The Surgeon as the Patient

Dinko ready to lift me onto the plane.

Dinko and Peter, Tamale Teaching Hospital nurse and doctor, took me to Accra. It was Dinko first flight.

My sons,Jim and John, helping me into our house on arrival home.

Cast after the second operation.

Sorry to say it has been an exciting few months. After returning to Tamale Teaching Hospital in January, 2022, I fractured my right leg by falling into an unprotected construction pit as I was walking home after finishing ear surgery at 7 pm on March 1st. My colleagues operated on me the next day, but they were not totally happy with the alignment. Since I was already scheduled to accompany my wife back to the USA in a few days, we thought it best to obtain a second opinion. The return trip home was difficult. The safety officer for Africa World Airlines was not going to allow me to board the small aircraft to Accra until my colleague, Dr. Adjeso, who conveniently happened to be his relative, persuaded him. Upon our arrival in Accra, the next leg for our Delta flight to New York was delayed overnight, but we finally arrived safely in the U.S. on March 6th. The orthopedic surgeon in New York agreed that the alignment should be improved upon and the reconstructive surgery was performed on March 14th. I am participating in daily physical therapy and now able to walk using a cane. The wound has healed and the pain is much reduced. My return to Tamale depends on the ability to heal further. My wife’s friend told her to break my other leg in order to keep me home, but the desire to get back to work is strong.

                                          

My fractured left tibia and fibula with titanium rod.

Iddi visiting me in Tamale Teaching Hospital. He pulled me out of the unprotected, construction hole.

Effective Medical Help in the Developing World

To be effective in providing medical help in the developing world, it is necessary to be on-site full time. Even though I had already come to this realization from working on-site full time in Ghana for the past fourteen years, it was further demonstrated when I returned from an absence of two years due to the COVID pandemic. Among the clutter and general disorganization of equipment and supplies, I found three fiber optic endoscopes destroyed by not sterilizing with 2% formaldehyde, but instead using parasol after being clearly instructed that this would do harm, two non-operative ear drill handles, a malfunctioning camera and flashlights, otoscopes and pulse oximeters not being used due to lack of batteries. On a personal level, our rented house was dirty even though a cleaning woman was paid monthly during our absence and water pumps, toilets and lights all needed repair.

An ongoing presence is essential to resolve problems as they arise and to ensure a consistency of an effective and well run medical facility.

Home With A Guilty Conscience

I returned home to the U.S. in March, 2020, when my concerned daughter purchased an airplane ticket for me, but I felt guilty leaving when there would be an increased need for a doctor during a pandemic. Since I was scheduled for a vacation and knew my family wanted me home, I thought I would take my vacation and then return. The border closed the day after I left and just recently opened. My colleagues at the hospital report that the people are healthy even though they are testing positive for COVID-19. There have been 50 deaths country wide among the 45,000 infected persons. If I returned and became sick, I would be a burden. There is only one working ventilator in our hospital. 

While home, I have been ordering medical equipment and we have just finished painting our house. I am getting to better know our two daughters-in-law and our four grandchildren, all under the age of six. Several family members have health problems which I also may be able to help. Returning might be possible early in 2021 after being vaccinated.

Encouragement to work in the developing world

As an American ear, nose and throat doctor practicing in West Africa since 2007, I encourage you to work in the developing world.The death rates for victims of accidents and women giving birth are fourteen times higher than in the developed world. Because there are few dentists to provide primary care, we have patients who die from septic shock caused by tooth infections. When we operate on our indigent patients, we often have to purchase medications for them.The hospitals in the poor regions of the developing world lack necessary funds, specialists, equipment, bandages, tracheostomy tubes, foley catheters and medications along with a consistent supply of water and electricity.

The developed world has so much while our brothers, sisters and children in the developing world lack medical care, sanitation, housing and transportation. Unable to afford a car, families rely on a motorcycle to bring their children to school. Accidents are frequent. I recall a five year old child who lost his arm when perhaps it could have been saved if there was a vascular surgeon on staff.

If you decide to work in the developing world, visit before going. You will learn what equipment you must bring. These rural facilities cannot afford to buy what you need, no matter what they promise. During discussions, they will tell you what you want to hear. Support is crucial - family, equipment, finances, maintenance, administration, assistance with customs and on and on. There are organizations and corporations who help, but it takes time and effort to locate and correspond with them. I am busy clinically, yet half of my time is devoted to repairing and requesting equipment.

The rewards are plentiful - experiencing a new language and culture, advancing in your chosen field and becoming friends with hard working, talented people.

The Difference Of An Ear, Nose and Throat Practice in New Jersey and Rural Ghana

My ear, nose and throat practice in a teaching hospital in northern rural Ghana is different than when I practiced in community hospitals in New Jersey, USA. My patients now are younger. The 2019 median age here is 21 years, in USA, it is 38 years. Weekly we remove tracheal and esophageal foreign bodies and see caustic ingestions and stridor in children. 

Another difference is how poverty influences patient presentation and treatment.  Because of their concern about expenses, the patients or their parents first attend a local villager who has a reputation for health knowledge and only after worsening of the sickness and obtaining permission from the village elders, do they come to our hospital in late stages of diseases and in septic shock. Resuscitation is necessary before definitive treatment can be done. There are three dentist in northern Ghana and septic shock and deep neck abscesses from molar infections is common. We now have a maxillofacial surgeon who will extract the carious teeth which we previously struggled at doing. Frequently the patients and the hospital cannot afford their antibiotics and we buy their antibiotics using donated funds.

Somewhat similar to the USA practice is the trauma caused from road traffic accidents, which here is the leading cause of adult deaths. The motorcycles and old imported cars along with inexperienced, risk taking, fast driving teenagers result in many deaths and injuries. The police have to do a much better job.