August 15th: Liberia

PURE team in Liberia

Ultrasound training continues in Liberia with Dr. Alex Vinograd working through challenging cases on a daily basis with our resident trainees at Phebe Hospital in Bong County and JFK Hospital in Monrovia. Here is her latest report:

“The last patient I saw this week was a young woman with abdominal pain who reported several months of increasing abdominal distention. On any given Friday afternoon in the United States, I can order dozens and dozens of laboratory and imaging studies. For many of them, I can get results in hours, if not minutes. In this hospital in Liberia, on a Friday afternoon, you can obtain little more than a hemoglobin and a malaria smear. From across the room, it looked like she was in labor.  She moaned and writhed in pain holding her abdomen.  She appeared to be nine-months pregnant – but her pregnancy test was negative. Assuming the problem was free fluid in the abdomen from a liver problem or peritoneal tuberculosis, she had been admitted to internal medicine.  But, when we place the ultrasound probe on her abdomen to investigate, there was no free fluid.  Instead, we discovered a massive cyst measuring 25 centimeters in diameter filling her abdomen! The ultrasound exam was a game changer, resulting in a completely new differential diagnosis, and new plan. Tell any physician about a female patient presenting with severe abdominal pain, a negative pregnancy test, and a large ovarian cyst and top of the differential diagnoses will be ovarian torsion – that was now the case. She was transferred from internal medicine to the operating theater with gynecology.   Findings were indeed consistent with an enormous ovarian cyst that had twisted on it’s pedicle – this had cut off its blood supply which cause her acute abdominal pain. It was removed and the patient is now was recovering well.”

Alex will be continuing our ultrasound training efforts over the next month and will soon be joined in Monrovia by PURE trainer Dr. Laura Diegelmann.