Progress or Regression?

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.

Addtional follow-up on previous human bite

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.

NEW MEDICAL CASE - WOMAN BITTEN BY MALE

I have been working hard since returning to Ghana in late June. Following, are photos of a woman who lost 60% of her lower lip due to a human bite. Surgery was performed in which the upper lip was rotated and advanced to the lower lip (See first photo below).

The two follow-up photos show the patient one month later. She is doing well except that the lip is tight and her teeth are cutting the inside of her mouth. With time, the tissue will adjust and her discomfort should disappear. The Ghanaian nurses commented that now her marriage should remain intact and she will not be turned out of her house - a fairly common occurrence when a disfigurement is involved.

Initial Presentation

One Month Following Surgery
One Month Following Surgery

Five years of unneccessary seizures

My cook’s tuberculous cough has diminished and the children with the peritonsillar and mastoid/facial abscesses are well. A 12 year old, who for five years has been falling as she ran away from ‘dwarf voices’, lacerated her ear. On medication now she no longer has daily epileptic seizures. Her old infected ear laceration will be allowed to heal by secondary intention before being reconstructed. Sadly, a psychotic woman drowned her eighteen month old baby.
By using a 110 volt light source and a 220v to 110v step down converter one Zeiss microscope is working. On May 22 I will be flying home for a visit and hopefully can get equipment to have both Zeiss microscopes working so ear surgery can be performed. Eighty patients are waiting.
Thirty five physicians, including the Dean and Assistant Dean of the medical school and our Chief Executive Officer, attended our weekly clinical conference on hepatitis B infection. All are enthusiastic in improving the care of the patients through our own initiatives rather than waiting for governmental or foreign aid. My appointment as clinical coordinator involves being active in the clinical meetings, informing physicians of workshops and arranging their attendance.
My English accent differs from the British accent Ghanaians are accustomed to. When I asked where I could buy baking flour, I was directed to a flower shop.

A Happy Day

We just finished removing paper from the nose of a child, when a four year old boy came in vomiting and dyspneic (difficulty breathing). He was salivating profusely and vomiting every ten seconds. Perhaps he was poisoned. The brother said he saw a blue pen top in the child’s mouth before the vomiting began. When he was examined, I saw a large blue pen top in the back of his mouth. The child was turned upside down and as the pen top moved superiorly, his breathing improved and his clearing of his throat subsided. The child was taken to the operating room, sedated and the large pen top removed with difficulty. The child did well and was sent home at 4PM. One life saved, charges 19 GHc ($19).