As a pediatrician, I work towards helping families raise healthy children every day.

A home of many of the Haitian children.

In Haiti, the challenge of this is great. There is so much working against the health of the children here. It starts with maternal health. The mothers of these babies have poor access to care, medicines, food and water. They may deliver at home, and the child may be sick for a long time before they come to the hospital. Once in the hospital, all of the major illnesses, such as pneumonia, diarrheal illness, and malaria, are much harder to control and cure in a severly malnourshed child. When I think about a typical well child visit in the US, I remember asking about childproofing, locking away medicines, keeping water temperatures safe. When I drive by tent cities, and see dangers at every turn. There are long iron rebars coming out of the ground and rubble. There are large piles of garbage and refuse adjacent to most tent cities. The government has crews constantly out working to collect and contain the trash, but it is a losing battle. There are open fires right next to the tents. When I first saw these things, I was shocked. When I saw two youngs boy splaying soccer, kicking a ball back and forth between piles of trash, it really hit me: this is their home. They have been here for so long, this is their average, day to day reality.

Beginning to work to fix these problems is hugely complicated, and I am certainly glad it is not my job. When I see healthy children in their school uniforms walking down the street, I marvel at the miracle. "How did you make it through, little one?" I ask, silently yet incerdulously. When I see the effects of these living conditions, such as babies with such severe malnourishment that their little bellies are round and swollen, and their skin begins to breakdown, I get motivated to do more. We cannot forget about Haiti. The journalists have moved along, the cameras have stopped rolling, but the need for help remains. I am very happy to be part of an ongoing effort to help make a difference in the lives of these kids. There is no quick fix here.

I continue to be impressed by the work of the Haitian physicians. November 12 was world pneumonia day. They organized many efforts to help the parents of Haiti prevent pneumonia, and seek treatment quickly if it does arise. One powerhouse pediatrician created "The 10 commandments of pneumonia " for mothers. She and her colleagues developed 10 basic tenets, including using clean water, getting immunizations, and recognizing respirtory distress. It is a very clever outreach model in an almost enitrely Christian nation.

On a personal note, I have been so blessed on my trip here. The Haitian family I am boarding with has been overwhelmingly gracious. On my first trip here, it was during the elections, and there was a lot of concern about political violence. I did not leave the clinic compound except for one day when I drove to get a cell phone. This trip has been like a sneak peek into Haitian culture. They present me with a new Haitian food to try each and every meal. For those of you who have traveled with me, you know I love nothing more than to sample the wacky and the weird. I have had my favorite from my last trip, soup joumou, or pumpkin soup. The peanut butter I have with breakfast is manba avec pimien, or with hot peppers. I don't think I will ever be able to go back to plain peanut butter again. And yes, concerned readers, I have been avoiding the street food.

The side of a tap tap- Haitian public transportation. They often have Jesus and Beyonce hanging out together, amid the bright Haitian paintings.

Little lives

I am always overwhelmed by the littlest lives.
We had quite the day today. In the NICU there are two babies who are in the 700 gram range (that's about 1 and a half pounds.) It is an attestment to the amazing work of the doctors and nurses here. They have limits to the resuscitation measures, labs, diagnostic tests, and medicines, yet they have kept these two fragile little lives going strong. The babies themselves are Haitian through and through- beautiful, brave, resilient, right from the first moments of their lives.
I also spent time on the malnutrition wards. Even after many trips to many poor countries, and taking care of these kids day in and day out, something about them still grabs me. I see babies who have thin, bony limbs where they should have cherubic limbs with roly-poly thighs and dimpled knees, and something gets stuck in my throat. Every time. There is a deep, intrinsic drive to FEED the baby that pumps through me when I see them. They inspire me to continue to tell their stories, to continue to work for the change that would allow them secure access to food. I try my best to take care of them in the short term. I worry about them once they go home, whether they will continue to grow, if they will have the strength to fight off infections, how they will do their first year in school.

The toddler ward

I brought the first batch of coloring books to the wards; they were a huge hit. Thank you to everyone who contributed to that project!

Heroes in Haiti

I have arrived safely in Haiti. The trip was unbelievably smooth. The 5 hour layover in Miami was tough- getting in at 11 pm and having to be back in the airport at 4 am was almost ridiculous.The man who worked the desk at the airport hotel said, "What's the point of checking into this hotel?" Wise man.
 I arrived Saturday morning. I met my host family, two wonderful Haitian doctors. They are amazing people: bright, engaging, and gracious. I am so lucky to have the chance to meet them.
I am here with a neonatologist, Alan Picarillo. We went to the hospital today for rounds, and a teaching session. Rounds was somewhat abbreviated as it is Sunday. I was very nervous about teaching. Pediatric rheumatology is a subject that can be difficult to teach. English is not the first language of most of hte residents, and my Haitian creole is getting stronger by the day, but still not up to lecture giving performance level. But the teaching was great. The residents were engaged and interested. They asked so many great questions and kept the talks going with their enthusiasm. I am so excited to teach the rest of the week. We have already had a few challenging cases presented to us. we are working hard to try and help take care of these beautiful children.

I spent most of the day with a pediatrician. She has worked in Haiti her whole life. We spent a lot of time talking about our work, and what drives us. We had a lot of shared passion for serving underserved populations, working in situations which challenge us, and providing social justice. These doctors could choose to leave Haiti. They could head to the States and live a protected and comfortable life. But they work tirelessly every day to improve the health of Haitian children. Their dedication blows me away. There are angels on this earth, and sometimes you find them in the most unlikely places.

Alan teaching the residents-I can't make it upload in the correct orientation. 

I like this picture of the smushed mosquito on my journal article. Stamping out malaria, one mosquito at a time.

Haiti, Here I Come!

I am preparing for my second trip to Haiti.
I was invited by Dr. Coliman to travel for a week to Port-au-Prince. I will be travelling with Dr. Alan Picarillo, an all-star neonatologist from UMass. I am so excited about this trip because I will have the opportunity to do a lot of teaching, and I find that to be such a rewarding part of my global health work. We will be working at 2 sites, HUEH and St. Damian's hospital.
I have been trying to practice my Creole;  I had a blitz session with a Haitian rheumatology fellow this past week at a conference. I can now ask about joint pain and morning stiffness, so I should be prepared for my rheumatology patients!
I depart tomorrow, and I am really excited to be back in Haiti. The patients and families I met on my first trip continue to inspire me every day.

Rollercoaster ride

     Sorry it's been so long since I have posted anything. We had major rain the past 3 days, which puts a big damper on my ability to access the wireless internet. Time is flying by here- today is my last weekday. I can't even think about leaving yet- there is just too much to be done.
     We have had some ups and downs this week, as always. The NICU has had some sad cases. We had a 4.6 kg infant delivered at 44 weeks with severe asphyxia. We also have an infant whose mother was in labor for 48 hours before she sought medical attention. These babies have such severe anoxia. One of them passed away last night, the other is in critical condition. The importance of maternal and child health supervision is evident everywhere you turn. Access to care is still a major issue here. And it is a hard, hard thing to be a baby in the developing world.
     We also have had some malnutrition admissions. One is a 3 month old girl who has a cleft palate. She is unable to breastfeed due to her cleft, and her mother cannot afford food. Breastfeeding failure is a major cause of malnutrition here because when mothers are unable to feed they often do not have another option. This poor little sweetheart just grabs your heart. She weighs four pounds, so she even infant clothes are baggy on her. She was really irritiable when she came in, but has improved after being fed. I went on a quest for a Huber nipple, which is a specialized nipple used to feed babies with cleft palate. As you can imagine, I was not successful. I could barely find a place that sold baby bottles at all. I am hoping Dr. Okoh can bring a few back from his trip to the states.
     We have had an interesting challenge on the wards this week. A few children from local orphanages have been brought in for various complaints. One of them has unbelievable splenomegaly, but nobody knows how long he has been that way or any family or medical history. The staff from the orphanage were interested to know if we would be interested in making field trips to see children at the orphanage for them. Apparently now they have 500 children they are taking care of.  If they had asked me before today, I would definitely have gone. Maybe next trip.
     We discharged one of the tetanus admissions this morning. He has been here the entire three weeks I have been here. He walked out of his room today(albeit stiffly) and said "I'm ready to go home." We all clapped for him- it is so good to see him well again. It is really uplifting to see a boy who was so sick walk out smiling today.
     Hopefully I will have internet access so I can publish some reflections before I leave.

Tryin' small

     Liberia is a place that never fails to challenge me. Sometimes the challenge is mental, sometimes emotional, almost always extreme. In Liberia, instead of saying someone is hanging in there, they say they are tryin' small.
     This was a brutal week. we lost two young girls. The first was the young girl who died of tetanus. The second was a lovely ten year old darling who died of respiratory arrest from pulmonary edema. The morning she died was one of the moments I was pushed by the demands of this place. I was trying to coordinate her care when she arrested. I ran to her bedside and she was breathless and pulseless. I started CPR, having the intern bag her while I did chest compressions. Ten seconds in we got a call that there was a critical infant born in the maternity ward.  Then I was informed that our baby with neonatal tetanus was having obstructive apnea from secretions and that her bedside suction wasn't functioning. Trying to triage 3 acutely ill patients while running the code and doing chest compresstions was an extraordinarily trying moment. I definitely prayed for grace. The intern had to step out and I gave a medical student a crash course in the proper seal and bagging technique. I gave another instructions on where to look for some suction supplies for the infant with tetanus. I did everything I could think of to save these children's lives. Two hours later, the babies were both doing well, and the girl had passed away. I was covered in sweat and saddened by the loss of a life ended too soon.
     There is always such inspiration here, though too. Last week I was called to the NICU to see a baby with birth asphyxia. She was seizing by the time I arrived. We gave her IV glucose and I ran around procuring her some phenobarbital to quiet her seizing brain. It took less than 10 minutes as I ran between hospital floors investigating emergency cabinets, but that is a long ten minutes. Every second of a seziure can seem like it is lasting for days. The baby began to breastfeed, slowly at first, but then increasingly well. She became more active and vigorous with each passing day. She was discharged home today with a happy mother. The NICU nurses asked if I was considering moving here, and told me I take good care of Liberia's babies. Hard to have dry eyes when you hear something like that.
      I have had the challenge of working as an attending here for the first time. Emmanuel has had other commitments for the past 2 weeks, so after the first half hour, I am leading rounds by myself. I had to switch gears fast from the medicine I am used to practicing to the resource limited setting. I have enjoyed the teaching immenselyand I have 8 medical students and 2 interns on my team. I also gave hospital wide Grand Rounds on Monday. I almost died when I opened the talk on my flashdrive and 1/4 of my slides hadn't been saved, but somehow I mustered through. I presented a tetanus case, and discussed the pathophysiology, current treatment recommendations, and public health issues of the disease. It led to a fascinating discussion between the Peds, OB, Internal Medicine, Surgery, and Anesthesia departments on the disease and management. It made me wish we sometimes had a forum like this back in the States!
       It is also my responsibility to give the students Friday afternoon lectures. I had prepared a talk on fluids and electrolytes, and one of the students was assigned to help me set up the projector and connect the power cords, etc. Since the projector was locked in Emmanuel's office, he had given me the key. I arrived ten minutes early to have ample time to set up. I was quite surprised to see the projector up and running. I asked the medical students if they had a spare key. Turns out they couldn't find the key (it being in my pocket) so they called the carpenter and had the doorknob and lock removed so they could set it up for me. Talk about overly enthusiastic medical students. I mean, you all know I love the nephron, fluids, and electrolytes, but busting down doors for my talk was a bit over the edge.  Luckily they have repaired the lock so I don't have to feel too guilty.
      I can't explain the passion I have for working here. It is brutal, it is hard. I have to work harder with sicker patients and less diagnostics and medications to treat them with. Yet I am always inspired by the strength of the patients, the beauty of the children, the community of families that rally around the family member in need. The people of Liberia know adversity, and that in the face of adversity, you cannot quit, but must keep trying, if only "small-small."

This never gets easier

We had our first loss on the Pediatric Ward since I have arrived. This never gets easier.
She was a beautiful 13 year old girl. She had an ulcer on her leg from a minor scrape from playing outside with friends. It was still there 3 weeks later when she arrived at the hospital with fever and malaise. We debrided her wound and started tetanus prophylaxis, but that night she began having lockjaw and spasms. We sedated her and continued therapy, and she did well for a few days.  But then she developed massive hemorrhage. I spent 7 straight hours at the bedside trying to stablize her with blood and frequent suctioning, but after a while we couldn't keep up with the hemorrhage and we lost her. We lost her in a heartbreaking and gruesome way. Her family was at her side the entire time, praying to save her, holding her hand, weeping. A free vaccine could have prevented all her pain, all of her suffering. A vaccine could have prevented a beautiful girl from dying too young.
This never gets easier.

The Other Side

Yesterday was an incredible day. They have built a new hospital in Tapita, in Nimba County, which is about a 9 hour drive from Monrovia, near the Ivory Coast. They asked the HEARTT director and the volunteers to come see it, and consider helping to staff it. Since it is the rainy seaason, the roads may or may not be passable, and there is no way of knowing. Since we are only here for a limited time, it was decided we should take a helicopter to ensure we could get there.
This was such an unbelievable ride. We were flown over much of Liberia, and we got to see a Liberia that is very different from the Liberia I know. About 5 minutes into the ride, the city (and almost all the roads) disappeared. All you could see was dense rainforest for miles and miles. Occasionally, there would be a small clearing with 4-5 huts. The green jungle rose and fell over the hills, some areas drenched in rain, some in sun, with the clear blue coast alongside. It was breathtaking.
When we arrived in Tapita, we were greeted by a group sent to welcome us. We were then escorted to the hospital. The town is a small, rural village, with most people living in huts and zinc houses, a few small stores and restaurants. The hospital was a gorgeous new sturcture, with very impressive facilites. At the hospital, we were met by the community health worker, the local chiefs, and local people who are involved with the hospital. They very formally greeted us in a receiving line and took us on a tour. During the tour, I was speaking to some local women about health care in the community. They have no working hospital, and the closest clinic is 6 miles away. They have a high disease burden, and most people cannot afford the fees of the clinic, so they do not go. One of the mothers told me: "It's terrible. Every 5 minutes you turn around, somebody's child is sick, somebody's child has died. It is too much." These women were amazing, kind and warm people. One of them asked me "Would you come to work in Tapita?" We talked for a while, about how there needs to be more than doctors, nurses, medicines, and equipment. But if all that was in place, I would be happy to work in such a nice hospital. I said: "I hope that all of these things come soon for you. I believe that children deserve to have someone to care for them. Children in Liberia, children in America, children everywhere. She held my gaze and said: "Now Doc, that thing is true." The power of that moment will be with me for a long time.
After the hospital meeting, we were escorted to lunch, which was a meat stew over rice with soda to drink. These people had so little, but were so proud to host us with what I am sure was a very expensive meal.
We could not stay long, but the people of Tapita made a big impression on me. I will not forget their warmth, their generosity, or their kindness. I hope HEARTT can work to help them soon.
When I arrived back at JFK, there was a lot to do. Two new infants in the NICU with respiratory distress, one began seizing an hour after birth. One of them was completely pale, I was worried he would go into hypovolemic shock at any moment. They are both stable today.
we have 2 patients with Tetanus on the wards, stable but on a heavy dose of sedatives.  We are trying to walk the balance of preventing spasms but not suppressing respirations. It is so hard to see children suffer from such a completely preventable disease.
I hope you are all well. Please keep the children of Liberia in your prayers.

Safe and Sound

I have arrived safe and sound in Liberia. The internet has been super spotty, so emailing and blogging has been tough.
The travel here went remarkably well- no delays on any of my flights, which is almost unheard of. As the plane was flying over Liberia, I was reminded what a beautiful and lush country it is. It is the rainy season so everything is green and blooming. I arrived in Monrovia to see all sorts of new changes. The airport has had a makeover, complete with shiny new tile, paint and airconditioning! I also almost fell off my seat when the road from the airport was paved. Lots of good stuff happening here.
I was so excited to start on the Wards yesterday. Emmanuel is a wonderful teacher. One of my interns was a third year medical student on Pediatrics my first trip. And one of my fourth year medical students was a 3rd year with me last year, so it was a great first day. It is so nice to be able to come back to the same site and see all the staff and nurses again. I was greeted everywhere with smiles, hugs, welcomes, and thank yous.
The Pedi Wards and NICU are not much changed. I wrote my first chemotherapy for a little girl with retinoblastoma, a tumor of the eye. We have 2 patients with retinoblastoma currently. It is quite heartbreaking to see them suffering from this disease. No matter how many times I come here, I am never less saddened by the injustice of the suffering of these children.
I am working hard and trying to get ready to cover Emmanuel when he goes, at which point I will be the only pediatrician in the country. Luckily there are some great emergency medicine folks here to keep me company. I am off to the hospital for now.

Last post at Work

Hey Everyone,
In case you haven't heard, I am returning to Liberia! I am so thankful to the folks at UMass who have supported this trip- I am so lucky to have such an amazing opportunity. To my family and friends, thanks as well. I will miss you all but I will be thinking of you all the time. I am BEYOND exciting to be going back!

Liberian lessons

We have had a lot more time to do teaching on the wards in the past week. In addition to our morning lectures, Venee, Amir, and I have been taking time to do one on one teaching with the students. It was a lot of fun doing physical exam with them in the past few days. They are very bright and have rose to all the challenges we have thrown at them.
As I continue to work in Liberia, I am more and more amazed at the bond between families. The mother and child share so much in the first few months of life. The mothers come in wearing dresses, and the babies' outfits or blankets are made from the same piece of cloth. The mothers carry their babies on their backs in their lappas while they do their work.
We had a case of malarial hypersplenism, also known as tropical splenomegaly. It is a more chronic and less severe course. I am astounded by the all the different ways malaria can present.
I want to say thanks to everyone at UMass. There were so many people that chipped in to make this trip happen, from helping with forms to covering shifts.

A Long, Tough Day

Yesterday was a tough day.
It started with a baby with pneumonia. The baby was an 8 month old with some congenital animalies that had been admitted with pneumonia. He was in severe respiratory distress. We tried some medicines and suctioning, but he became apneic and bradycardic. We did CPR and brought him back, but he was still working so hard to breathe. My training has taught me that a malnourished, little baby is only going to be able to breathe for that long before he gets too tired. You recognize how much he would be helped by taking a break from all that work with mechanical ventilation, but we don't have the capacity for that yet. We used all the medicines available. I mixed and hung my very first aminophylline drip to try to open him up, kept him on the maximum amount of oxygen we are able to give with the compressors, but it was just too much for him.

Flag Day

Today was a holiday in Liberia, Flag Day. The hospital is running on a holiday schedule, which means We rounded in the morning, but no clinic in the afternoon.

It is funny how patients seem to come in with illnesses in themes- one day it seems to be all malaria, one day it is malnutrition, another day bronchiolitis. Today all our malaria patients decided they wanted to get better, collectively. We discharged a whole crew of happy kids. I am trying to attach some pictures to this blog of some of them, but the internet makes it SO slow. I think it might be quicker to print the pictures and send them in a corked bottle across the Atlantic for everyone to see.

I have done a lot of teaching about bronchiolitis in the past 2 days. There are no isolation rooms or blue gowns and masks to be had here, but we do encourage good hand washing. I have also been showing the mothers the benfits of normal saline and blue bulb suction. Even though I am in Africa, I can't escape RSV.

We have a few diagnostic puzzles on the floor. We have been limited because the xray machine has been down since we arrived, although we can do an ultrasound. We also have limited access to labs, and they don't have any labs on weekends or holidays, so we are trying to do our best with our brains, stethoscopes, and intermittent internet access.

Feeding time

Hopsitals of Hope has brough 4 monitors onto the Pediatric ward! They have attachments for oxygen saturations, blood pressure, and heart rate, and can even print an EKG. The staff was trained on them last week. We have a patient on the ward with bronchiolitis who was having some respiratory distress, so the nurses put him on the monitor. Shortly after, JFK had its first case of monitor-itis, where the family kept calling me over because they were concerned something was wrong with the baby. The reason for their concern was the blood pressure was coming up as "no reading" because the cuff was not attached to the monitor.
We are working hard on the malnutrition cases at JFK. We have done a lot of education with the medical students and the interns to use the WHO handbook and get these kids on feeding schedules. We have one little boy who is severely malnourished, even though he is 11 months old he only weighs 9 pounds, and has trouble tolerating feeds. He pulled out his NG tube this morning and his mother had gone home to get more clothes for him. Since it was Sunday and my schedule was a little lighter, I decided to feed him myself.
I lifted him out of the bed and he was like a bird, so fragile and light in my hands. As I snuggled him, instead of adorable baby chubby arms and legs, he seemed angular, as though every bone was making an impression on my arms. He reached up for the feeding syringe as though it was his favorite bottle, and he happily enjoyed every drop of his feed. Though there is more to do than I have time for in my short stay here, I am grateful for moments like these.

Free At Last

Today had an interesting start. We live in the doctors dorms, which is a JFK provided facility. It has a gate to our sleeping quarters, which is locked with a padlock. This morning we had a lock malfunction, and we were locked in. It is quite intersting to be unable to get out your door in the morning. Luckily we were planning to head to the wards early, so we had time to call security to let us out. It took him a few tries to break the lock open, but when he finally sawed it off the door, he started to shout "Free at last, free at last, thank God Almighty, free at last!"
There is an amazing group here right now called Hospitals for Hope. They are partnering with JFK to update lots of the wards and medical supplies. They are bringing in donated supplies from all over the world and working hard with the administration at JFK to make big changes at the hospital. I am in awe of all the good work they have done in the past week.

Quinine quinine everywhere

Or should I say mosquitoes, mosquitoes everywhere? There are mosquitoes all around-at the dorm, in the hospital, on or walk in between. And there is no shortage of severe malaria all around. Malaria is such an awful disease which can make a perfectly healthy child very sick in so many ways. There is cerebral malaria, complete with seizures and altered mental status, and children can be obtunded for days. The amazing part is when the kids get better, they just sit up and start eating, and then walk out the next day.
We have a very sad case in the NICU right now. The baby was born "depressed," meaning it dit not breathe spontaneously and was limp. He was put on oxygen, but when we arrived to see him, he began seizing. He seemed to have sustained some sort of birth injury, since he had a cephalohematoma. We gave him all the treatment we had available, and tried to do a head ultrasound, but did not have the right probe. The next day, he was floppy, and his pupils were fixed and dilated. We are all very sad for him.

Country Medicine

It is funny how time passes in Liberia. I feel like there is so much work to do everyday, but I can get caught up in one task. We are seeing quite a bit of malnourishment on the wards. The Peds team spent a good deal of time calculating, and then mixing, a formula for one of the babies out of ingredients we had on hand.
I gave a talk on nephrotic syndrome yesterday, which was really fun. I am going to try and do a journal club either this Friday or early next week. The medical students are very eager to learn and ask lots of great questions.
We have a case on the Wards of a girl with sickle who came in with malaria and pain crisis. She is the first patient I have ever seen in Liberia with sickle cell. Where are all the sicklers, we wonder.
I am learning so much every day about malaria, typhoid, malnutrition, and even some "country medicine," which is what they call Liberian home remedies.

The quiet after the storm

Today was the first real weekday of rounds. I met the medical students, and was reunited with the residents. We have a very large team, but lots of opportunity for teaching. We have many interesting cases on the wards right now, and a few diagnostic mysteries. Again, I long for some diagnostics and consultants, but I feel lucky to have my amazing pediatrics colleagues to consult with.
All of our patients who were "jerking" yesterday are improved today, and one even got discharged home from the ED because she was looking so good.
I am sorry for the lack of pictures thus far, but my camera battery died the second I landed in Monrovia. I am going to steal Amir's camera tomorrow, though. It would be really embarrassing to have my only picture on this Liberia blog to be of Worcester, MA.

The weekend

Today, I rounded on the Wards, ED, and NICU, then stopped for a lunch of jollof rice in the hospital cafeteria. I forgot how spicy Liberian food can be! I feel like I am back in the swing of things.
It is a wet rainy season here, and malaria and typhoid are rampant on the Wards. The Liberians are complaining because it is so cold (75-80 degrees) but when I am rounding in the hot crowded hospital with no breeze, I am glad for the slightly lower temperature.
It seemed that everyone was "jerking" today, which is what they call seizing. A few of the children were certainly jerking from severe cerebral malaria, a few from suspected meningitis, and one little girl had what looked like it may be early tetanus, but for her sake I hope it wasn't.
The wards are more crowded than I was here the last time. They have added more beds and cribs in every room. Right now we have more children than beds, even with the additional ones added.
The nurses greeted me warmly today and welcomed me back. They then promptly asked for hand sanitizer, which I consider a victory.

On the Ground

I have arrived! I made it, even though my flights gave me palpitations the whole time. I swear next time I am driving to JFK- it has to be quicker and less stressful. Luckily my connection was delayed as well and I made it to Brussels. That airport was a very clean and comfy place to have a layover.
I was able to meet up with Amir, the MD from Mt Sinai. I snoozed away most of both flights. I arrived in Liberia around 6 pm and drove to Monrovia with Alvin, an old friend from the last trip.
JFK looks as great as ever, though I was not able to take pictures because it was POURING RAIN. Ahh, the rainy season.
I am rounding on the wards tomorrow- I cannot believe I am back!