Tamale Teaching Hospital is a good hospital

Tamale Teaching Hospital is a good hospital. Newly appointed and recently trained physicians, pharmacists, laboratory technicians and administrative professionals have improved patient care. The new graduates are dedicated, knowledgeable and hard working. They are capable of working in the most sophisticated medical settings with the proper orientation and training. Their lectures at the hospital clinical meeting are excellent. Medications and bandages are available through the persistent efforts of the new caring, hard working and honest administrators. However, the staff is limited by the lack of equipment. In the hospital there is one electrocardiographic machine, three ward oximeters, no vaporizers or intravenous infusions pumps. Our otolaryngology clinic is lacking a pediatric nasopharyngoscope and bronchoscopes, laser, rigid telescopes for sinus surgery and suction debriders for nasal polypectomies. “One looks for what is needed and then one uses what is found” and “We are managing” are the appropriate practical Ghanaian sayings in response to this lack of equipment. Six Columbia St.Lukes/Roosevelt ultrasound physicians and public health professionals, under a General Electric grant, gave an excellent two day ultrasound workshop. Ultrasoundography is inexpensive, non-invasive and without complications. Two ultrasound machines were donated, which are appreciated, but thirty are needed along with maintenance for the five millions patients in northern Ghana. All is not Utopia. Human nature is universal and there are those who do not work when necessary, saying they are underpaid. But, we are managing.

The day after Christmas

Saturday, 26 December 2009
This day off found me rising at the usual 5:30 AM, breakfasting on yams and onions, muffins, fresh orange juice and a pau pau, which I purchased with haggling yesterday. I studied Dagbani for an hour by listening to conversations that I had recorded while in taxis traveling to and from work. It is fun to use the small hand-held recorder I recently purchased as some passengers are not familiar with recorders nor have they ever heard their own recorded voice. They also roar over my atrocious pronunciation. I laugh too when I listen. Just this month I have been able to have a simple conversation with a familiar topic. It gives me a thrill as language learning is difficult with my moderate hearing loss. Afterward, I placed cuttings from flowering bushes in water and compost soil and following that, I spent an hour studying a patient’s disease. Today, the disease was hydrocephalus and Arnold-Chiari malformation, because I lost a three-month old Wednesday with this condition. The child had a progressively enlarging head and dyspnea from bilateral vocal cord paralysis when he presented with cerebral malaria, seizures and died. A pediatric fiberoptic nasopharyngoscope was needed to examine this sick infant’s larynx. The adult scope was too wide to pass through her nose.
Lunch today consisted of a yam, string bean and carrot stew, diluted orange juice and a Christmas present of cashew nuts which Cyndy gave me yesterday. Then another gardening break. This time planting pau pau trees in the dry cement-like soil. Each side of the house now has a row of ten pau pau trees; the symmetry is pleasing. Time to treat myself to whatever I choose. This blog posting is being written because my friend and former medical school roommate mentioned on a call yesterday that there were no blog entries since November. Next on my agenda: taking an interactive aviation course online or looking up sites for my birthday-family vacation this March in Egypt. Hopefully the hospital will not call to disturb this Type A personality. I described my day after reading "Narrative of the Life of Frederick Douglas, an American Slave, Written by Himself." It is an excellent book and he could certainly give me a few lessons in writing. P.S. Corrective comments are appreciated.

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.

An exhausting, but successful week.

Twelve year old girl hit hit by a broken machine belt crushing her larynx and lacerating her pharynx.

Three year old whose house wall fell on him causing a concussion, swollen tongue and upper airway obstruction.

This week was exhausting, but successful. Three patients presented with severe upper airway obstruction requiring emergency tracheostomies. The first patient had complete upper airway obstruction from a carcinoma of the larynx. Following his tracheostomy, his tracheostomy tube obstructed twice due to lack of humidity, suctioning and the use of too small a suction catheter. The second patient, a three-year boy had the wall of his house collapse on him during a heavy rain causing a concussion, orbital fracture and swollen tongue, which required an emergency tracheostomy. The third, a twelve-year old girl, had a crushed larynx caused when a machine belt broke hitting her flush in the anterior neck causing a thyroid cartilage fracture, separation of the true and false cords from the arytenoids and retropharyngeal air. Intubation was impossible and a cricothyrotomy was performed. The following morning the tracheostomy was properly repositioned and the larynx was sutured and stented back into its proper position. Sunday afternoon I slept five hours exhausted. I am in need of tracheostomy tubes of all sizes (as my own supply has dwindled), suction catheters, laryngeal stents and suction machines.

Return From a Visit to the US

Right mastoiditis for twenty-five years with hearing loss, facial paralysis and epidural abscess.

I recently returned to Ghana, accompanied by my wife, after a 45-day home emergency visit to the US because our son ruptured his appendix. He is now fine.
On arrival at the house in Tamale, the refrigerator, air conditioner and washing machine did not work. These problems have now been partially corrected.
The hospital staff warmly welcomed me back and asked about my son. There were no major failures in the ear, nose and throat clinic and our clinical conferences had continued successfully. During my first day back, a 40 year-old woman patient presented with a chronic ear infection, facial paralysis, sensorineural deafness and a frontal headache which required mastoid surgery. Her facial nerve was three times normal size, but intact and responded to stimulation, which indicates it may work again. During surgery, a tear in the middle fossa occurred requiring repair by the new neurosurgeon. The cautery machine did not coagulate, only cut, and this has to be looked into. More probes for the cautery and bits for the drill are needed for future cases.
There is a ton of work.