On Monday, Dr. Tadios helped me tackle this complex mass. This lady had come to the hospital with a several month history of headaches, visual problems and seizures. She was able to get a CT scan which revealed this mass beneath the frontal lobes of her brain. After discussion with her and her family we took her to surgery, and I think we were able to remove a vast majority of the tumor.

Surgery here in Ethiopia requires a little creativity. At home there is a specialized instrument and a well defined procedure for everything. From patient shaving to sterile preparation to patient positioning, neurosurgery has evolved into an exact science. Electric razors good. Straight blades bad. 5 minute betadyne prep good. Any break in sterile technique bad.

In practing medicine here, I have had to abandon many of the firm doctrines I brought with me. The patient is shaved by whatever means we have available. If there is alcohol, we can prep with that prior to iodine. If not, the iodine prep is adequate. Since there is not specialized way to hold the patients head, we learn to operate in the best position allowable by the table.

So it is with the tools available to us here. At home, there is a specialized drill for each application. A special drill to make a hole in the skull. There is a separate attachment to connect the holes and remove the bone. Another drill to assist in reattaching the part of the skull we removed. The Black Lion Hospital does not have a power drill and there are two hand drills (one recently discovered). So simple tasks like reattaching the piece of the skull we removed, become more involved endeavors. Regardless, the surgery went very well and she should go home soon.

This weekend will be a long one, so I will be spending a few days in Egypt. Can't wait to see the mummy of Ramses II.