A day in the life of neurosurgery in Ethiopa

tion

We have had a great improvement in morning report, thanks to the effort of Steve Friedberg from the Lahey Clinic in Boston.  We have the usual 3-5 cases each morning of trauma during the night.  Now, however, there is also a report of any complications in the past 24 hours as well as some impromptu brief reports by residents on some subject of interest the day before.

Pre-op.  Note deformity of spinal cord just
below the brain

Excellent alignment after wiring and fusion of C1 to C2

15 y/o with a huge tumor; need to
abort surgery because of excessive
bleeding and no means to control it.

Miniature plums; my favorite snack

Today there was good and bad news.  The very large pituitary tumor that we operated on last Saturday developed paralysis on his right side 48 hours following the surgery.  Thus far there is no improvement, but a CT scan yesterday suggests that improvement is possible if not likely in view of his young age (25).  The good news relates to a case of a fracture of the odontoid (high cervical spine) from last Friday.  There was very substantial displacement of the fractured fragments and we were having great difficulty manipulating him into alignment; in fact both  before and during surgery we were never able to get good alignment.  As a last ditch effort, one of the residents had an idea during surgery, that was quite dangerous, but there seemed no viable alternative.  He pressed with great force on the C2 spinous process as we wired a bone graft into place and the C1 to the C2 vertebra.  Today, first of all the patient has no neurological impairment;  furthermore, an x-ray shows absolutely perfect alignment of the fractured fragments.  We were all shocked and thrilled by the result.  If you wonder why they fall so frequently from construction sites look at this:

The source of many of our spine fractures

We had a meeting today with the head purchasing officer of the hospital as well as an outside consultant who seemed to know the ins and outs of the government/hospital procurement system.  Who knows if they can deliver, but they asked us to give them name, stock numbers and sources for all of the consumables that we would be needing each six months.  They seemed serious about this; we will see what comes of it.  I will be supplying them with all the information they need and supposedly they will find sources for all of this.  We will see what happens.

I’m going to take all of the attendings and residents (total of probably 20 or so) to dinner my last night here next week.  Spent a few hours trying to find a suitable place that would also accept Visa, and finally settled on one of the two Jupiter International Hotels that has a lovely, though small dining room.  They assured me that we could have half of their room.

Went back of Mama’s Kitchen, one of my new favorite dining spots and had a wonderful chicken shish kebab.  Wonderful unique flavor and with soup, salad, dessert, tea included.

There is a wonderful miniature plum that is harvested annually only in January, while I am usually here.  Of course you should not eat fruits and vegetables that are not peeled.  I have developed a formula that seems to work.  Was the fruit well with soap and water (from the tap and likely not potable), let it air dry, and eat the succulent fruit.  Thus far (keep your fingers crossed) I have had no problem.