their attendance and interaction at weekly clinical conferences. These conferences have received national recognition and now physicians can obtain educational credits from these meetings for renewal of their medical licenses. Within a week, two forty-foot containers of medical supplies will arrive thanks to the efforts of many people, including Rotarians and Project Cure.

The overall health of the community has not improved. Better housing, nutrition, immunization, transportation, water and sanitation are needed in addition to health care. One of my infected infant patients died because of malnutrition. Two other deaths among my patients occurred which were preventable in better conditions and there was one preventable surgical complication. Repairing equipment ruined by voltage surges has required much time and effort. Currently, an essential autoclave (for sterilization of instruments) is in need of repair.

I am happy, content and working hard here. I hope my successes outweigh my shortcomings.