12/18/2011

2011 NEWSLETTER


 EARTHWIDE SURGICAL FOUNDATION

2011 SUMMARY

I would like to thank all our generous contributors. It has been approximately six years since Earthwide Surgical Foundation was granted 501(C)(3) non-profit status by the Internal Revenue Service. I am very happy with our progress towards achieving the Foundation’s goals, namely, to deliver surgical care to the poor of the world by means of manpower, equipment and education. The following are some of the highlights of the past year:

MISSION TRIPS

1. On 2/10/11,  Dr. Camazine returned to the Nigerian Christian Hospital for a mission trip. During this visit, 13 Nigerian upper level healthcare workers including 6 surgeons, 3 surgical residents, and 1 nurse anesthetists joined him. All these individuals came to learn and donate their time and energy. During a 18-day period, over 600 patients were treated and 137 major operations performed. This trip to Nigeria was unusual in that all members of the team were Nigerians except Dr. Camazine. This aspect of the trip is quite unique and we were very proud to get such a strong local participation. Participating physicians included Drs. Onkeonye, Ifeanyi, Bock, Ngwu, Akpanudo, Jambo, Eguzo, Enyinnah, and Mishack.

2. On 6/4/11, Dr. Camazine and his daughter, Maraya (19), joined Health Talents International on a surgical mission trip to Guatemala. They performed performed 33 procedures on 27 patients 5 days.

3. On 6/18/11, Susan Camazine, RN, joined the Caris Foundation team for a surgical mission trip to Malindi, Kenya. In five days, Susan scrubbed on over 60 operations.

4. On 6/24/11, Dr. Camazine returned to the Nigerian Christian Hospital for a mission trip. During this visit, 14 Nigerian upper level healthcare workers including 7 Attending Physicians, 5 surgical residents, and 2 nurse anesthetists joined him. All these individuals came to learn and donate their time and energy. During a 3 week-period, 150 major operations were performed and over 600 patients were treated. All members of the team were Nigerians except Dr. Camazine. This aspect of the trip is quite unique and we were very proud to get such a strong local participation. Participating healthcare providers included Drs. Onkeonye, Ifeanyi, Bock, Ngwu, Akpanudo, Jombo, Eguzo, Ezeonwumelo, Nwajei, Akpan Akunekwe, Umerzerike, Oje and Anyanwu.  With the “loaner” ultrasound from SonoSite, many scans were performed. Dr. Camazine did a daily Blog, which was well received.

5. On 9/24/11, Dr. Camazine returned to the Nigerian Christian Hospital for a mission trip. During this visit, 9 Nigerian upper level healthcare workers including 6 Attending Physicians, 2 surgical residents, and 1 nurse anesthetists joined him.  All these individuals came to learn and donate their time and energy. During a 3 week-period, 133 major operations were performed and over 700 patients were treated. All members of the team were Nigerians except Dr. Camazine. This aspect of the trip is quite unique and we were very proud to get such a strong local participation. Participating healthcare providers included Drs. Onkeonye, Ifeanyi, Ngwu, Jombo, Eguzo, Ezeonwumelo, Umerzerike, Oje, Nwajei and Anyanwu. Dr. Camazine did a daily Blog, which was well received.

PROJECTS

1. Earthwide has started a new project called the Henry Farrar Memorial Fund to honor the great missionary surgeon Henry Farrar, MD. The fund will support the teaching of local surgeons, one of the main goals of Eathwide.

2. Earthwide, with the assistance of Al Jones, MD, is supporting the Bachelor of Science in Nursing training of Eric Oje.

3. Dan Milner, MD, Assistant Professor of Pathology at Harvard Medical School, and Pathologist at the Brigham and Women’s Hospital, processed the surgical specimens from the Nigeria trips. His services are greatly appreciated and will greatly improve the quality of care to our patients.

4. Dr. Camazine has initiated collaboration between Nigerian physicians and Dr. Phalguni Mukhopadhyay, oncologist at the Central Texas Veterans Healthcare System, Temple, Tx. Dr. Mukhopadhyay has agreed to assist with chemotherapy protocols so that the Nigeria physicians can provide care for their cancer patients.

5. Dr. Camazine has expanded the teaching opportunities in Nigeria by introducing “Surgical Workshops”. These are hands on teaching opportunities for Nigerian Surgeons. Surgical colleagues from many different parts of Nigeria have been invited to join the team at the Nigerian Christian Hospital and learn from the unique surgical pathology. Physicians from Delta, Benin, Abia, River, Enugu, and Anumbra States have participated.

6.  Dr. Camazine, with the assistance of SonoSite, Inc. has started an Ultrasound workshop in Nigeria to teach local physicians the use of portable ultrasound. SonoSite, Inc. has provided a “loaner” portable ultrasound for this purpose. Clinical experience, combined with Internet teaching opportunities, will provide the opportunity for the local physicians to become proficient in this diagnostic modality.

7. Dr. Camazine wrote a book about his work at the Nigerian Christian Hospital. It will be published with the assistance of Dr. John Bailey and Body and Soul Ministries.

8. Dr. Camazine and Dr. Kelechi Eguzo are writing a book called “Where There Is No Oncologist”. This will be a practical, how-to do-it, manual for chemotherapy in resource-limited environments.

9. Drs. Camazine, Egozo and Milner wrote an article “Giant dermatofibrosarcoma protuberans of the face and scalp: A case report” for publication.

10. Drs. Camazine, Akunekwe, and Milner wrote an article “Synovial sarcoma in the anterior abdominal wall of a young Nigerian female: case report” for publication.

11. Earthwide Surgical foundation is joining with Professionals for Humanity to run a free 3-week surgical clinic in Bayelsa and Kaduna States, Nigeria.

12.  Dr. Camazine started a daily Blog on the work of Earthwide Surgical Foundation. It can be seen at www.earthwidesurgicalfoundation.blogspot.com.

13. Jose Ramirez, CST, who has participated on numerous mission trips, gave a lecture at the Annual Houston Workshop Texas State Assembly of A.S.T., Inc. on 10/16/11. His lecture, on his work at the Nigerian Christian Hospital with Earthwide, was very well received.

SUPPORT AND DONATIONS

1. The employees at Good Shepherd Medical Center (Longview, TX) donated medical equipment for the African trips.

2. The employees at ETMC Carthage Hospital (Carthage, TX) donated medical equipment for the African trip.

3. The employees at ETMC Gilmer Hospital (Gilmer, TX) donated medical equipment for the African trip.

4. The employees at Metroplex Adventist Hospital (Killeen, TX) donated medical equipment for the African trips.

5. The employees at Longview Regional Medical Center (Longview, TX) donated medical equipment for the African trips.

6. Ethicon Inc. (via MAP International) donated a huge amount of mesh and suture for hernia repairs, which were critical to our surgeries.

7.  Baxter (via Americares) supplied Floseal for hemostasis for our difficult surgeries.

8. Tyco Healthcare/Kendall (via Americares) donated a large supply of dressings and Xeroform for our work.

9. Teva pharmaceuticals (via Americares) donated Etodolac for postoperative pain control.

10. Ortho-McNeil Inc. (via Americares) donated Ultram for postoperative pain control.

11. Schering-Plough Corp. (via Americares) donated Afrin Nasal Spray for our ENT work.

12. App Pharmaceuticals (via Americares) donated Cefazolin and Ceftriaxone  for our work.

13. Johnson & Johnson Co. (via Americares) donated Neoform Tutoplast Dermis for our work.

14. Syneture (via Americares) donated suture for our work.

15. Hospira (via Americares) donated Precedex for our work.

16. AutoSuture (via Americares) donated skin staplers for our work.

17. ValleyLab (via Americares) donated electrodes and electrocautery pencils for our work

18. C.R. Bard (via Americares) donated Avitene, mesh and drains for our work.

19. CooperSurgical donated Lone Star Retractor Kits, gynecological instruments and laparoscopic equipment to Earthwide.

20. Ethicon (via Ryan Newhouse) donated mesh for our many hernia repairs.

21. Integra LifeSciences Corporation donated a skin grafting knife and blades for use in our many plastic surgery cases.

23. Walking in Love Ministries donated suture and equipment for upcoming trips to the Eku Baptist Hospital and the Nigerian Christian Hospital.

24. Atrium Medical donated surgical mesh for hernia repair for our work.

25. Fred Ingham, ETMC BioMed Division, donated valuable diagnostic and monitoring equipment to Earthwide.

26. SonoSite, Inc. provided a “loaner” ultrasound for the work in Nigeria.

27. Friends of Ostomates Worldwide-USA (FOW-USA) donated ostomy supplies for patients who require ostomies. This is very important for these unfortunate patients since quality ostomy supplies are either not available or very expensive in Nigeria.

28. Applied Medical donated a selection of surgical supplies including laparoscopic cholangiocaths, laparoscopic clip appliers and Alexis retractors.

29. Biogel USA donated gloves for our trips.

30. Kate Neylon, from Ethicon Endosurgery, sent an emergency supply of staplers overnight for the September trip. These staplers will save the lives of 4-5 patients with abdominal disasters.

31. W. Todd Allen, DVM, donated surgical staplers for our work.

32. The Merci Program (Medical Equipment Recovery of Clean Inventory), via Sandi Luthie, of the University of Virginia Health System, donated valuable supplies for our mission trip to Nigeria.

33. Earthwide Surgical received donations from the following individuals:

1.     Josephs/Chinme Anudokem
2.     Mark Becker
3.     Charles Branch, MD
4.     Cynthia Camazine
5.     Mark Crane, MD
6.     Diane Dibenedetto
7.     Peggy Dorrell
8.     Alan Freedman
9.     Patricia George
10.  Ted Hopens, MD
11.  Azikiwe Ikeora, MD
12.  Lloyd Jones, MD
13.  Robert Lawrence, MD
14.  Barbara Maufas, RN
15.  John Melvin, MD
16.  David/Joyce Newhouse
17.  Eileen Padberg
18.  David Price
19.  Gurram Reddy, MD
20.  George Robertson, MD
21.  Carol Rogalski
22.  Hiroshi Takita, MD
23.  Don Thompson
24.  James Walsh, MD
25.  M. Jill Wehmer
     
34.  Earthwide Surgical received donations from the following organizations:
1.     Americares (Cia Marion)
2.     Atrium Medical (Dan Hill/Trey Merkens)
3.     Biogel USA (Brian Conom)
4.     Body and Soul Ministries (Dr. John Bailey)
5.     CooperSurgical (Victoria Ziko)
6.     Covidien
7.     Ethicon Endosurgery (Kate Neylon)
8.     ETMC Carthage Hospital
9.     ETMC Gilmer Hospital
10.  ETMC Tyler Hospital
11.  Friends of Ostomates USA (FOW-USA) (Ruth Salinger)
12.  Good Shepherd Medical Center
13.  Ethicon (Ryan Newhouse)
14.  Integra Life Sciences Corporation (Gianna Sabella)
15.  International Health Care Foundation (Al Jones, MD)
16.  Longview Regional Medical Center
17.  MAP International (Anne Blount)
18.  Merci Program (Sandi Luthie)
19.  Regency Therapeutics (Reagan Ragnes)
20.  Walking in Love Ministries (Mary Kay/Fred Posey)

AWARDS

1.     Dr. Camazine was awarded “Man of the Year” by the Nigerian Christian Hospital.
2.  Drs. Onkeonye and Ifeanyi were awarded “Missionaries of the Year” by the Nigerian Christian Hospital.

WHAT DO WE PLAN TO ACCOMPLISH?

1.     We will continue supporting the Bachelor of Science in Nursing training of Eric Oje.

  1. We plan to produce a video from our last trip as well as CDs of our digital pictures.

  1. We are intensifying our efforts to obtain needed supplies and equipment. Many companies have been very generous.

Brian Camazine, MD
President, Earthwide Surgical Foundation
1933 Eastwood Drive
Henderson, TX 75652
254-718-0659

NEXT TRIP

My next trip to Nigeria will be early January 2012. Too long for me, but too short for my wife. Supplies are starting to arrive from all over the country.






12/12/2011

FOLLOWUP-AMELOBLASTOMA


 



















This 13 year old had a right hemimandibulectomy for a mural ameloblastoma on 10/18/11 (my birthday!). She had a wound complication but has healed fantastically. The followup picture is about 7 weeks after surgery. She is speaking and eating fine.

11/15/2011

SERTOLI-LEYDIG CELL TUMOR

During this past trip, a 21 year old female came to clinic with a pelvic mass. In 2010 she had a laparotomy with excision of her left ovary for a tumor. Unfortunately, she was lost to followup and never received chemotherapy. 

We reoperated on this patient. We found a tumor recurrence anterior to the bladder, which we resected. The pathology showed a Sertoli-Leydig cell tumor, which is a member of the sex cord-stromal tumors. This tumor can produce androgens (male hormones) in one third of patients and cause masculinization including acne and hirsutism, voice deepening, clitoromegally, temporal hair recession, and an increase in musculature. These tumors are sometimes called arrhenoblastomas or androblastomas.

Our patient recovered without difficulty and is now receiving chemotherapy.

11/10/2011

GOOD NEWS-YOU HAVE BASIDIOBOLOMYCOSIS

On my last trip, Ika Imene, a 60 year-old man,  arrived with a right lower quadrant mass and abdominal distention. We operated and found a large 8 cm cecal mass. We did a right hemicolectomy. When we cut the specimen open, we found a near obstructing mass in the colon. I was sure we were dealing with a colon cancer.  Ika recovered without any complications but I thought his chances of cure were slim.

Yesterday, Dr. Danny Milner contacted me with the pathology results. Great news-the patient doesn't have cancer, he has basidiobolomycosis. I never heard of this before and I doubt many people have. Basidiowhatever is a rare disease caused by the fungus basidiobolus ranarum, an environmental saprophyte found worldwide. Treatment is surgery combined with antifungals. Great news for the patient.

10/25/2011

BRAVERY

We have it easy in the USA. Education is highly accessible. Travel abroad is easy. Not so in Nigeria. Eseose (God's Gift) is a very interesting woman I met in Nigeria. She is 27 years-old; newly wed to Dr. Kelechi Eguzo, administrator of the Nigerian Christian Hospital. Since her marriage, she has become pregnant for the first time and is due in September 2012. 

She attained a Bachelor of Science in microbiology at the Ambrose Alli University,  Ekpoma. She applied for training in Food Science and Technology in Belgium to begin September 2011 and was accepted-a prestigious but expensive school. She applied for her visa in May but the visa did not come through until this week.  Now she leaves for Belgium today, to start the course of study almost 2 months late.   

Think of the obstacles this young woman faces! She has never left Nigeria, She has little money. She is traveling to a foreign country to start school 2 months late. She is pregnant for the first time and will have her baby in a foreign country with no husband or relatives with her. She is as brave as they come! She is a hero!

This story is unusual but not unique. All over Nigeria, people are battling against all odds to inprove their situation. While we in the USA are living, Nigerians, and billions in the third world, are just struggling to survive. Kudos to these brave people who accept these challenges.

Addendum: Eseose made it to Belgium. She is struggling to catch up on studies and having some money problems but surviving!

10/21/2011

HOME

I arrived home today. I'll rest tonight then start making plans for the next trip tomorrow !

10/19/2011

SURGERY DAY 22-FINISHING UP


Liver mets
Yesterday was the mother of all surgery days. We started with 2 pediatric hernias. Next we operated on a lady with a right lower quadrant mass and an enlarged liver. We suspected a cecal cancer with liver mets and, unfortunately, we were exactly correct. We did a right hemicolectomy as the tumor was near obstructing. 

The next patient was an older lady with a large flank bulge. She had a previous surgery and most of her intestines were in a hernia that tracked posteriorly. We repaired this with mesh. Next a submandibular mass which I am sure will be an adenoid cystic carcinoma. The mass was hard as a rock. Then, a woman came in with a fibroid which was prolapsing through the cervix and bleeding. We resected it without a problem.


Next,  a 13 year-old with a large jaw mass. On palpation, the jaw was crackly from the bone being thinned out in areas to less than 1 mm. In other areas, there was no bone! This is probably an ameloblastoma. We had to perform a total right hemimandibulectomy. 


We then placed a chest tube in a man with a pleural effusion. Next we operated on a 21 year-old female who previously had a resection of an ovarian endodermal sinus tumor. She failed to get her followup chemo and now has a recurrence. We found a tumor mass above the bladder. We were able to remove all visible tumor and she will get chemo. 




Finally, we operated on a 25 year-old female with a scalp mass that has been growing for 24 years! We suspected a dermoid cyst. We were correct, as we found, when we accidentally entered the cyst and yellow mush squirted all over the field. There were three of us working on the case and I'm sure each was praying it would be the others that entered the cyst first-LOL!



This is it. I am leaving for Lagos today and then to the USA. We completed 133 cases in 22 days.  Most patients are heading home. There are a few who will be in the hospital for awhile. There is already a list of patients growing for ths next trip. 




Addendum (10/27/11) : Our lady with the dermoid cyst is doing well and discharged. I can't wait for her hair to grow out!






10/18/2011

HAPPY 55TH BIRTHDAY


Many doctors, nurses, employees and patients came out to wish me a happy 55th. It was.




After surgery, we had a birthday party with cake!

10/17/2011

SURGERY DAY 21-LATE NIGHT

Surgery was busy today. The word is out that the trip is almost over so many people are coming at the last minute, hoping to get their surgery done.  For tomorrow we have a mandibular tumor, a giant ventral hernia, a submandibular mass, a cecal cancer,  2 pediatric hernias and a recurrent ovarian tumor in a 21 year-old female. More will becoming,  as well. Tomorrow is the last day of operating so we plan to finish all comers, even if we stay up all night. We have done 122 surgeries.

Sister Mary Joseph Nodule
The clinic was also busy. One old man came with an umbilical tumor, a Sister Mary Joseph Nodule. The tumor was fungating and bleeding so we resected it-not expecting a cure but a slight improvement in the quality of life for the patients final days. He has carcinomatosis from an unknown source.

A patient from two years back also came today. She is 40 years old. In 2009, she came in with a rectal cancer. I performed an abdominoperineal resection which involves removal of the anus and formation of a colostomy. She was wealthy enough to get chemo and radiation after surgery and is doing quite well now. She was wearing a standard appearing colostomy appliance, which surprised me. She was able to purchase it in the market for 350 Naira, about $2.33. She uses a bag about every 5 days so she will spend about $150 /year on ostomy appliances-not much unless your monthly salary is $100!

It is 845 PM. We just got called for an obstructed hernia so we are returning to the hospital. Don't wait up.

CHIEF ENGINEER

Jerry Nwosu used to be the assistant cook. Then the hospital electrician was electrocuted and he became the Chief Engineer. He is fantastic! He is trained as an electrician but he can fix anything. He is the one that set up the emergency light system for the operating room. He even fixed my hair trimmer.  We are lucky to have him.

10/16/2011

SURGERY DAY 20-GAS-GANGENE

Today I was called for an emergency-a woman with an injection abscess of the buttock. The patient had the abscess for several weeks after an injection for malaria. She looked terrible-wasted, pale, diaphoretic and tachycardic-a true emergency. Her buttock was grossly swollen, red and full of pus. 

Wound 1 day after I&D
When the patient was asleep I could examine the wound better. I could feel crepitus (air) in the tissues. When I cut the wound open, pus and air bubbled out-gas gangrene-a clostridial infection. This patient is critically ill and the situation is complicated by her being HIV positive. Even in the USA, this would be a challenging case.

We will see if she can survive.

10/15/2011

SURGERY DAY 19-GALLSTONES

262 stones
Gallstone disease seems to be less common in Nigeria than the USA but we do see some cases. The incidence seems to be increasing. This may be because the obesity epidemic is coming to Nigeria.









On this trip, I have performed 3 cholecystectomies. On my last trip we performed several as well, including one woman who had 262 stones! I have been quite surprised how beautiful the stones are from Nigerian patients. 

Beautiful stones
A new team member has arrived, Charles Nwajei, MD,  a Urologist. Charles went to medical school at the University of Calabar and did urology training at University of Benin. I first met Charles when he came to NCH in 2006. Uche brought him for extra training. He has just finished all his training and is looking to get some additional general surgery training. He is a kind, quiet man. He is a good surgeon and an asset to to the team.






We have discussed cassava previously. It is a dietary staple in Nigeria. Today on the way to work we learned some more. The young man in the picture has a mobile millstone for grinding cassava. The mash is then made into gari. His machine runs on gasoline. He charges 200 Naira ($1.33) to grind 2 large bags.







Cassava in....











                                                                 Gari out!

10/14/2011

NIGERIAN SCAMMERS

Nigerians have a bad rep in the world which may have begun  with the four-one-nine scams. The 419 is an advance -fee fraud (see example below).  This type of internet fraud appears to have originated in Nigeria but is now omnipresent. The Nigerians who make lots of money from internet scams are sometimes called Yahoo Millionaires or Yahoo Boys.

Of course, the 419 is not Nigeria's only public relation problem. It is common for Nigerians to be portrayed poorly. For example, Nigerians are portrayed as scammers  in Sony's PS3 commercial.

In the movie District 9, they are portrayed as an evil, gun-wielding gang, cheating and killing the downtrodden Aliens-who only want to eat cat food and return to their planet. This is a great movie about man's inhumanity to man (or alien). Of course, it is banned in Nigeria!

Most of these stereotypes are quite funny if people can just 'get over it". And remember what W. C. Fields said. "Never give a sucker an even break".






Please My Dear I Need Your Help.
   

I know you will be surprise to receive this email, but Before I go further I will like you to understand that, I am writing this mail to you With due respect trust and humanity, I appeal to you to exercise a little patience and read through my letter I feel quite safe dealing with you in this important business, honestly i am writing this email to you with pains, tears and sorrow from my heart, i will really like to have a good relationship with you and i have a special reason why i decided to contact you, i decided to contact you due to the urgency of my present situation here in the refugee camp. My name is Miss. Mary Kipkalya Kones, 25yrs old female and I from Kenya here in Africa; my father was the former Kenyan road Minister. He and Assistant Minister of Home Affairs Lorna Laboso had been on board the Cessna 210, which was headed to Kericho and crashed in a remote area called Kajong'a, in western Kenya. The plane crashed on Tuesday 10th, June, 2008.
     
    After the burial of my beloved father, my stepmother and uncle conspired and sold all my father's properties to an Italian Expertrate which they shared the money they sold from the properties among themselves and live nothing for me. Unfortunately to me I fined my father's briefcase and when I opened it I found a document which my Father used to deposited amount of money in one bank here in Burkina Faso, with my name as the next of kin. I travelled to Burkina Faso here I am, to withdraw the money for a better life so that I can take care of myself and start up a new life and also further my education, when I arrival to the bank, the Bank foreign Operation Department Director whom I meet in person told me that my father instruction to their bank is that the fund would only be release to me when I am married or present a trustee/partner who will help me and invest the fund overseas after the transfer, and the bank ask me to go and look for a foreign partner, that was why  am contacting you, which I believe that you are going to be honest and reliable person that will help me and stand as my trustee/partner, so that I can present you to the Bank for the release and transfer of the inherited fund into your bank account in your country.
     
    I have chosen to contact you after my prayers and I believe that you will not betray my trust. But rather take me as your own sister. Though you may wonder why I am so soon revealing myself to you without knowing you, well I will say that my mind convinced me that you will be the true person to help me. Moreover, I will like to disclose much to you if you can help me to relocate to your country because my stepmothers have threatened to assinate me. The fund my Father deposited into the bank, is ($8.5 USD) Million United State Dollars, and I have confirmed from the bank here in Burkina Faso, on my arrival, You will also help me to place the fund in a good profitable business venture in your Country, However you will also help by recommending a nice University in your country so that I can further my education. It is my intention to compensate you with 40% of the total money for your services and the balance shall be my capital in your establishment. Now my dear as soon as I receive your positive response showing your interest and wiliness to help me, I will put things into action immediately. In the light of the above, I shall appreciate an urgent message indicating your ability and willingness to help me and also handle this transaction sincerely. Awaiting your urgent and positive response. Please my dear I want you to keep this as a top secret only to your self for now until the bank will release and transfer my inherited fund to you as my appointed trustee/partner. I beg you once again not to disclose this to any body until i come over your country because I am afraid of my wreaked stepmother who has threatened to kill me and have my inherited fund alone. I thank you very much and am expecting to hear from you soonest.




     
 Yours Sincerely
  Mary  Kipkalya Kones. 



District 9 Alien












SURGERY DAY 18-MORE KELOIDS




"If I were two-faced, would I be wearing this one?"  Abraham Lincoln




You have seen this sweet little girl before. She is 11 years-old, the same age as my son.  She came to the operating room yesterday with a smile. There was no crying when Eric placed the IV and she walked into the OR with a grin. There are no complaints today-even when I cleaned the wound for pictures! After excision of the keloid we injected depo-medrol and will continue this monthly to try to prevent a recurrence. The result isn't perfect but the patient and mother are very happy.

10/13/2011

SURGERY DAY 17-DEATH


It was the time of the preacher
In the year of '01
Now the lesson is over
And the killing's begun


It is a drag, but sometimes patients die after surgery. When this happens, I question every aspect of our care to try to understand why the death occurred. We can't undo the past but we can improve the future.

On this trip we had a few deaths including two preoperative deaths- two babies came to the hospital  many days after disasters had occurred in their abdomens'. We had planned to operate on both but they died before getting to surgery. Both cases were long shots, but I have seen these occasionally have a happy ending. The irony is that if these two patients had come one hour earlier, they almost certainly would have been postoperative deaths. In the USA, this would result in several inches of quality control/peer review paper. In Nigeria, we can just accept that we tried our best under very difficult circumstances and the patients died.

We have completed 109 surgeries. 

10/12/2011

SURGERY DAY 16-WHEN THE LIGHTS GO OUT



Uninterrupyible power supply
Despite being a major oil producer, Nigerians are often without power. The power generating company NEPA (National Electric power Authority), and the associated delivery infrastructure are terrible. Power outages are the norm-lasting from minutes to days. Yesterday, for example, we had no power and this trip has been one of the worst in recent years. Most facilities have a back up generator which, in reality, often becomes the main source of power. NCH has a large generator but it is decades old and expensive to run. There is also a smaller generator but it cannot run air-conditioners. Recently, Dr. Kelechi installed an uninterruptible power supply (inverter). This is a system of batteries that are charged when there is power and take over when there is an outage. It is designed to run the OR for 4 hours but, after installation, it was found that the batteries were bad so the system can only supply power for about 1 hour-and the system cannot run the air-conditioners. Well, at least we have light!



Wilson-nurse anesthetist
It is a sad day-Wilson is leaving. They need his anesthesia abilities back in Enugu. He has been a great help. Chineke gozie gi (Go with God).










Smart-surgical technician and author
Today we crossed the century mark-100 surgeries. We are still plugging ahead. I am doing my surgeries with Smart Uruakpa-an excellent surgical technician who can close a wound much better than I can.

I LOVE WHAT I DO


"Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do"  Steve Jobs

Some have asked why I do what I do-Travel overseas, leave my family, risk my health, reduce my salary etc.

The answer is simple-I love what I do.


"In the end, it's not going to matter how many breaths you took, but how many moments took your breath away"  Shing Xiong

10/11/2011

SURGERY DAY 15-URETERS



Yesterday was a busy day. We started with a bilateral inguinal hernia. Next, we reexplored a woman on whom we did a radical hysterectomy for cervical cancer. She had preoperative chemotherapy. The left ureter was involved and very small, so we ligated it. On reexploration, we reimplanted the ureter ito the bladder. After this, we reexplored the woman with an intraabdominal pregnancy-her bleeding had stopped so we closed her abdomen. Next we did 2 goiters. We then debrided the wound of the woman with sarcoma of the chest and shoulder.


Massive ascites
We proceeded to what we thought would be our last case of the day-a young girl with an abdominal mass and massive ascites. We explored her and drained 8 liters, then removed an ovarian tumor. We are hoping it is not malignant.









We packed up to go but on night rounds found a woman with a near strangulated bowel in a Pfannensteil Incison. We repaired her hernia with mesh-the bowel was bruised but seemed viable.

Today we operated on a baby with syndactally. We had done the left hand in June and today we did the right hand. Then we worked on a baby boy with a severe burn contracture of the leg. We did a series of Z-plasties to release the contracture.  Dr. Umezerike and I then worked on a lady who had a uretero-vaginal fistula post C-section. We divided the ureter distally and reimplanted it in into the bladder and the problem was solved. Next, we moved on to a lady with an ectopic pregnancy. We removed the tube and pregnancy which was hemorrhaging into the abdomen. We then did the mandatory daily goiter and finished with a submandibular tumor!

Jaw Tumor
An interesting patient came to clinic today. He has a recurrent lower jaw mass-probably an ameloblastoma. He has had this problem for 5 years. It is a very difficult situation because resection would require removal of almost the entire lower jaw. He needs reconstruction. I will see him next trip and perform the resection. 















Gynecomastia
After SQ mastectomies
The man on the left came to clinic with bilateral gynecomastia. This is not life threatening but very embarassing for him. We performed bilateral SQ mastectomies and he was very happy. 

























The boy on the right also came to clinic today. we removed a large left maxillary tumor in February. He has a beautiful result.
























SURGERY DAY 14-EXHAUSTION

Yesterday's blog was cancelled due to exhaustion. Eight major cases yesterday and 93 total.

10/09/2011

SURGERY DAY 13-MALARIA

Today, Dr. Samuel Oje, resident in OBGYN, called me for an emergency. A young woman, HIV positive, came with a fetal demise. Despite induction elsewhere, the fetus would not pass. Samuel did a c-section and found a intraabdominal pregnancy with a long dead fetus. All the bowels were adhesed together secondary to the placenta which was in the Pouch of Douglas. The posterior wall of the uterus was perforated by the placenta. We slugged our way through the superglue and got things sorted out. She is doing well.

Delux Suite
I came back from surgery tired and crashed in the "Delux Suite". As you can see, I sleep under mosquito netting. Malaria is a major problem in the world, especially in Sub-sahara Africa. There are 250 million cases of malaria per year and about 1 million deaths, mostly in young children. I have had malaria and it is no fun! Fortunately, I have some resistance now so, if I do get malaria, it is mild.

We have done 85 cases. Tomorrow is Monday so more patients will be pouring into the hospital. 

10/08/2011

SURGERY DAY 12-HOW ABOUT SOME MODESTY?

"Be who you are and say what you feel because those who mind don't matter and those who matter don't mind"- Dr. Suess

A few people have stated "How about some modesty for these patients" or "You can identify them". I have thought about these issues. Quite simply, I won't dehumanize these patients by "cutting out their privates" and "blackening their faces. The patients I see are real patients, with smiles and frowns, breasts and  genitals. If we crop out their humanity, we also crop out their problems. Let's look at some examples. 

The poor little girl below is a real patient a with a terrible cosmetic problem- a giant keloid secondary to an ear piercing. Despite this, she can come before the camera and smile, knowing there is some hope with surgery. I think we lose a lot be covering her eyes. She is no longer the smiling little girl but just an ear with an ugly blob.  The eyes are a window to the soul.














Let's look at another example-this woman has a term pregnancy but also has an ovarian cyst that is twice as large as the term uterus. Her belly is so full she can barely breath and her feet are swollen from venous obstruction. Despite these problems, and the fact that she is about to have major surgery, she is smiling and her bravery comes through. Can we really get the story from the cropped picture. Nope! 














I explain  to patients that the photos are for communicating about the work we are doing. I ask their permission. They are almost always happy to have their picture taken.

Today is a busy day-a  radical neck/total thyroidectomy, a cholecystectomy, a cholecystectomy/TAH, a bilateral hernia repair and bilateral subcutaneous mastectomies. Fortunately, Dr. Uche is back and we are ready to work. We have done 83 surgeries. I am starting to get tired.




10/07/2011

SURGERY DAY 11-HALSTEAD

"Surgery would be delightful if you didn't have to operate" - W.S. Halstead

Most surgeons are happy to be in the operating room. We can do dramatic surgeries, effect changes and are in control. But that doesn't mean we always want to do surgeries. The best surgeons know when to say no.  At the NCH, I am always encountering the most difficult cases-patients who have had surgery multiple times before or who have been elsewhere and told that surgery is too difficult or 'impossible'. We are often the hospital of last resort. Many times we tackle these cases and we get  good outcomes-sometimes not so good. But, it is hard to tell a patient that you have nothing to offer them-except a prayer.

Theo
A new team member has arrived-Theo Ezeonwumelo. Theo did medical school training at the University of Port harcourt and is doing surgery training at the Federal Medical Center Umuahia. He is a fourth year resident now. He came to work with me in June, 2011 and is back. Theo is a very pleasant and humble chap, like his attending Dr. Mike Enyinnah. We are glad to have him.








To date, we have done 71 surgeries-many are still waiting. We started today with an incarcerated hernia. Next, we did an unusual case, a term pregnancy with a giant ovarian cyst. The cyst was twice the size of the term uterus. We attacked the cyst first and it exploded all over the operative field. Gallons of fluid poured out. We removed the cyst,  then we did the CS. We followed this case with a giant goiter, 400 grams. Several more surgeries were done but they are all starting to blend together. Dr. Uche is returning in the morning and we have some big surgeries scheduled.

Term preganancy with giant ovarian cyst
Drained ovarian cyst