Liberia #27

Liberia #27

I leave in the evening with Robert who is driving me to the airport. Traffic that direction is bad in the evening, so we leave 3 hours ahead. We move through the stop and go traffic till we are on the outside of Monrovia about an hour later. For the remaining drive we are able to go 40-80mph. Honking scatters people and animals off the road, so is done very frequently. Arriving at the airport, we approach the large metal gate. A guard questions why we are there. After taking each of our temperatures by pointing the thermometer at our foreheads, we are permitted to enter the airport area. We drive up to the terminal and unload my bags on the ground. Next Robert parks the car and helps me carry my bags up to where there is another person in a gown, mask and gloves to take my temperature again. I am asked to fill out a questionnaire, wash my hands with chlorine, then enter with my bags. At the entry to the baggage counters, another person takes my temperature and I wash my hands in chlorine water again. They review and take my questionnaire. Next I take my bags to the check in counter and get my boarding passes. I’m about 1.5 hours ahead of time. I go through security and wait in the boarding area. Going through security, the security lady asks to look in my carryon. She pulls out my falafel sandwich. She says it’s not permitted to take food in, and asks what I want to do. I said “eat the sandwich”, so she puts it back in my carryon and I go on in with it. Later I eat my sandwich with much appreciation of the flavors. The time comes, and we board the plane. I am so thankful to be leaving Monrovia, being in good health.

In Belgium, our temperatures are checked as we exit the jet way. We turn in another questionnaire that we were given on the plane. We are then shunted outside security, and I have to go through it again to re-enter. I find my terminal and gate then wait about 6 hours till my flight. I watch a number of movies on the plane and eventually sleep a half hour or so.

Arriving in Newark, we walk to immigration. Someone is there reviewing passports and asks where I’m coming from. I know they want to know Liberia, so I say this, even though Belgium was really where I was coming from at the moment. They send me down a side hall to a small room. Behind the counter are immigration officials who ask that I stand beyond a ribbon about 8 feet away from them. She is wearing a face shield, mask and has gloves on as she types information into her computer. She asks a series of questions, which are similar to what I’ve filled out on previous forms. They ask about personal sickness and symptoms in detail, about contact with Ebola patients or dead people. After my answers they decide I need more questioning by CDC personnel. One of the officer’s gowns up in full bunny suit PPE to take me down the hall where I meet two CDC people in a small room with three chairs. I sit down and they ask more questions. They call their hierarchy and eventually decide I am safe to continue my travels. They show me to another desk where I receive a phone and a packet of information on Ebola and how to do the monitoring and am told to contact my health department in the morning. I am taken back to a different immigration area and they take my passport and do the usual things I recheck my baggage to continue on and find my next gate. My flight is cancelled. So at the desk I find I’ve been rerouted to make it home about 3 hours after expected. After about 35 hours of travel I arrived back to meet my beautiful wife and very happy dog, for the drive home. The following morning I meet with the health department to set up the monitoring situation. All are very helpful and pleasant.
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Liberia #26- Feb 1

Liberia #26- Feb 1

I am called at midnight to see a patient that feels weak. There is a young man outside. I walk up to him and the people gathered around him. I ask who speaks Engish, and a number of them respond that they do. Well what is happened to him? “He feel week” What else? “He got malaria and typhoid”. The guy looks up at me, and I get the sense that he is putting it on. I am immediately very annoyed with him. OK, I don’t want diagnoses, I want symptoms! What are you feeling? What is hurting? They don’t respond. Either tell me what’s happening or go back home! “He feel week” The 22yo guy, stands up walks around then sits down again. He is obviously not terribly sick. I tell them to go home. “No, he sick” “he not think good. He got typhoid and malaria” what do you mean by he has typhoid and malaria? “ silence. I think of walking away, but stay a little longer. Headache? “his head can hurt him!” fever? “he no got fever” stomach running (diarrhea) “no he no running!!” vomit? “he no vomit” Eventually I find out that he has been a little off this evening and I ask what drugs or alcohol he’s taken. He is kind of acting high and irritable. They deny everything. Said this happened to him before when he had malaria. I seen plenty of cerebral malaria, and this is not what they act like. Though very annoyed with the whole situation, I decide at least he is not a risk for ebola, and admit him. I give the usual quinine and artemeter, to cover malaria, knowing that if he likely just slept, that he would be fine. Still suspecting drugs as the cause.

At 3 AM, Im called to see a woman who just came in pregnant and has vaginal bleeding. I find out she is at term, and bleeding a little. By the time I get in there, the midwife has had a chance to evaluate her and ask more questions. She had had a spot of blood. It is her first pregnancy, and she has not lost her water yet. She is only dilated 1cm. So she is many hours from delivery with good contractions. Since she isn’t bleeding at all, based on midwifes exam, I head back to bed. 7AM comes to early. My last day in ebola land!

I awake, to the alarm, get up, eat some breakfast, and have my personal devotions. I cannot wait to be back home with my wife! I go in at 8AM for the hospital devotional. There were two deaths last night. One an old guy with a stroke that had been worsening the last 4 days. The other a woman I admitted at about 8PM who had been sick for a week and unconscious for that last day. She had looked about ready to die when I admitted her. Apparently she haden’t even gotten the IV yet when she died. I’m not surprised.

I do rounds on the 36 patients, while Dr. Seton does administrative stuff she needs to get done. She will be the only doc taking care of all inpatients as soon as I leave, and continuous call. I do the dressing changes, and eventually make it back to my place to pack. I take my last bucket bath and get dressed in regular cloths.

So I’ve noted a few things that would improve life at Cooper for Dr. Seton, and many things that could help them provide better care. If you are interested in helping financially here are some things that need to be done.

-new air conditioner for Dr. Setons apartment

-new windows for Dr. Setons apartment- to keep dust and generator noise out, and keep cool in.

If you are interested in helping towards these please send your contribution to:

Summersville SDA Church

70 Friends R Fun Dr.

Summersville, WV 26651

Include a separate note that it is for Cooper Hospital and Dr. Seton

Other medical things are needed:

New mattresses

Windows throughout the hospital

handheld pulse oxymeters

handheld thermometers (surface temperature monitors)

more glucometer strips

a decent lab setup about $10,000 for CBC and chemistry machines and materials and reagents

X-ray machine that works and someone to develop pictures- if a digital system- then that isn’t necessary no developing would be necessary ?cost?

some new operating instruments- needle drivers, and scissors

Cidex to clean the endoscopy equipment.

impregnation tablets for the mosquito nets

a new autoclave

funds could be sent to either Summersville SDA church or to AHI below- designating what it was to be used for or general needs of Cooper Hospital: Sent to:

Adventist Health International

11060 Anderson St.

Loma Linda, CA 92350

Phone: (909) 558-4540

Fax: (909) 558-0242


Can be done online through the Adventist health international website as well.

for more mission stories visit our mission website

for information on our missionary and christian workers oasis visit Safe Haven Oasis

Liberia #25

Liberia #25           Sabbath morning.  I sleep in a little bit, then get up to go make rounds.  It takes me a while but I round on the 36 patients.  When I’m nearly finished, “doc, der two pasunt outsite.”  Ok, I will see them in a few minutes, when I’m done seeing the last two. “I bring tem insite?”  No I will see them outside. I finish seeing the last two and writing their progress notes.

First there is a little girl.  She can barely stand, but for a few seconds.  She is about 6 and very weak.  I hear that she vomited once about 3 days ago, and has had a fever for a week.  I look in her eyes and they are pale.  I feel her belly, she squirms a little and needs to lay down.  Her liver is large as well as her spleen.  She has likely had malaria for quite a while or repeated episodes of malaria.  As the malaria parasites burst red blood cells, the spleen is the organ to filter the broken blood cells out of the blood stream, this can happen in sickle cell disease too.  So I admit her and start treatment.  Whenever the lab technician is available I will have them check for malaria and the blood count.

I look for the next woman in a car, and the car has already left.

I go change and walk to church.  The singing of the choir is with harmony and mostly songs I know, so it is very nice.  The sermon was well amplified and almost hurting my ears at times.  The church air conditioner quit about 15 minutes after I arrived, so it got quite hot very shortly, and they eventually opened all the windows.  After church I returned to the hospital to quite an uproar.

What happens when two people die, the burial team takes one of the bodies, and the family of that body, takes the other body that remains?  A huge mess, which should never have happened in the first place.  We have been instructed by the minister of health to notify the burial team of all deaths in the hospital so that the burial team can bury them with appropriate precautions.  This has caused quite a problem for us.  A few months ago they were cremating all the bodies, now they will bury them in a cemetery with the family present.  I guess the burial team came last evening and took one dead patient.  The family of that patient arrived early this morning and with the help of the security guards and a couple workers took the body they thought was their family member and drove away.  It was not their family member.  So the second family shows up to request their family members body, and there is no body to be had.  This generates many phone calls and a flurry of anger, and eventually the previous family is on the way back with the other families dead relative.  There was much hubbub as two families and one body were present.  I asked to speak with the oldest guy of the first family and asked the second family to please depart and go outside.  They complied.  As in most cultures, it seems the older people are more likely to be reasoned with than the young men and women.  I explained to them that their family member that had died in the hospital had already been taken by the burial team and that we needed to unload the body they had into our morgue.  After much discussion about them not ever being told that the burial team was called, they eventually allowed us to remove the body out of the car and into the morgue.  So three workers fully gowned up in PPE and took the body bag on a cot to the morgue.  They were unhappy that they spent a lot of money to transport a body that wasn’t their own away from the hospital then back again.  So I told them to come back Monday and we would discuss it further after more details and when the administration was present.  They got a call that the burial team was about to bury their relative, so they eventually left.

I called the daughter and the eldest male member of the other family in to verify that the woman present was their relative.  We unzipped the white body bag and they confirmed that it was their relative.  I re-called the burial team with them present.  They begged for us to let them have the body and let them go embalm and bury it.  I reconfirm with Dr. Seton if this can be done, and it cannot, per the minister of health.  So I recalled in the two people, out of the group, and inform them.  They cry and go out.  The metal gate at the door of the hospital is immediately flooded with many people, shouting and yelling and very angry.  Fortunately there is “security” and a gate.  Otherwise there could be much more problems.  Security has no weapons, but at least have a uniform.  One of the nurses, Odi, is very good at talking at high volume.  She talks and talks to them through the gate.  I am called back tot the gate to go outside to see a patient that just arrived in an ambulance.  With the crowd at the door, I consider that it may be unsafe to venture outside.  Crowds are more likely to do stupid things, than individuals.  So I wait by the inside.  The ambulance realizes that I’m not coming out, so they come up and ask for the referral paper back, and head out to a different hospital.  After about 45 minutes the crowd dissipates to go call the police.  I do not think they will get anywhere with the police, but likely loose more money in pocket change.  The previous family wants to see me Monday to discuss their lost money.  So it won’t be over yet.  Plus the burial team still needs to come and get the remaining body bag.

Eventually they come, and with much more commotion and arguing, they eventually leave with the body.

“Doc kam outsite, der a pashunt in de ca.”  I walk out, around the corner, and up the stairs to the ground level and out the front of the hospital.  I see that the crowd that was there earlier has dissipated.  I go out and see a 34 year old guy in the back seat.  They say he has had a fever for two days, doesn’t want to eat and is weak.  He denies headache, vomiting, diarrhea, difficulty swallowing.  He looks a little weak and I ask if he has passed out.  They deny this.  I look at his eyes and they are normal.  I decide he likely has malaria or typhoid and decide to admit him.  As he walks into the hospital he is weak and squats in the lobby.  I am sitting there writing orders, when the nurse says he is bleeding from his mouth and moves away from him in fear.  He says he had a sore tooth and put aspirin in it, and that is why he is bleeding.  I ask him to open his mouth, and stick out his tongue.  He has a laceration on either side.  It is deep but not something I would need to suture closed.  He still denies, and says it was the aspirin.  I don’t believe this at all so I wonder what else he isn’t telling me.  I tell him to go back to the car, and I will treat him as an outpatient, with oral medicine.  They resist, and the patient starts arguing with me (obviously better off than he was purporting to be), so with more forcefulness I tell them to get out to the car.  They comply.  I continue writing, outpatient medicines now.  The mother comes back in to tell the real story hoping I will change my mind.  She says that he was walking from the beach when he had a convulsion and bit his tongue.  Now that looks like what happened, based on the way his tongue looked like.  I continue writing for oral meds to treat him, and as I  do they get in their car and drive away.  A person outside, heard as they left, that they had already been to a number of hospitals and were turned away.  I think it is unfortunate that people need to falsify symptoms to get what they want.  It happens in the US too, for people trying to get pain medicines.  Here it is to try and get admitted.  But had they been up front with me, the laceration of the tongue would have matched the story, and I would not be hesitant, not knowing what else he wasn’t telling me.

Liberia #24

Liberia #24

A few days left in here than home to my wife!  For the past
few days
we?ve been running at capacity, about 36 beds.  We had a bed or two
for pregnant patients, and a couple for children.  The child?s beds
are not full length so adults cannot use them.  The private,
semi-private, common rooms are full.  Yesterday I admitted about 3
stroke/hypertensive patients.

Yesterday afternoon: ?Doc, dis man hurtin!?  Where?  ?His stomak
be hurtin.?  How long? ?Since dis morning? Does the hurting come
and go, or is it constant?  ?It hurtin!?  No, is the pain, strong
then small, strong then small? ?it be hurtin strong!?  Eventually I
decide it is a constant pain that hasn?t let up since it woke him up
this morning at 2 AM. He points to his right lower abdomen.  So kidney,
bladder, appendix, colon, typhoid are all within possibility.  I palpate
his abdomen and he is quite tender in the exact spot where I would
expect the appendix to be.  But to be sure I ordered a CT scan, got a
CBC to check his white blood cell count, and verified his kidney
function numbers.  NOT! We cant do any of those, so I ask some more
questions, decide that appendicitis is at the top of my list, and tell
him that we need to operate to take out his appendix.  I tell him that
if I am wrong I will fix whatever is the problem and take out the
appendix anyway, so that next time he has right lower quadrant pain, it
is not appendicitis.  Later when the operating room team is ready we
start.  I cut the skin with a scalpel over the area of pain.  Blood
starts oozing out.  The cautery cord will not work, so I put little
clamps on all the bleeding areas and continue in.  At the muscle layers
I spread them apart rather than cutting them.  Once in the belly, I feel
around for the typical firm feel of the appendix that is inflamed.  I do
not feel it.  So I find the base of the colon and follow it.  I free it
up from the abdominal wall and then find the appendix running up behind
the colon.  Slowly I free it up.  It is very long and has early signs
inflammation.  It seems to go all the way up to the liver, and from the
incision I?ve made is quite difficult to get high enough.  After
struggling for some time and extending my incision, I eventually get it
out.   I close up the different layers, irrigating with saline a number
of times, to minimize the chances of a wound infection.

Today I started with rounds after the morning devotional.  The
old woman
with and infected foot, who had debridement, is doing better day by day.
The woman with the breast cancer is doing well, and wants to go home.
The 9 guys who were from the industrial accident, with burns and body
aches are all doing well.  An old man who came in, in a coma, is doing
well.  His hypertension and diabetes under control now.  The patient
that we did a hernia repair on a few days ago, is ready to go home.  The
appendectomy patient from the last paragraph is going great, and has no
pain.  Really, I cut you open and you have no pain?  He says he did this
morning a little, and it is gone now.  Some people are very tough with
regards to pain.  The younger guy next to him with diabetes, high blood
pressure and chest pain, feels good today and wants to go home. I
reiterate for the 3rd time that he has to take his medicines for the
rest of his life and he should never stop.  That he is at risk for
stroke, heart attack, kidney, eye, and vascular problems.  He again says
he understands.  Two old men in another room, both with strokes.  One
seems to be improving the other one now comatosed, he will likely not
make it through the day.

I go and do some dressing changes, which Dr. Seton has not
yet, they are looking better each day.

I see a patient with HIV in clinic that we treated for a bad lung
infection, and she is doing great.  I decide to go find Dr. Seton, and
show her the patient as an encouragement.  The nurses say that she is in
E2- a private room.  So I saunter down there.  As I walk in, I see
nurses opening packages, a tank of oxygen standing in the middle of the
room.  Dr. Seton doing chest compressions on an old woman on the floor.
I ask if she wants help and she does.  I open the bag mask that the
nurses can?t figure out how to assemble and start bagging the patient.
We hear a couple ribs break (fairly common when doing adequate chest
compressions on old people).  With time she regains a hart rhythm and
respirations.  She was moved to the floor so that she was on a hard
surface for the chest compressions.  We lift her and place her back in
bed.  she has an oxygen mask on and an oral airway in place.  We do not
know whether her brain has survived the lack of oxygen.  We decide that
if her heart stops again we will not do any more compressions.  She has
been running in and out of a fast heart rhythm about 160.  And we have
no medicine to treat this, nor and EKG to determine what exact rhythm it
is.  I later come back to the floor, as Dr. Seton is filling out the
death certificate.  That patient died.

Later on I am called to come quickly.  This usually means
someone died.
So I go to the floor.  There is another old woman who came in with a
stroke and her consciousness has been declining today.  Her tests show
she was HIV positive.  I decide that based on these findings we will not
do chest compressions as the chance of reviving her is zero.  I tell the
young woman at the bedside that I am sorry, and she starts wailing and
beating the wall.  Another of the 5 patients in the room, start crying
as well.

We have some really sick people, and not the best resources to
care for
them, so it isn?t surprising that many of the sickest ones die.
Though I feel we sometimes go to far in keeping people alive in the USA,
I am once again thankful to have been born in a third world country
where there is good health care.  If you are from Liberia, you have no
options outside this country and limited inside the country.  We, on the
other hand, can get in a plane, fly around the world, and see a doctor
in Europe, Mexico, or Philippines, to get our plastic surgery, eye
surgery, or whatever we want.  We are very blessed!  I hope you take a
minute and reflect on the many blessings you have, to live in the place
you do and have the things you have. You have many more things than 90%
of the inhabitants on our globe!