Poverty prevents appropriate medical care and a happier life

Three weeks ago a twenty year old male had his tumorous mandible/jaw removed by a visiting professor of surgery. The large defect, from angle to angle, was reconstructed by using the fibula bone from his lower leg. However, the grafted bone did not take and it will need to be removed. This good looking young man will no longer be handsome without a jaw. His tongue will fall back, causing life long eating difficulty. He cried when told the graft has to be removed. The original surgeon, who has returned to his university, believes a second attempt could only be successful if done where better facilities exist. We are urgently trying to arrange this, but finances and insurance policies make it a one in a million chance of happening. I have come to like and respect this young man and feel saddened for his future. This is the poverty I see daily.

Our patient at the finish of the removal of his tumorous mandible/jaw; unfortunately the fibula graft which was used for reconstruction did not take and needs to be removed.

A traditional healer is chosen by my watchman.

Shortly after going on leave to greet Scarlett,our first grandchild, my watchman, Abdulai, fractured his leg and chose to be treated by a traditional healer.  On my return, I visited him, meeting the traditional healer.  Abdulai asked that his pay be continued during his illness.  I agreed, but requested he be examined by the hospital’s orthopedic surgeon. The orthopedic surgeon put him in a more stable cast and in two months he should have a good strong union. The total cost for the traditional healer’s services is twenty-five percent of Abdulai's monthly salary, while the hospital’s total cost is one hundred seventy- five percent.

Saving Lives of Children in Africa With Diseases other than Ebola

This week, two children presented near death from airway obstructions and both are now doing well.

The child seen below ingested a fish bone the week before and an abscess developed in his throat obstructing his breathing. At surgery, the retropharyngeal abscess was lanced and his breathing improved.

Pictured is the abscess anterior to the vertebrae obstructing his airway. The abscess is the large irregular structure in the middle of the photo i.e. in the middle of his throat.

The other child, a 13 month-old, was born with a cyst behind her right ear which enlarged to the opposite side of her neck causing breathing and eating difficulty. Seven days before arriving, the abscess had been aspirated at a different location with temporary improvement. However, when the child presented to Tamale Teaching Hospital, she was in respiratory distress. Only after the abscess ruptured was the child able to be intubated and the abscess drained. The child is now doing well.

Sickness in rural West Africa

Some of our patients are so sick and in such pain. There is a twelve year-old boy, Ernest, who never complains, but is dying from an extensive sinus neoplasm. His biopsy was taken three weeks ago, but no report yet. We try to relieve his pain with oral morphine three times a day. If his biopsy reveals a lymphoma, he may be helped with radiation and chemotherapy, but he has lost so much weight.

Because her corneas became dry from her burned eyelids retracting, skin grafts were place in the eyelids of the burned epileptic mother of four who fell into a fire during a seizure. Her surgery could not be performed in the main theatre because the central air conditioning system is not working. Since her deteriorating vision would not allow a wait of two weeks for the air conditioning to be fixed, the surgery was done under local anesthesia which added to her pain. The eyelids, now with the full thickness skin grafts, are covering her corneas and hopefully this will save her vision.

The above situations demonstrate the difficult conditions in which sickness is treated in the developing world. The shortage of pathologists to help diagnose and the lack of basic maintenance to facilitate a do-able working environment are just two examples.

The boy in orange was playing under a car when it drove away and he had his scalp taken off. The smiling boy had 95% of his left ear avulsed in a road traffic accident. The ear was sutured back and is doing well.

Road Traffic Accidents in the Developing World

This post of 27 April 2013 was never posted and is now posted.

Currently the Ghanaian doctors are in conflict with the government over their pay and are caring only for emergency and ward patients. Even so, we have been busy with a massive road traffic accident in which four patients died out of sixty. We were able to save several patients, including a six year old girl. Many of these patients presented in shock from blood loss, fractures, head trauma and respiratory injuries. The chance of dying in the developing world from a road traffic accident is ten times that of the developed world. The developing world does not have efficient transportation to the hospital, the necessary medical specialist on staff, or the supplies to care for these patients. After working into the night caring for these patients, five Ghanaians and I were directed by a taxi driver, who had a strong alcoholic breath, into a taxi. The driver then announced that he realized the taxi did not actually belong to him and we would have to transfer to his taxi in front. The Ghanaians verbally insulted him and I, myself, questioned whether I should be getting into his taxi. Nonetheless, I fortunately arrived home safely and did not become another statistic that night.

Foreign Body Aspiration and Burns in Ghana, West Africa

A sign over the entrance to the Burn Center at Cook County Hospital, Chicago, reads: “There is a special place in heaven for those who care for the burn patients." Tomorrow, skin grafts will be placed in the burned, retracted eyelids of an epileptic girl who fell into a fire during a seizure. Her burned, retracted eyelids no longer cover her corneas, causing the corneas to dry out and if not corrected will lead to blindness.

Epileptic woman with burned, retracted eyelids.

A seven year-old girl collapsed at school, regained consciousness at home and was brought to Tamale Teaching hospital. On admission she was not in distress, had a normal oxygen concentration and chest x-ray, but she had decreased breath sounds in her left chest. The mother mentioned the child eats groundnuts/peanuts. At bronchoscopy, an ebony seed was removed from her trachea. The child was sent home in good health.

Ebony Seed removed from trachea of this girl with the help of nurse anesthesiologist.