Machine Perspective

One of the terrible truths about pretending to save money by buying cars used, is that one pays with time, in the mechanic’s shop.  And God knows, if time is really big money, then I have lost quite a bit to various mechanic over the years. There is one in Kokomlemle who is my go-to guy for Air conditioning.  He is a magician with the small motor that runs car airconditioning under the hood.  In this hot month, he has taken quite a bit of my time.

He has a lot to teach me however, about business.  And I want my surgical practice to run as smoothly as his AC practice runs, one day.  He has a good system, and runs a tight ship with his lieutenants and apprentices.  Its a joy to watch them work.  Which is why I noticed the arm of one of the guys putting finishing touches on the radiator mount.  There was something about the angle of his wrist as he turned the screw, that caught my attention.  Then I saw the long scar running all the way from his elbow to his wrist.  As he tightened the screw I noted its sinuous course around his left arm, and then I realised what it was .

It was surgical work so intricate, that I knew it could be just one of 5 people in the country who could have done it.  The surgeon had taken an island of skin, fat and some underlying muscle, along with its blood vessels from the upper arm, and swung it almost 180 degrees to cover a defect on the top of his hand. Now he had a barely perceptible hump extending from his wrist to the area where his fingers begin.  When he finished we had a medical chat.  I knew his surgeon.  He told me that he had a wound on his hand that had refused to heal for years.  His hand had continued to be pulled upwards, and outside position of  function by the contracting band of thick scar, which was also incapable of covering the chronic ulcer.  He had spent years cowering in the shadows, avoiding people, moving from charlatan to charlatan claiming to have the magic bullet that would transform his hand… until he met the team from the Plastic surgery Unit in Korle bu.  Now here he was, making sure that I could stop sweating on my way to and from work.

A few days later I met his surgeon, and he remembered this guy.  He was worried that he did not turn up for physiotherapy,,, I reassured him that my AC had given him all the physio he needed in a day…. He had met the surgeon he needed to make him useful to society, and I am sure he will continue to push ahead to make a career for himself.

I am struck by how sure I was that I would know his surgeon.  Ghana has had specialised surgery since pre-independence, but we have done very little to increase the numbers. Sometimes when it comes to medicine, we treat ourselves like the failed football nation we are… comparing ourselves with others, and finding some comfort in historical numbers.

Liberia has one neurosurgeon for 5 million people, but they had a devastating civil war. Ghana has 25 neurosurgeon for 36 million people.  Egypt has 500 neurosurgeons for 100 million people.  Do we really expect people to stay in this country for specialised surgical care?  Do we expect the people who can afford top notch surgical care to stay in this country and deal with the extra risk of submitting to surgeons who may not be doing enough complex surgery to stay on top of their game?

Our specialty surgery situation is much more serious than our football situation. If we do not develop the ecosystem that develops good players and teams, we just lose championship games.  If we do not develop our specialty surgery situation, we lose lives.  Precious lives, that usually have numerous other lives dependent on them.   At the moment, the top killers of young people in this country are road traffic trauma and  noncommunicable diseases.  Most of their burden and complications are serious, and multi-specialty.  Only specialist trained physicians can make the real difference.

If we train more of them, we secure the future.