Chapel, rounds, then 3 cases and some clinic. The boy with the arm infection was a little better. First case was a carpal tunnel. Next a guy with a femur fx above a Sign nail that was placed retrograde.  The distal fx was healed fairly well but not completely. Took the nail out first, then went antegrade but the nail came out medially through the older fx, which was healed in a slightly translated position, and the nail was too short to go antegrade and cross both fx sites adequately.  This was the longest nail they had, so went back retrograde and buried it, which worked. Next a sequestrectomy on a 6 yr old boy with chronic osteo of the ulna. Poor child. Lots of open fractures from MCA's [motorcycle accidents] on the ward. The Chinese started selling cheap motorcycles here about 10 yrs ago and trauma has skyrocketed since.  

We were discussing Cameroonian healthcare with the residents and other staff during a break and some interesting facts came out. The PAACS and CIMS training programs are Christian programs which make the residents commit to practicing and serving in Cameroon or Africa after graduation. There is another program in Cameroon where the residents universally leave the country, usually for France, after graduation, I am told. The US has 11% of the worlds healthcare burden/need and 30% of its physicians, while Africa has 30% of the world's need and only 5% of the physicians. While this is easy to understand in view of the economic luxury of living in the west versus the countries here, it creates the neglect and desperation that is so evident here. Two of the American physicians here lived in Sierra Leone with their kids during the 1990's before the civil war, where the situation was much worse. 

50% mortality for children before the age of 5, such that parents often did not name their children because they would not want to get too emotionally attached, only to lose them. 

Another physician resident in the PAACS program was born in Angola and lost both of his parents during the Civil War there. He has a wife and 5 children, three of whom he adopted at home in situations similar to his. They are nearing high school graduation now and he will adopt more. He plans to return to Angola to help rebuild after finishing here. Christ came to inspire us to such acts of mercy.

Four cases so far tomorrow: Sign IM nail for mid shaft femur fx; ORIF of intracondylar distal femur with plate (large frag plates with 4.5 screws available, nothing fancier) - should be interesting with no fluoro; ORIF inter troch fx with same plates as above no fluoro again; ex fix open distal tibia; i&d, ex-fix open humerus fx. 

I also am scheduled for Chapel, a surgeons meeting, supposed to give a lecture and have a Bible study on the Book of Luke tomorrow night.  Should be busy.

Bob