Patients with Brancheal cleft cyst and Lafort I,II and mandibular fractures

Right brancheal cleft cyst and left brancheal sinus

Lafort Fractures

Photos of daughter Beth's visit

Daughter Beth arriving in Tamale

Beth and I at Christmas party

Watermelons at Tamale main market

A Christmas visit from my daughter

Modifying my actions to the Dagomba culture and the Dogomba nurses using the microscope and headlight are slow and awkward modifications of behavior. But, it is happening.

I have chosen to do only elective surgery until both iodine antiseptic is obtained to properly sterilize the patients’ skin and all my equipment is unpacked and organized. The hospital wards are in need of paint and freshening up, but seeing a rat emphasized the low standard of maintenance. For the privilege of being brought to the front of the line and being introduced as a family member, the patients pay the staff a fee. A common occurrence is the acceptance of a patient’s death when there is no available equipment, funds, and/or specialist to perform the necessary treatment to save a patient with a curable disease. Our proposal to renovate the hearing assessment room was denied because the original non-government agency has changed its mission. On the positive side, the chief ear, nose and throat nurse cancelled his travel plans in order to help me with an emergency tracheostomy.

A woman patient, who had been treated for asthma for three months, actually had stridor from an aryepiglottic, submucosal swelling which necessitated an urgent tracheostomy. Deeper biopsies will have to be done if the report is non-specific. Her swelling has reduced on post-operative antibiotics. Several thryrotoxic goiter patients with congestive heart failure and stridor had disappearance of their stridor when medically treated. Another patient with acute epiglottitis presented, but this patient also had jaundice and leukopenia. His human immunovirus test was negative. A sixteen-year-old boy with multiple facial fractures, Lafort I and II, and mandible was successfully referred and treated at Kofu-Annochi Hospital, in Kumasi.

Delighted to have my daughter Beth, visiting for Christmas.

Weekend Break in Accra

My wife and I spent this weekend in a different world from Tamale, in the Ghanaian capitol, Accra. There is an international influence in Accra. We ate in several fine Indian and Ghanaian restaurants, and stayed at a nice Ghanaian Lodge, all fine by anyone’s standards. After working every day, with our evenings busy trying to ready a rented house for occupancy, it is a refreshing break.

Several adult cases of acute epiglottitis were treated. Although Homophiles Influenza bacteria is the usual cause, Dr. Kitchner, chief of the Otolaryngology Department at Korle Bu Hospital, said Adult Immune Deficiency Syndrome might be the underlying cause and these patients should be tested for human immune virus.

We refer many profoundly hard of hearing children to the school for the deaf. Their deafness is often caused by malaria and/or its treatment. I saw a patient with severe permanent deafness resulting from artesinate, amodiaquin and ciprofloxin treatment. The patient was asymptomatic for malaria, but when he presented with eye disease and tested positive on a blood smear for malaria he was treated with this tragic result. Ghana states that its disability incidence is ten percent. Although the figure is hard to determine, it may be too low.

My United States colleagues have been kind enough to offer advice and supply me with articles regarding some of the difficult surgical cases shown in the photos.

After a lapse of several years, a new clinical conference at Tamale Teaching Hospital was attended by eighteen enthusiastic physicians. Five of these physicians were (housemen) residents, rotating through the hospital during their training break.

Work is hard, exciting, satisfying and worthwhile.

Medical Photos and Descriptions

This woman's enlarged thyroid has caused hyperthyroidism and heart failure.

This one year-old girl has a complete cleft lip and palate.

The man below had an infection of the mouth at age three which resulted in a deformed and elevated lip.

The young girl below has a deformed jaw and abdominal mass. This is the most common cancer among African children-- Burkitt's Lymphoma. Besides the lymphoma in the facial bones, she has an abdominal mass of lymphoma.

This man below had some herbal medicine placed in his nose that ultimately caused chronic sinusitis and fistulas from his sinus into his cheek and mouth.

This young girl developed a frontal sinus mucocele which is displacing her right eye.