Concerning Ovarian Masses

Lately, I have seen a fair amount of Gynecologic pathology. I have treated pelvic abscesses (pus in the pelvis) related to pelvic inflammatory disease or complications of pregnancy and delivery. The number of ovarian cysts, tumors and cancers has also increased in the last 9 months.

** WARNING: GRAPHIC IMAGES **
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Recovering from a Facial Nerve Palsy

After heavy rains last year, a wall of a local primary school building fell on top of children who were in the classroom. The most severely injured patient was a young girl who sustained a closed head injury with a basilar skull fracture. She was treated with medicine to reduce the swelling of the brain and steadily showed improvement. She also developed meningitis during her hospital stay.

As she continued to improve over the following days, it became apparent that her facial nerve (which controls the muscles of the face) had been damaged in the accident. After a couple months, she complained about the inability to close her right eye when she sleeps and therefore the eye was watering. She is the granddaughter of one of out friends in town, so I was able to regularly provide saline drops for her eyes until they improved.

The facial nerve palsy is still recovering, but I see improvements every time I run into her in town. Each time I see her or talk to her grandmother, I am just thankful that she is alive and thriving.

Rectal Prolapse – Before & After

I recently posted about a boy with a rectal prolapse caused by his attempt to manage the pain of a large bladder stone. I realize many of our readers don’t know what a rectal prolapse is. It’s not pretty, that’s for sure, but I deal with them fairly often at our hospital. Here’s a good example of a case that illustrates the how much relief can be given to a patient by correcting this condition.

A 45 year-old man presented to the hospital with a long-standing history of intermittent rectal prolapse which had acutely become much worse and was not reducing (returning back inside the anus). The longer the rectum remains outside the anus, the more edematous or swollen it becomes. It bleeds easily and makes it impossible to sit down. Eventually, it causes intestinal obstruction. By the time the patient came to the hospital, it was beyond conservative measures and necessitated an operative solution.

** WARNING: GRAPHIC IMAGES **
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But what is the relationship between magic and modernity in postcolonial Africa?

Magic, divination and the belief in spirits imbuing material objects and ancestors, is hardly ‘a hangover from the past’ but rather an attempt to locate meaning and prosperity in a modern, postcolonial world characterized by monetary forms and global market economies.

Bernhard M. Bierlich

Bladder Stone

When a mother came to our hospital with her two-year-old boy suffering from a rectal prolapse it seemed like a standard case.

In children, the main treatment is to improve the child’s nutritional state and the rectal prolapse will fix itself. In the meantime, buttock strapping can protect the rectum and provide relief.

However, this child’s mother also noted that the patient cried and pulled on his penis whenever he needed to urinate. A quick ultrasound of the child’s bladder revealed a calcified mass inside.

Apparently, the stone was acting like a ball-valve and blocking the exit point for urine through the urethra. The child’s straining to urinate is what likely caused the rectal prolapse. I removed the stone from the bladder through a small abdominal incision. Afterwards, the patient stopped pulling on his penis to urinate and the rectal prolapse resolved.

Looking at the size of that bladder stone (in a two-year-old!) I can’t imagine the pain he has struggled with (enough to cause a rectal prolapse!). I’m its removal has completely changed his quality of life and probably his mother’s as well!

Teeth Cleaning (and then pulling)

Every year Dr. Fuller Robinson of Roanoke, Virginia comes to BMC to do mobile dental clinics in the region. He’s 88 years old and refuses to let that stop him. This year he came out to do his 41st trip since 1981!

Trey had a dental visit in the US last December but we thought it wise to swing him by Dr. Robinson’s office at BMC while he was in town. The dentist poked around a few minutes and declared Trey’s teeth to be perfect. He also invited me to come along with him on one of his village trips.

The next day I followed him to a remote village near the Ghana/Togo border. There over 140 Bimoba men, women and kids were waiting for him and his team. They all had teeth that they wanted pulled. All morning long, Dr. Robinson, Tommy Harrison, three BMC staff and two doctors volunteering from Boston looked into mouths and removed teeth.

Me with a mother & son whose teeth I pulled

After about 4 hours and the crowd of patients seeming to grow, Dr. Robinson finally told me to put my camera down, don some gloves and get to work! He patiently showed me how to patient pull a tooth (you don’t actually pull, but gently and steadily wiggle it back and forth until it loosens and rolls out) and then gave me my first patient. The triage would send me the easy, simple cases and refer the more complex ones to the pros.

A couple hours later, with the sun low in the sky, I looked up and saw the queue was finally gone. Never in my life did I think I’d go out to shoot photos and end up pulling 27 teeth in the process!