The baby was named Paul - my name in Liberia

Today is Saturday and I'm on call. It's not too busy. I'm back from the hospital after seeing some minor problems in the ER. Yesterday morning, when I was doing the ward rounds to see the woman with the ruptured uterus, I asked her whether she would like to visit her baby in Benson Hospital. She was afraid of going home with the catheter still in, but she wanted to visit her baby. I asked the nurse whether we could arrange a home leave and transport for her. I don't know if they have ever done it before but they were very happy to arrange for her to see the social worker. I was glad they also recognised the importance of building up this kind of mother and baby bonding. This morning I asked the mother how was her baby. She told me he is a boy but has not decided his name yet. Everybody said he should be named Paul - my name in Liberia. She was very happy and all of us shared her joy. There was a seventy year old man admitted two weeks ago with peritonitis. Fortunately, he recovered from the sepsis but he had a stroke after surgery. He is semi-conscious with right side paralysis and has to be fed by nasal-gastric tube. The condition seems static with little improvement. This morning I asked the nurse to discuss his discharge plan with the family. I met one of his family members and explained to them the situation and what they needed to consider before taking him home. I felt that the staff were quite willing to discuss this with the family. They also considered that involvement of the family in the rehabilitation was important. I met the patient's elder son this afternoon when I went back to the hospital. He thought that we were going to discharge his father soon. I explained to him that it was not necessarily so, but the family need to plan before-hand. There are lots of things they need to prepare. He was very grateful for this advice. We had three patients admitted last week with ingestion of caustic soda, one woman, one child and one man. The child and man were fine and discharged. But the woman had a severe burn to her mouth and throat. John had put in a tracheotomy for her to protect the airway on the first day of admission. She recovered well and the swelling subsided. She was back onto oral feeding. John took out the tracheotomy tube on Thursday. Before we went for lunch today, we found that her conscious level had deteriorated a lot. We guessed that she was not breathing enough although she breathed quietly. So the carbon dioxide level in her body rose and made her unconscious. We put back another tracheotomy tube and sent her to ICU. I ventilated her with the Ambubag. She recovered well and regained consciousness. Had we not recognised it, it might have been too late when we were called back to the hospital. There are quite a number of caustic ingestions here. We have another girl with caustic ingestion ending in severe esophageal stricture and malnutrition. We have no imaging facilities, no thoracic surgery, no esophagoscopy nor dilatation instruments. What we can offer her is putting in a feeding gastrostomy tube. She was well and slowly regained weight. She was discharged yesterday. We also have lots of burn cases, especially the children. We all agreed that if we spend more resources on public education and safety measures, we could save much more in treating them. Sam, one of the OT assistants, asked me to see his brother today. He had history of TB of the spine four years ago. He was properly treated but he had suffered lower limb weakness since then. He could not walk and was put in a wheelchair. X-rays showed old TB spine damage involving four of the thoracic spines but no collapse. I examined his brother and found that he still has good muscle power and sensation. I'm sure he can walk with some sort of walking aid. I showed him another young man coming in with one and a half year history of spinal injury, also in a wheelchair and multiple pressure sores. We also found that this young man had remaining power in his lower limbs. We had started training him standing and later walking. He is now walking with a frame. I asked him to walk in front of Sam's brother. It's very encouraging for him. I referred him to the Handicap Center in Monrovia for training and rehabilitation. The family is very excited. There are so many cases of retention of urine mostly due to the post-gonorrhoea strictures and some due to the old age prostate hyperplasia. We don't have any urological instruments in the hospital. We can only put in a supra-pubic catheter for them. They end up carrying the catheter back home and come back for changing every four to six weeks. Some may choose to seek help from the urologist in town or the Government JFK Hospital, but they have to pay. They simply cannot afford it. These patients return with all kinds of complications from the catheter. All these kind of health education issues, domestic safety, rehabilitation and medical services require the rebuilding of the infrastructure of the country's health care system. I learnt that there were lots of experienced doctors in Monrovia before the war. They all flew away after the conflict. It happens in most conflict areas. It leaves the country hardware nonfunctioning, if there is still some left at all. For example, we are informed that the Government JFK Hospital is going to have no general surgeon throughout the month of March. Mamba Point has to take up all the surgical emergencies in the town during that period. We hope the situation may improve. The Monrovian doctors who had left may return. MSFs may one day be able to end her mission here. Au Yiu Kai