26 July 2011

It always feels so short

It always feels so short, but six weeks goes by quickly.

I'm back home, after 156 cases on 77 patients followed by a week in Europe for the wedding of two beautiful people.

Thank you for following. Until next time.

11 July 2011

Training, relief, and development

Last week, Agneta took out a man's jaw.

But, before I tell you about that, some background. There is a tension in global health between relief and development. I've written about this before, but to summarize:

Where infrastructure doesn't exist (or does so at a level that barely meets the needs of the population it undergirds), aid comes in two, often mutually exclusive, flavors. At the risk of oversimplification: if attention is focused on the redevelopment of infrastructure, the vast masses of patients who become sick while this infrastructure is being redeveloped are left undertreated. On the other hand, if attention is focused on these patients, the infrastructure is itself undertreated, perpetuating the steady stream of those who need more help than it can provide.

Bridging these two basic paradigms of aid is thorny. Although each is important, each has its stentorian prophets, and development's prophets have, of late, carried the day.

To a (very) large degree, the sort of work that's done on this ship leans toward the less popular of the two, with occasional nods toward development. Sustainability and capacity-building are discussed nearly constantly, local surgeons have been a fixture in the operating room, and agricultural education, mental health education, and primary health education programs form a part of the ship's mandate. (At one point in the last four years there was also a well-digging program; I'm not sure when or why it saw its demise). But, as a whole, we provide relief to the medical infrastructure in the countries we go to.

So, when Agneta took out a jaw last week, it was more than just an operation.

Dr. Agneta Odera is a fourth-year surgical resident at Tenwek Hospital in Kenya. She and two of her Pan-African Academy of Christian Surgeons residency colleagues are on-board for three months, doing month-long rotations in general surgery, anaesthesia, and head and neck surgery. Yesterday, she finished her month with me on the head and neck service.

Agneta is one of the finest residents I've ever gotten the opportunity to train so far in my short surgical career; she has the makings of a great surgeon: she is compassionate, detail-oriented, knowledgeable, and handles tissue like an expert. So, training her wasn't difficult, and last week, she flew solo on a segmental mandibulectomy and reconstruction for a large midline ameloblastoma.

Watching a resident flawlessly perform an operation is always a thrill. Watching her flawlessly perform an operation she had never seen three weeks prior, and knowing that her commitment is to Africa, to surgical development on this continent, and to bucking the brain drain—knowing that she leaves this rotation with at least one measurable, sustainable skill which she can take back with her is more than just a thrill. It is immensely, deeply satisfying.

09 July 2011


In talks I have given about working here in West Africa, I have made the point that facial tumors tend to be viewed as something more than physical, that there is the presupposition that patients with these tumors suffer from some supernatural antecedent cause, be it demon possession, witchcraft, or the anger of God.

I have always, however, felt a little bit disingenuous making these sorts of statements, not because I didn't really believe that they were true, but because they were things I had heard from others who work here, and, as a result, were subject to the vagaries of hearsay. In making these statements, I was at risk of perpetuating an exaggeration.

On June 30, the Standard Times Press, one Freetown's newspapers, published a photograph of a child with a facial tumor. I'm reproducing the accompanying article verbatim.*

12-year-old turns pig

History will never end, at least for the residents of Makeni. It was on Monday, the 28th of June 2011, around 1:30pm, an alarm was raised by the residents of K_____ Street, Makeni, when onlooker witnessed the unusual event of a 12 year old boy, Kaddy Bangura, transforming himself into a pig at his residence.

Makeni it seems has now become infamous as a witchcraft town. This Reporter upon hearing the news went to the Makeni Police Station where Kaddy Bangura was taken to.

I was informed by the Information Police Officer at Makeni Police Station Sergeant Senessie that the boy is presently with the President of the Traditional Healers at Calaba Town.

Upon arrival, the President, Dr. Kabbah, took me to the room where the boy was housed in and was allowed to conduct an interview with him. Kaddy Bangura narrated his story about how having put faeces in his auntie's Foo-Foo she was about to eat, the "Auntie" made a "Karafilo" (a form of protection against evil) which resulted in his being powerless in enacting the transformation from a pig back to his human form, and was thereby left with a pig head and his human body.

The President of the Traditional Healers Association, Dr. Kabbah, noted that there is something going on in the Makeni area.

He admonished all that witchcraft does exist in Sierra Leone. Dr. Kabbah noted that Kaddy's condition now is such that no doctor on Earth can cure him.

*All identifying patient information has been changed to protect privacy; the picture itself is, for the same reason, not reproduced.