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.