Making Progress

Last week, with my wife, Cyndy, in attendance I had the honor of being inducted into the Ghana College of Physicians and Surgeons. The following night she flew home for Christmas with the children and I went to pilot an ultra light plane, but was grounded due to visibility. While waiting for better visibility, I toured the Akosombo Dam, which supplies seventy-five percent of Ghana’s electricity. Before the weather improved, I had to return to Tamale. It was a nice break.

When going to Church, I was picked up by a small taxi which already had eight occupants. I hesitated to get in, but joined the crowd. When requesting a stop, the driver questioned if I was not going to the hospital. This explains why he picked me up with a full cab. He was doing his part to help me get to the hospital.

The following photos are of an infant who swallowed a hair clip, an elderly man with a left facial paralysis and meningitis from a chronic ear infection, a party for three doctors who are leaving to continue their training and the ultra light plane which I never got to fly.

"We Are Managing" A Favorite Ghanaian Saying

 Scholar Athletes at the Savelugu School for the Deaf

With the help of Doctors Tuopar and Cammilari, maxillofacial surgeons from the United Kingdom, we reconstructed a young woman’s nose, which was damaged by an electrical burn. Some readers may find certain photos upsetting, so I will post one of her after she has healed. Her reconstructed nose is looking good and today she smiled for the first time. The defect caused her psychological trauma; perhaps her husband left her for he has not been seen.

The four-year old who ruptured his eye when he was run over by a motorcycle has done well and he now has vision in that eye.

Poverty makes work difficult. Tamale Teaching Hospital cannot afford to purchase alcohol for disinfection, to replace the broken bulb for our only operating room light, or to pay my nurses to travel to the schools for the deaf to take ear impressions in preparation to be fitted with donated hearing aids. Very poor patients who cannot afford the cost of the national health insurance do not receive any financial aid. When we request assistance for such a patient’s care, the social service department simply writes to benefactors asking them to help. I have seen this process to be successful only once.

Offsides! No goal.

Taking ear impressions for hearing aids for the children at the School for the Deaf

Nurses taking bilateral impressions quickly in the high tropical temperatures.

We examined 150 children at the Savelugu School for the Deaf and found thirty had stones, wax or foreign bodies in their ear canals.  Most of the children had hearing at birth and subsequently lost it which suggests malaria or its treatment as the cause. While at the school, I watched their co-ed soccer game and when an offside goal was scored with a resulting dispute, I ruled out the goal among cheers and cries of anguish depending on which side one was on.
Among the cases this week were the loss of a twenty year old man who died from septicemia resulting from a tooth infection and a four year old who sustained a ruptured eye globe when he was run over by a motorcycle. The medication necessary for the septicemia from the tooth infection was not locally available;  for the child with the eye injury, I did the best I could, because the ophthalmologist was away in Wa doing cataract surgery for people who are too poor to come to Tamale.

It is a Privilege to be Working at Tamale Teaching Hospital

           After five years at Tamale Teaching Hospital, there are still major setbacks. One is the inability to sterilize telescopes and fiberoptic cables, which are used to remove foreign bodies from children’s lungs, because the sterilizer lacks a timer and will ruin the instruments. Another is the repeated occurrence of voltage surges, which this week destroyed our microscope’s light source and four bulbs. The microscope is critical in caring for our patients. A replacement part is being obtained from Zeiss Meditec and in the meantime, a Design for Vision light source, which happens to connect with the Zeiss fiberoptic cable, is being used to give light to our microscope. This is our last light source that fits.

Some of the staff are a pleasure to work with and the knowledge of the young physicians is impressive. Our Ghanaian attending physicians all have PhDs, having done graduate work in Russia, Netherlands, Germany, Great Britain and the Ukraine. It is a privilege to be working with them.

Tamale Teaching Hospital has ten Cuban physicians rotating every two years as a result of a Cuba-Ghana agreement and their presence is greatly appreciated by the Ghanaians. Recently the hospital received an ambulance from Chicago with the help of the American Northern Ghana Association. This ambulance now joins the ambulance donated by Iraq, with its prominent Arabic markings, picking up patients throughout Tamale. I am the only United States physician in this area which is seventy percent Muslim and I am well accepted and appreciated.

Rheostat which does not work

An electrical surge ruined this rheostat for our clinic Zeiss microscope. We are trying to obtain replacement reheostats. Our backup light source's rheostat also was burnt out with a power surge. Maintenance is time consuming. 

One Happy Family And "Tuck In Those Mosquito Nets"

                           Excellent Anesthesia

                   Donated Karl Storz Telescopic Forceps

          Groundnut (Peanut Shell) which blocked his trachea and breathing.

   The happy mother and child the day after the removal of the obstructing groundnut (peanut) shell.

             This past Wednesday morning we were to perform the first laryngectomy and neck dissection in northern Ghana. At eleven o’clock the evening before, we were called to the hospital for a three year old child who aspirated a groundnut shell into his trachea causing him severe airway obstruction. The peanut shell was successfully removed with the help of donated Karl Storz telescopic forceps and a Project Cure video monitor and camera. The child’s family was overjoyed at the remarkable life-saving outcome for their child and subsequently thanked us several times. After finishing this case at four am, I was unable to retrieve my house keys due to a faulty clinic lock, so I slept in the hospital until 7 am, ate two cartoons of cookies, drank two cartoons of juice and performed the laryngectomy, finishing that evening at 7 pm.
Northern Ghana is presently in its rainy season, with 76 degree Fahrenheit temperatures, many mosquitoes and numerous patients with malaria. Malaria worldwide kills one person every two minutes. Here ninety percent of the mosquitoes carry the malaria parasite and can inject one thousand malaria parasites into you with each bite. Only one malaria parasite has to survive to result in a person getting malaria. For a week I had been bitten four times a night until a visiting  guest mentioned that they tucked their mosquito net under their mattress and when I did the same, there were no longer any bites and I had a restful night’s sleep. The only reason I do not have malaria is due to my daily anti-malaria malarone.

Severe complications resulting from untreated minor disease

As expected in a place with few dentists and one physician per 27,000 inhabitants, our patients present late with severe complications from tooth infections resulting in airway obstruction, neck abscesses and septicemia. Other diseases which progress to severe complications due to the lack of health personnel are: 1) Nasal polyps resulting in sinusitis, brain and forehead abscesses, 2) Laryngeal, sinus and parotid tumors which are no longer curable and 3) Untreated congenital cleft lips, palates and cysts. Our acute cases are trauma from road traffic accidents, falls from trees, and foreign bodies in the lungs and esophagus.

The necessity of drug regulation was evident by a boy with a sore throat who took a local medicine and began bleeding from several sites, resulting in his death.

There are only two headlights for eight examiners. We ordered six portable camping headlights hopefully to be brought over today by a visiting otolaryngologist. There are an additional four headlights in a container which should arrive in two months.



Untreated tooth infection which spread to the neck.



Untreated nasal polyp which lead to sinusitis and brain abscess.

Recently, we heard an excellent lecture on macular degeneration by Professor Chapman, a visitor from the University of Louisville. Macular degeneration, which usually develops later in life and responds to vitamins, is not common in Ghana because the life expectancy here is 56 years.

What one man can do, the birthing hole

Eighteen kilometres north of Tamale, the farmers earn 50 cents a day. Here there has traditionally been a high infant and maternal mortality rate until a young physician introduced a local custom into the hospital. He noticed the pregnant mothers were not attending the prenatal clinic nor choosing to deliver in the hospital. He also learned that there was an unpleasant nurse who was working there. The nurse was eventually fired, but still the pregnant mothers did not come. When the physician visited their homes, he discovered that the women deliver while squatting over a “birthing hole” in the floor. The birthing hole is the size of a basketball, flush with the floor. He then decided to place birthing holes in the hospital delivery room and the woman now come, resulting in a great reduction in maternal and infant mortality.


He also eliminated their custom of dealing with malnourished children who were thought to be punishments from God. The mother would steal away to the forest with the malnourished infant in a shawl on her back, run and loosen the shawl, allowing the baby to fall to the ground. The woman would then return running to the village, not looking back for she believed if she did so, her next child would also be malnourished. A malnutrition center was built to care for these children and it was made to resemble the village’s own compounds. The women were amazed at the resulting weight gain and improved health of the malnourished children. They have come to understand that help is available and now bring their malnourished infants into the malnutrition center, no longer leaving them to die in the forest.

Obtaining Needed Medical Equipment

Currently I am home in New Jersey and have obtained needed medical equipment from various companies and organizations. This equipment increases our ability to save lives, results in less patient pain and a faster recovery.  Donated funds have been used to purchase supplies and repair broken instruments.

Anspach-Synthes, Karl Storz, Smiths Medical, Designs for Vision, Carl Zeiss, Jedmed, Corvidien, Orthocare, Johnson and Johnson, ArthroCare, Dale, Boston Medical Products, Becton Dickenson, Medtronic, Ortho-McNeil-Janssen Pharmaceuticals and Surgitel have generously donated equipment.

The American Academy of Otolaryngology-Head and Neck Surgery Foundation, Catholic Medical Mission Board, International Aid, MAP International, AmeriCares, Medicares and Precision Instruments have forwarded their donated medical equipment and supplies.

Very dear to my heart is the promise of Starkey Labs to visit Ghana this year to disperse several thousand hearing aids to the children in the schools for the deaf and to our patients.  None of these children have hearing aids.  Our ear, nose and throat department will visit the schools for the deaf, clean the children’s ears and take ear impressions in preparation for the fitting of their hearing aids.  A microscope is sorely needed to adequately and painlessly clean their ears and I am confident our medical manufacturers will contribute if it is at all possible for them to do so. With a team effort, so much can be accomplished.