What are the benefits for a Board Certified American doctor
to work full time for twelve years in the developing world?
When I first came to the Northern Region of Ghana, I did
not foresee the numerous benefits.

Living in a different culture continues to be the biggest reward.
The people are polite, kind, thoughtful, religious and show
great respect for their dead. Like any society there are
exceptions, but they are few. Learning a new language has
been fun although it requires a lifelong attempt to master.
The food, rich in vegetables and fruit, includes dishes very
different from those experienced in the U.S.

As a doctor, I have grown and have been humbled by being
the only specialist for two million inhabitants when I first arrived.
Many patients present with illnesses that are already well
advanced. In addition to practicing my particular specialty of
otolaryngology, I must care for a variety of medical conditions
because of the lack of other specialists. A doctor in the
developing world has to be his/her own secretary, fundraiser,
purchaser, custom clearer and repairman.

Our medical visitors are a joy, even if I am left to care for the
complications their patients may have afterwards. On my trips
home, I have enjoyed Istanbul, Amsterdam, Lisbon, Cairo,
Rome and soon Cape Town.

Once in town a boy came over to say hello, his way of
thanking me. Many appreciate my work and I am content
in doing this needed healthcare.

  Ear, Nose and Throat Nursing Students

Child who had a groundnut (peanut) in the trachea 

is better after removal yesterday

New Hearing and Vertigo Clinic

We have started a weekly hearing and vertigo clinic. Although the supply of material and prostheses needed for ear surgery are still being obtained, we were not able to wait when a 24 year old girl presented in coma from an invading cholesteatoma of her left non hearing ear. Her pars flacida cholesteatoma extended anterior to the malleus, deep into the petrous bone, destroying the malleus, incus and horizontal canal. A radical mastoidectomy was performed and left open, because our patients frequently do not return and we do not have an MRI to observe for residual cholesteatoma. Two days ago we saw her in the clinic and she is doing well, without headache. Another successful ear case this week included a seven year old girl from whom we removed a stone from her middle ear. She was referred from another hospital where they had tried to remove the stone. When we removed her stone at surgery, we found the girl had a total eardrum perforation, dislocation of the malleus and the stone in her middle ear. With a microscope and good equipment, stones can be removed without anesthesia and without complications. Finally we were asked to see a patient who developed sudden profound bilateral hearing loss. He had become paralyzed from tuberculosis of the lumbar vertebrae and simultaneously lost his hearing. We now have to check if he received any ototoxic drugs prior to being transferred or if he has tubercular meningitis.

A Twenty Five Day Struggle To Save An African Infant's Life

A nine month old girl was transferred to our hospital in respiratory distress after being fed hot porridge by her mother. Was the respiratory distress due to a burn of her larynx or did the porridge enter her lungs? Examination of the larynx revealed a swollen, reddened larynx obstructing her breathing and an endotracheal tube was passed relieving her airway obstruction. In order to prevent the child from removing her life supporting endotracheal tube, she was sedated; a feeding tube was also passed. She developed pneumonia, malaria, diarrhea, abdominal distention and her endotracheal breathing tube came out on the eighth day. At that time, the swelling of her larynx had subsided and she was able to breath. Finally on the twenty-fifth day, after her mother had been educated on feeding, she was well enough to be sent home.

 Examining the infant girl prior to discharge.

 Burned, swollen larynx with endotracheal tube passed through her vocal cords.

                                                             
  Ready to go home.

Medical Cases from Africa

A four year old presented who aspirated a tamarind seed two weeks before. Every time we tried to remove the large, swollen seed through the vocal cords it would fall off the forceps. Breaking the hard seed into smaller pieces to allow passage was also unsuccessful. Even by paralyzing the patient we could not extract the seed. Keeping the patient sufficiently oxygenated was a problem. An incision was made in his trachea and the seed was removed directly from the wider trachea. The child was discharged healthy in four days.

A 60 year old man presented septic, with a deep neck abscess. He had had a tooth removed six years ago. His x-ray showed a dense object in his peritonsillar region and examination of the oral cavity showed a partially visible object. His neck was drained of 150 milliliters of exudate and removal of the object revealed it to be a round piece of wood with a ceramic base. It looked like a prosthetic crown or the broken end of an oral clamp. The patient denies having had a prosthetic crown put in after his tooth removal; however, it will be shown to the maxillary surgeon for further clarification.

                                          Tamarind Seed

The Advantages of Practicing Otolaryngology in Ghana by an American Otolaryngologist

Practicing otolaryngology for twelve years, the majority of the time as the only otolaryngologist without other specialists in an area of over two million people, has required studying, reading, consulting physicians, accessing Hinari and Youtube. Caring for many sick patients has been the best teacher of all. Helping to restore the health of others resulted in increased confidence and the personal satisfaction of contributing to society.

Living, working and sometimes disagreeing with the Dagomba of northern Ghana resulted in appreciating another culture, religion and race. It taught me the common human feelings shared by all men. The Dagombas welcome strangers believing we are enriched by each another. One of their proverbs states that a stranger can do no wrong. They forgive my many mistakes and truly appreciate the little help I have given.