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Saturday, November 21, 2009

Steady but slow progress

Workload and problems with electricity and computer have caused a delay in any additional blog postings. The twelve-year old with a crushed larynx pictured in the previous blog could not adequately breathe or phonate; further surgery removed obstructing granulation tissue and a keel was placed between the vocal cords to improve her voice.
Yesterday, a two-month old with shortness of breath, severe chest retractions and normal cry was referred and may have a congenital double aortic arch compressing his trachea. Laryngoscopy and bronchoscopy may help diagnose the cause of the child’s dyspnea. Hopefully the obstruction is due to a cyst of the larynx which I may be able to remove. If it is a vascular malformation, the cardiothoracic unit at Korli Bu in Accra may be able to correct it. However, a big problem is the family’s inability to pay the expenses of traveling and staying in Accra for the duration of the child’s treatment. Most families cannot afford these costs and the child will be brought back to the village to die.
With our Egyptian pathologist having returned home, proper patient care has deteriorated. A biopsy of a patient with laryngeal cancer was sent to another institution four weeks ago and still there is no report. His cancer is now inoperable. In the future, I will send the patient to have the biopsy and treatment at the other hospital until we have a working system here.

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