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August 18, 2008

Perspective of West Africa: Why Bother to “Mission”?

Arch Surg. 2008;143(8):728-729. doi:10.1001/archsurg.143.8.728

Deep in the Ashanti region of Ghana, “well” is a relative term. Everything was going well for us until that 14th operation in 24 hours. Before that 14th case, our team from The Johns Hopkins Hospital, which had been working for the last day at the remote Asakore Mission Hospital, had already had a headlight failure that required us to use a camping light during surgery, inguinal hernias so large that we had no other option than to place mesh in unsterile conditions, and a cautery malfunction that delivered an unforgettable mild shock after passage of an observable spark to my body. (The adjective “mild” was used by the rest of the team and remains in dispute!) Despite these various setbacks, things really were going well until one of our team members, whom we had posted in the recovery area, pulled me out of the operating room urgently. She took me to see a 57-year-old woman whom we had just operated on to remove a large, mobile, submandibular mass. In light of the facilities available to us, our only option had been to perform the operation using local anesthesia and intravenous sedation. I found the patient gasping for air and could see that a mass the size of a small melon had developed on the right side of her neck in the hour since we had finished the surgery. Because the nearest mechanical ventilator was 150 miles away, and there was limited lighting for reexploratory surgery, my panic was a reasonable expectation. Surely, my friend and anesthesiologist, Devin, who was a veteran of 12 such missions (this was my third visit to Ghana), would have some miraculous solution. However, all I saw were his eyes over his mask screaming the question, What are we doing here?