Nguludi

Another of Malawi's pretty little secrets, Nguludi is tucked away in the hills outside Limbe. It's a verdant valley with an unexpected mission hospital and church.

At the hospital, seeing patients: primary amenorrhea in a 22-year old. Would you believe Mayer-Rokitansky-Kuster-Hauser Syndrome? (oh, yes, of course) Blind vagina, likely no uterus, to be confirmed by laparoscopy because we are not convinced by the (very expensive but notoriously unreliable) radiologist's report that he "located" her uterus on ultrasound.

Update: A visiting gynecologist brought his old-school laparoscope. One generation removed from a magnifying glass in a tube, fabulous to see how it was done. So we got to see directly that there was in fact no uterus but only rudimentary fallopian tubes attached to normal-looking ovaries. So diagnosis confirmed.

Have we done the patient any good? Well, probably not. We could tell her that sadly, there is no chance of children here in Malawi. The technology for surrogates exists elsewhere, but not here.

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Blantyre: The Celtel tower was the latest casualty of the lightning, so my planned couple of hours at the internet cafe to finish up CaRMS didn't happen. Hi-speed in Blantyre vs dial-up in MJ is the difference between 2 hours and 8 hours, and my blogging, it should be noted, has been done whilst waiting for my pages to load. Yup, still loading. Dial-up=no photos, sorry.

Anyhow, did you know the University of Toronto has an Office of International Surgery? Does this sound like it was made for me? And they are here! Believe it or not, providing access to the UofT Libraries to African surgeons! How amazing is that? Given how hard it is to get your hands on up to date print materials in this part of the world, and even if it wasn't, this is an incredible resource, which can only improve patient care.

(no applause, just throw money)

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Sinterklaas. No, I don't speak Dutch either, but who cares. It was a fun Christmas party for the little kids and I won an elephant!