Today a six year old, severely injured boy shook my hand in thanksgiving. This lad was in a traffic accident five days ago, split open his face and lost the front portion of his jaw. During surgery, his life was marginal. Now after five days he is alert and with everyone's care he will live. His reconstruction will be a major problem. In the same accident, his mother lost her ear and had to have her arm amputated. There are daily visits, dressing changes and frequent directions with the nurses. He understands English, but cannot speak because of the tracheostomy which was necessary to enable him to breath. Today, he persistently and with determination seeks out my hand. At first, I thought it was to prevent me from hurting him as we dressed his wounds. But, he shook my hand in thanks. I felt this tender handshake in my heart and it will be remembered my whole life.
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.
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.
A sterilizer, two light sources, a head light and its fiberoptic light cable all broke. Power surges destroyed the light sources. Expensive automatic voltage switches will now be used with all equipment. The fiberoptic glass cable melted when the cable was used in another company's light source. A water sensor went in the sterilizer and luckily today a spare got it working again. Medical companies are repairing and sending additional equipment as donations. Their support and generosity is encouraging, heart warming and touches me greatly. It is nice knowing there are many good people who will help. It has taken over a year to set up a modern ear, nose and throat department at Tamale Teaching Hospital. Only emergency surgery is being performed with over one hundred twenty-five ear elective cases waiting to be done. Once the operating microscope is working, a full surgical schedule will be undertaken. Hopefully this will occur within a month as another replacement transformer will arrive. While covering the surgical ward when the general surgeons were away, a 12 year old boy was dying from an abscess of his leg. With much opposition from the staff due to their extreme conservatism and reluctance to do something new, an extensive drainage of his loculated abscesses was surgically performed and within several days he improved. It is a great feeling to save a life, especially that of a young child. He gives me a big hello and a smile whenever I pass his bed. When I need cheering up, I go out of my way to visit him. He is gaining weight, moves his leg well and hopefully will not require an amputation. With the return of the general surgeons he is now under their care. We did the first microscopic mastoidectomy with a drill in Ghana. It was an urgent operation as the man had a periosteal abscess from chronic mastoiditis. A ton of preparatory work was necessary to bring the patient to surgery. During surgery, sterility was broken because the staff lacked proper training. However, the patient did well in spite of this and the sterile technique will improve with time and added equipment.
The woman mentioned in my previous blog re-visited the ear, nose and throat clinic yesterday and a better history was obtained. It seems she had been bitten by another wife of her husband. The Muslims are permitted to have several spouses and one sometimes hears that the multiple wives sometimes like this arrangement because it enables the work load and other responsibilities to be shared. However, this patient demonstrates that all is not bliss in every mutlitple Muslim household. Given the extensive facial trauma and the limited communication between the patient and myself, she seems to be doing well both physically and emotionally. Thursday, I will perform a mastoidectomy, a first in this region.
