Oluyinka O. Olutoye, MBChB, PhD.

1st Period June 2007

2nd Period November 2007

News of my being awarded the James IV Travel Fellowship came as a pleasant surprise; I felt honored to have received this award. I spoke with Tom Krummel to obtain some guidance with planning my trip. He gave very helpful suggestions and also directed me to other prior award recipients who assisted in my planning. I had discussions with Brad Warner and Selwyn Vickers who gave me helpful hints about places to visit. I resolved to plan a trip to far and exotic parts of the world I had not visited and institutions whose practice of medicine and surgery would be quite different from my experience in the United States. My initial plan was to visit Saudi Arabia, Vietnam and Australia. I also wanted to visit countries in Africa. This proved to be overly ambitious. Nevertheless, I was able to accomplish about 80% of the initial plans and visited these countries, with the exception of Australia.

In the planning stages, I had difficulty making contact with James IV Association members in countries I wanted to visit. Some of the countries had no members on record. I made contact with pediatric surgeons at foremost institutions in these countries and planned to two trips � one in June and the other in November.

First Period of Travel (June 2007)

The first trip was planned to coincide with a conjoined twin separation in Riyadh, Saudi Arabia. Just prior to the trip, the surgery was postponed but it was too late to make any changes. The first trip comprised visits to Saudi Arabia, England and Vietnam.

May 31, 2007

Just before I left the hospital for the airport, I ran into my department chair � Dr. Charles Brunicardi. He congratulated me. I thought it was for the recent Dateline NBC program featuring one of our fetal surgery cases. He went on to say that the appointment and promotions committee had met and unanimously approved my promotion to Associate Professor. It only needed ratification by the council and the president of the University. I rushed over to call my wife, Toyin, in the operating room where she was anesthetizing a child. I had to tell her first. Next I called my parents. That would be all for now until formal announcements are made.

I took a taxi cab from the hospital to the airport and checked-in about two hours before my flight. The 3:45 PM flight CO 34 from IAH � LGW departed on-time. About 2 hours into the flight, a request was made for any medical personnel on the plane to indicate. I pushed my call button as did several others. Incidentally, while boarding, I had noted the unusual site of a person in full scrub attire boarding for a transcontinental flight. It was no surprise that he was recruited to help. I guess he came �dressed� for the occasion. I tried catching up on unfinished manuscripts on the way.

June 1, 2007

Arrived at Gatwick airport at 7 AM local time. Took the coach to Heathrow, and then a Hotel Hoppa to Crown Plaza Hotel where I spent the night. I have a one day layover in London before leaving for Riyadh. I slept most of the day, then answered emails and made a few phone calls. I got an email from Dr. Mohammed Namshan in Riyadh. I would be expected to give 3 talks � 1 for the pediatric surgery division on Sunday morning, another to the Pediatric Surgery Club Sunday evening, and then the hospital grand rounds at noon on Monday. Saad Al-Mulhim (one of my former fellows at Texas Children�s Hospital, Houston) would like me to come to Dharan to give a talk at his hospital (Saudi Aramco Hospital) on Tues Jun 5 and return to Riyadh Wednesday evening. Got a late dinner and packed for the next day. I had to separate my luggage, due to baggage restrictions on the Riyadh flight. I will leave clothing I packed for the London trip at the �left baggage� section of the airport tomorrow. As a US citizen traveling to the Kingdom of Saudi Arabia, I had to be very cognizant of the travel restrictions, cultural preferences and security issues. Interesting things I learnt about visiting the Kingdom of Saudi Arabia. You have to be invited to visit the Kingdom. Females are the property of the males and cannot visit unaccompanied by a close male relative. Cousins are not considered �close� relatives as cousins can marry. I had to be invited by Dr. Abdullah Al-Rabeeah, the Chief Executive Officer of the National Guard Hospital in Riyadh. He is a Canadian-trained pediatric surgeon whom I had met at the Canadian Association of Pediatric Surgeons Meeting a few years earlier. He has a special interest in conjoined twin separations and has one of the largest clusters of recent cases. We had maintained contact and I had planned to visit Riyadh to observe during one of the twin separations prior to receiving the travel award. He designated one of his junior colleagues, Dr. Mohammed Namsham to be my contact person.

June 2, 2007

I made contact with some high school friends in London prior to embarking on BMI flight 775 to Riyadh. The flight was not too full. It was about a 6 hour flight. I arrived in Riyadh about 8.05 PM local time. I noticed that as we touched down in the Kingdom, the women on the flight then got dressed in their abayas. This is a flowing black gown with veils covering the entire body except for the eyes, hands and feet. Riyadh is apparently a very conservative Islamic city and there were �religious police� that monitor and implement compliance, even of foreigners. I got through immigrations uneventfully. A public relations officer form the National Guard Hospital was there to meet me and arranged transportation to the Sheraton Hotel. On the way, I called Dr. Bashir Ighile an orthopedic surgeon who works in the northern part of the Kingdom. I had met him when he visited his family in Houston, Texas. The trip to the city was interesting. The airport is about a 30 minute drive from the city and it� s through the desert. The route is lined by trees to prevent sand drifting unto the roads. It was an interesting feeling as a foreigner in a foreign land. This is not my first time traveling to foreign places, but it was the first time that I could barely speak the native language and could not even read the inscriptions or the road signs. I felt totally dependent on my guide. The Sheraton Hotel was one of those recommended by my hosts. Upon arriving there I could see why. It was quite well fortified and had several levels of security and a metal detector prior to entry. There were barricades all around the building to deter would-be bombers. �Welcome to the Middle East�, I thought. Once inside, the hotel was top notch. It had a combination of Western and Middle Eastern d�cor. I had dinner alone at the Al Bustan restaurant in the hotel. Got working on my talks for the next day and didn�t get to sleep until about 2.30 AM local time. Local time here is 8 hours ahead of Houston in the summer.

Sunday June 3, 2007

Sunday is a regular working day in Saudi Arabia. The weekend is Thursday and Friday. It�ll take getting used to. I was picked up by the public relations protocol person at 8 AM and taken to the National Guard Hospital in Riyadh. There I was met by Dr. Mohammed Al- Namsham, the head of pediatric surgery. He had trained in Halifax, Nova Scotia and returned to the Kingdom in 2003/4 to be Chief of Pediatric Surgery. He took me on a brief tour of the hospital and then took me to the conference room where I gave a talk to an audience of pediatric surgeons and neonatologists. My talk was titled: Management of a Fetus with Prenatally Diagnosed Saccrococcygeal Teratoma. It was a 20 -25 minute talk and was well received. I met Dr. Stanley Crankton, a pediatric surgeon originally from the Cameroon, who has been at the National Guard Hospital for about 18 � 20 years now. Interestingly, I had met him earlier at the British Association of Pediatric Surgeons meeting in Stockholm, Sweden in 2006. I was introduced to several of the neonatologists and also met the other pediatric surgeon on staff. I was taken on a tour of the NICU, PICU, wards and OR. The hospital is a vast one-level hospital except for the new outpatient clinic that�s a 4- storey building. There is a lot of construction and expansion going on to expand it from its current capacity of 950 beds to 1500 beds. Included in this is the building of a separate children�s hospital adjacent to the current structure. They are very busy with over 1000 cardiac pump cases a year. They have recently upgraded two operating rooms with �OR ONE� technology. The new operating room is almost an exact replica of what we have in our hospital at Texas Children�s Hospital. They have 11 operating rooms � one dedicated to pediatric surgery. In addition, there are 4 separate ORs for cardiac and transplant and another two for Obstetrics. The hospital is also renowned for conjoined twin separation. About seven have been separated in the last 3-4 years. There are currently two sets in the hospital, one set separated in April 2006 and another set with omphalo-ischiopagus tripedis due to be separated July 2, 2007. At 11 am, I met with Dr Abdullah Al-Rabeeah, a pediatric surgeon and the CEO of the hospital.

He�s a very influential man in the Kingdom with direct links to the monarchy. General opinion is that he functions in a cabinet level capacity. He does all the conjoined twin separations. There was a huge picture in the PICU of Dr. Rabeeah and the King with about a dozen sets of separated conjoined twins. I had a 40 -45 minute conversation with him. He is definitely a man with a plan and a vision. He outlined his expansion plans for the hospital and the National Guard Health program in general including their hospital in Jeddah, and the many primary care centers. They also have a school of nursing with branches in 3 other cities, and a medical school in Riyadh that has a completely electronic curriculum and virtual aids. The curriculum is a problem-based learning curriculum adapted after that in Sydney, Australia.

After lunch, we went to visit the Antivenom production center. This center within the hospital premises makes antivenom from snakes captured locally. They have an array of poisonous snakes that they keep and milk for venom weekly. A stable of horses 12 km away is used to create antivenom which is then tested in the laboratory here for purity, efficacy and neutralizing effect on rabbits, guinea pigs, mice and rats. We had a demonstration of the milking of snakes and scorpions. The antivenom is sold commercially to the entire Middle East. They have also developed an ELISA technique to measure venom levels within the patient�s serum so they can effectively identify the venom and calculate the neutralizing dose of antivenom required. Both monovalent and polyvalent antivenom is available. A very fascinating place. Another vision of Dr. Rabeeah is to have self-sustaining, fund- generating commercial ventures to sustain the hospital. They are also looking into plasma separation and stem cells as another area.

I was taken back to the Sheraton for a brief break and then picked up for the meeting of the Riyadh Pediatric Surgery Club. This is a meeting of pediatric surgeons from all the hospitals in Riyadh. There are several hospital systems in Riyadh � The National Guard Hospitals � for the National Guard, The Military or armed forces hospital for the ministry of defense and aviation (MODA), the ministry of health � King Faisal Specialist Hospital, The University, and King Fahad Medical City. The meeting this month was hosted by King Fahad Medical City. About 50 people were in attendance. They had several interesting case discussions. Frank but collegial discussions were had. I gave a talk on the management of prenatally diagnosed cystic lung lesions � including the movie on fetal lung resection. It was very well received. I was approached by Dr. Suad Al Shenafi of King Faisal Specialist Hospital to visit his hospital tomorrow. Also Dr. Aayed Al-Qahtani of the University hospital would like me to give grand rounds there on Saturday. There is considerable interest in doing fetal surgery here. Dr. Namsham drove me back to the hotel. I stayed up to work on my talk.

Monday June 4, 2007

Dr. Suad Al-Shenafi picked me up at 7.30 am and took me to visit King Faisal Specialist Hospital. This is the foremost tertiary center in the Persian Gulf, more aptly called the Arabian Gulf. He trained in general surgery at Halifax, Nova Scotia, spent 1 year in Sydney Australia, and then a pediatric surgery fellowship in Halifax before returning to Riyadh in 2004. He has interest in setting up a fetal surgery program. In fact, the hospital is pushing for it more. He visited several fetal programs in the US last year � Boston, CHOP, UCSF and Cincinnati. The chief of OB-GYN also has some links with Wayne State. I gave him some advice about steps to take in planning for a program. He is being mentored by Dr. Rabeeah. They had a perinatal conference earlier in the year that Rusty Jennings attended from Boston, US. I visited the hospital and met the other two pediatric surgeons � Dr. Saleh Al-Nasser, the division head; and Dr. Hanny Hassab.

They took me on a tour of their NICU, PICU and ward. They have an awesome facility. Extremely modern with PACS system, full technology, and nothing lacking. I could easily have been in any of the top children�s hospitals in the US. Their NICU is complete with the latest ventilators and HFOV. They do not do ECMO. They get by with gentle ventilation for their diaphragmatic hernia patients. I was really impressed. I got to meet the chairman of surgery as well.

Suad then took me back to the National Guard Hospital for the noon grand rounds. I gave a talk on Fetal Surgery. It was attended by neonatologists, perinatologists, surgeons, students, etc. Dr. Rabeeah was also there. I gave a 50 minute talk. After that, I returned to the hotel and was picked up later for a visit to Old Riyadh. I got to see the museum of the old palace where the battle of Riyadh was fought. I bought a full regalia Saudi outfit for $50. Also went shopping at the jewelry stores and bought my wife some jewelry.

Tuesday June 5, 2007

I slept in late. I talked with Toyin about her presentation before she went to sleep in Houston. I caught up on my sleep arrears. I was taken sight seeing at the malls. They are HUGE. The supermarkets have anything you may think off. Electronics are not necessarily cheaper but there are more options - US, Europe, Asian sources.

I checked out of the Sheraton and was taken to the airport to fly to Damman airport, on the eastern part of the Kingdom, right on the Arabian Gulf. There I was hosted by Dr. Saad Al- Mulhim (a former international fellow at Texas Children�s Hospital) who picked me up at the airport. We met up with Dr, Salem Yazbeck who is now his partner at Saudi Aramco Hospital in Dhahran. We all went to dinner at an Indian Restaurant on the Aramco compound. Nice food. I was checked into Steinecke Hall � in honor of the American who found oil in Saudi. Didn�t get to sleep till quite late; worked on my talks. The Saudi Aramco (Arab- American Company) is the largest company in the world in terms of reserves (the oil reserves of Saudi Arabia). They have a hospital system that supports their employees and their families. The Aramco Company owns most of Dhahran and the compound is a �safe haven�. It is the only place in the entire kingdom where women are permitted to drive. Life within the compound is akin to being in any western country. Nevertheless, alcohol is still forbidden, even in the compound. Women are not restricted in their dressing and can move freely here.

Wednesday June 6, 2007

Dr. Yazbeck picked me up early. We attended the pediatric morning conference at 8 AM. Saad�s fellow gave a talk on splenectomy for sickle cell patients. At 9 am I gave a talk at the general surgery conference on Negative Pressure Wound Therapy in Children.

We went for lunch at the Sunset Beach in Khobar, one of the tri-cities with Dhahran and Damman. It�s a beautiful resort on the coast of the Arabian Gulf. Returned to Aramco for the 2 PM grand rounds on: Fetal Surgery: The New Frontier. It was very well attended. Lots of interesting questions. Everyone thinks very highly of Saad there. It made me really proud to have been involved in his training! He is the busiest, most academic, and a very well loved surgeon in Aramco. After the presentation, I returned to the Steinecke Hall for some rest and then Saad picked me up for dinner at another Middle Eastern restaurant in town with the chief of surgery and the chief of medical staff. It was a nice evening. Lots of food! I got back to the guest house about 11 PM and stayed up late. Still can�t sleep early.

Thursday June 7, 2007

Saad came to pick me up at 9 AM and we stopped at a restaurant for breakfast. I had checked out of the guest house. It�s the weekend in the Middle East today and tomorrow. We took a leisurely drive over the causeway to the boundary of Bahrain. It was a long bridge over the Persian Gulf. Huge desalination plants on the side provided the water for this region as well as the water pumped over 300 miles to Riyadh. The water in the guest house was quite salty. The water at the Riyadh Sheraton however, was quite good. We drove to the airport and I flew back to Riyadh. The protocol folks did not come to pick me up on time. Waited in the airport for about an hour. I went back to the Riyadh Sheraton and checked in again. I got re-assigned my former room. Dr. Bashir Ighile of the Armed Forces Hospital in Tobout was there to visit me. We went out to dinner in a Brazilian style buffet dinner at Il Terrazzo on the 3rd floor of the tall Faisalel tower (the one with globe in the middle). I got to try camel meat and ostrich meat. The ostrich was very good. Camel is quite gamey and tough.

Friday June 8, 2007

Slept in a bit. Went to breakfast with Dr. Ighile. We chatted until he had to leave about 11 am. Went to the hotel, took a nap and caught up on manuscripts. I was picked up about 5 PM by the public relations folks. I was accompanied by two geneticists from Manchester University. We all went to the camel market. Took pictures of camels. I got to ride on the camel twice. It was a lot of fun. We came back to the hotel. I took a shower, dressed in the Thorpe and utra (formal Saudi attire � 7 pieces) and went to the dinner with Dr. Rabeeah, Dr. Qathani, Dr. Onazi, Dr. Namsham, and Dr. Jeddin. They were all impressed with my outfit. We went to an authentic traditional restaurant. We sat on the floor on Persian rugs. We drank tea and mint, aired our robes with smoke from perfumed sticks. Lots of food. We could all only eat about 20% of what was presented. Dr. Al-Onazi from the military hospital arranged from me to come and visit his hospital and give a talk before I go to the University. I went back to the hotel to get ready for the talks.

Saturday June 9, 2007

Dr. Al-Onazi picked me up to take me to the Military Hospital in Riyadh where I gave a 7.30 AM lecture to the department of surgery about the prenatal management of cystic lung lesions. I was given a tour of the hospital. It�s a pretty modern hospital but poorly set up. Several different buildings built at different times and poorly connected. You have to walk outside in this oppressive heat. Fairly modern equipment. They also have an interest in fetal therapy. They have not started anything yet.

I was then taken to the King Fahd University Hospital and the College of Medicine where I was the guest of Dr. Aayed Al Qathani. He trained in Canada and had interviewed at CHOP. I think I took him on tour at CHOP when he interviewed. He is their laparoscopic guru here, quite innovative and politically savvy. He�s interested in having Toyin and I come back for locum. I gave a noon grand rounds on Fetal Surgery and Prenatal Intervention: An Overview. It was poorly attended. After the meeting, I was taken back to the hotel to rest. I was then picked up later by Dr. Qathani�s protocol officer and taken shopping with Prof Jose Boix Ochoa, a world renowned pediatric surgeon from Barcelona, Spain who in enroute to Jeddah to give a talk. We went shopping through the gold areas and perfumery. Dr Qathani had the protocol buy us both perfumes. He also paid for a traditional perfume I bought. They are very generous. We went back to the hotel and I packed. Prof Boix Ochoa taught me how to use Skype � the internet phone. I downloaded it unto my computer. We later went to dinner with Qathani at an Italian restaurant. We left there just barely in time for me to get my luggage from the hotel and head for the airport. I checked out from the Sheraton, settled my bills and Qathani�s driver took me to the airport. I checked in for the BMI flight to London Heathrow. I departed Riyadh 2 AM local time.

My general thoughts about Saudi Arabia.

One cannot help but be impressed by the level of development of the major cities. Riyadh, a city of about 4-5 million people is in the middle of the desert with no source of water except for deep wells or desalinated water pumped from the coast in Damman, ~300 miles away. The grocery stores and malls are huge and stacked with products from all over the world. There is an impressive irrigation system in other parts of the Kingdom allowing them to make enough wheat and fruits to even export! The society is interesting, to say the least. It is under Islamic rule. The shops are filled with pretty clothes even though all the women are covered wearing abayas. The abaya outfits are getting slimmer and with more designs. Some of the young girls appear to be pushing the envelope in terms of dressing. There is a definite class system, even for professionals. Training in the western world is considered high premium. Nevertheless, remuneration is based on your citizenship. American, British or Canadian citizens are paid the highest and can be consultants. A US-trained Nigerian will be paid much less than a US-trained American. Training in Eastern Europe, Africa, Asia or the Middle East even carries less weight. Those are the assistant consultants. Nevertheless, a Saudi national, no matter how junior or inexperienced, will be the chief.

LONDON, ENGLAND, June 10 � 17, 2007

Sunday June 10, 2007

Uneventful flight to London � Thank God. Arrived in LHR about 7 AM local time. I picked up my luggage I had left in storage enroute to Riyadh. I took the tube to Bayswater station and walked to find the Palace Court Hotel, a small bed-and-breakfast on 64 Princes Square, London W2. It was a bit hard to find, especially lugging my luggage on foot. I got there about 9.45 AM and hecked in. I wasn�t sure I wanted to stay there. I got upgraded to a double room temporarily. I had breakfast, took a shower and went looking for Kingsway International Christian Center (KICC) to go to church. I didn�t get there till noon for an 11 AM service. I got there before Pastor Ashimolowo began his sermon on Attaining your Dreams and Vision. I met a high school colleague of mine, Chidi Opara, who is in charge of transportation at KICC. After church, I took the train back to the hotel, called up my friends in the city and slept. Local time in London is 2 hours behind Riyadh but still 6 hours ahead of Houston.

Monday June 11, 2007

I woke up a bit late, had breakfast and called Anita Waterman, Prof Pierro�s secretary at Great Ormond Street Children�s Hospital (GOSCH). I got directions and went there arriving bout 10.30 AM at the Institute for Child Health (ICH), 30 Guilford Street, just behind GOSCH. Prof Pierro himself came to meet me, took me on a tour of the hospital and took me to the theatre to watch some cases being done by Mr. Paolo De Coppli and Mr. Eric Martin Kiely. GOSCH is an interesting place. It�s a very old building that dates back to the 17th century. A great deal of it has been refurbished and newer units added. ICH is an institute of the University of London. It�s an academic unit of which Professor Agostino Pierro is the chief but this has no bearing on the hospital. There is no surgeon-in-chief of the hospital nor head of pediatric surgery. The surgeons/physicians have no administrative clout in the British national health system NHS. Mr. Eric Martin Kiely is the most senior pediatric surgeon. Others are Mr. David Drake (upcoming BAPS president), Prof Pierro, Mr. Paolo De Coppli (a colleague of Paola Midrio in Padua, Italy who trained in tissue engineering in Boston in Atala�s lab) and Mr. Joe Curry, a contemporary of Bruce Okoye who came to spend a year at CHOP after I had left. I spent the afternoon with Mr. Kiely. He�s a distinguished gentleman who is quite adept at laparoscopy even with his advanced age. I watched him do laparoscopic hernia repairs and I think I will try them when I get back. He uses 4-0 prolene on an RB1 or Rb2 needle, a 5 mm port at the umbilicus and two 3mm stab wounds at the mid abdomen left and right, operating on each side from the contralateral side of the table. Three surgeons� knots first to keep the stitch from sliding. Intracorporeal knot tying. Pull up the peritoneum away from the vessels and the vas and stitch them, taking a bite of the muscle laterally. I also learnt about techniques of atresia repair with end- to-end 7-0 prolene parachuting stitches very close together on the decompressed distal bowel but symmetrically spaced out on the larger proximal bowel. They do well and attain full feeds within two weeks. Went back to the hotel and bought Chinese food and Schwarma for dinner. I slept off after eating but stayed up most of the night. There were no hotels around the hospital that were available so I ended up staying in the bed and breakfast and got moved to a smaller room in a few days. I got in touch with several secondary school classmates in the UK whom I have not seen in ages. The plan is to all try and get together on Friday, DV.

Tuesday June 12, 2007

I went to GOSC hospital. I got to observe Prof. Pierro in the theatre. He didn�t have any major cases � colostomy closure, and recurrent CDH repaired with a Dacron patch. I also briefly watched Mr. David Drake do a laparoscopic fundoplication that ended up being converted open. They use the bariatric liver retractor. I went to listen to a seminar on fetal medicine at ICH given by a British perinatologist. Her perspective was interesting. She counted as successes diagnoses in which prenatal diagnosis has resulted in a decreased number of live births. She mentioned only CDH, MMC and cleft lip when talking about open fetal surgery. She obviously did not think much of open surgery, and insinuated that it was not applicable in humans. I did not stay until the end to ask questions as I had to leave to give my own talk at the surgery journal club � titled Fetal Surgery. I gave an over view. It was very well received. Lots of questions were asked by the faculty and fellows. I went back to the hotel and ate Chinese food for dinner. Slept from 6-9 PM, then stayed up all night watching cricket. My jet lag still has not resolved. I doubt it will before it�s time to leave again

Wednesday June 13, 2007

Went to GOSCH early. Professor Prem Puri (Dublin, Ireland) is at GOS as the visiting professor and lecturer at the Simpson Smith Symposium tomorrow. I joined him on rounds as we went around the units with the GOS pediatric surgeons and registrars and fellows. It was a really nice time. I got to comment liberally. It was nice to see how similar or dissimilar things were done in 3 different countries (England, Ireland and USA). The residents also presented their research to us. Very interesting. One of them has identified some loss of MHC class II antigens in patients with Hirschsprung�s disease. I was so sleepy, I couldn�t fully concentrate. In the afternoon, I went to the hotel to rest. Did a little shopping on the way back, but didn�t really sleep. Freshened up and went back to meet up for dinner at Prof. Pierro�s Home. I met with Prof Puri and his wife, Arnie Coran (from Ann Arbor, Michigan) and we also picked up Prof Alaistair Millar and his wife, Sue (formerly of Birmingham UK but now back in South Africa). We met Dominique Pierro and their children. Afterwards, the taxi dropped me off at Fulham South station and I took the tube back to the hotel. Got back about 11.30 PM and slept.

Thursday June 14, 2007

I slept in a bit and went in for the 59th Annual Simpson Smith Symposium at GOS. It was very well attended by staff and consultants from all over the UK and beyond. The first half was on short bowel syndrome and intestinal failure. The second half was on How I Do It � Common Problems. Prof Prem Puri gave the lecture on Vesico-ureteral reflux. I got to meet Prof Lewis Spitz. Mr. Niyi Ade-Ajayi was there. I was so tired; I could barely keep my eyes open. It was a nice symposium. Afterwards, I went to the hotel and packed an overnight bag. My luggage had been moved as I had been switched to a smaller (single) room. Dele Olawoye and his wife, Victoria stopped by to visit. Deolu Bajomo picked us all up and dropped the Olawoyes off. I went to spend the night at Deolu�s House. We talked at length and finally slept about 2 AM.

Friday June 15, 2007

Deolu and I left his home about 7.30 AM and headed into the city. I took the tube to my hotel to drop off my bag. I went in to GOSCH. I joined Prof. Pierro in the theatre. He did a diagnostic laparoscopy in a girl who had a normal appendix but only bloody fluid in the pelvis post menstruation. I watched a redo laparoscopic fundoplication by Mr. Curry.

I left before the cases were done to go to King�s College Hospital. There I met with Mr. Niyi Ade-Ajayi and Mr. Mark Davenport. We made rounds. This is a general hospital with a children�s hospital comprising the 4th floor of the hospital. They have a lot of Nigerians on staff � nurses and some doctors. The hospital is not as new and refurbished as GOS but they appear to have a wider variety of cases. GOSCH is a free-standing children�s hospital without an accident and emergency department so they get only tertiary referrals. KCH gets it all. In addition, they are involved in the biliary atresia study and also have a very active program for fetal occlusion of CDH. They take care of about 30 CDHs a year of which over half have fetendo. The FETO kids have done fairly well once they are born closer to term. FETO has been done for right CDH as well as left. They all needed patches suggesting higher severity. They no longer use Gore-Tex or surgisis but use permacoll (a pig collagen derived non-absorbable material � I�ve never heard of it). Their NICU is not very impressive but had 5 CDHs two omphaloceles etc., while I visited. All the CDHs were on low settings � PIP less than 19 and Fi02 less than 0.3. It seems the FETO at least results in less morbidity. I went to round on the wards with Niyi Ade-Ajayi. We then went to visit with Kypros Nicolaides, the MFM guru who does all the fetal intervention work. I discovered Jacque Jani is there as well, having finished his training with Jan Deprest in Belgium. They have done about 20 FETO cases now. They also do balloon retrieval before birth. He was doing a cord occlusion for monochrionic twins discordant for hydrancephaly using bipolar coagulation and then laser coagulation of the cord. No gloves, hardly any preparation. He is talented with ultrasound and needles. Jacque Jani compliments him with the technical skills. They have a very busy unit that keeps going until about 10 pm at night. Niy iand I went to see a new NICU admission with NEC and pneumoperitoneum. He then took me to his home, about a 15 minute walk, where I met his family. Niyi and I talked about all the programs he�s been trying to help coordinate with Nigeria to improve pediatric surgery. We also talked about the high mortality of gastroschisis in Africa (70% and higher in Zaria and Kenya). He has a mannequin that teaches application of silos for gastroschisis. I asked him to keep me in the loop so I can participate as well. Niyi later took me to 805 Old Kent Road to a Nigerian restaurant where I met with several old friends. We all had a wonderful time catching up on old times. Some of them I hadn�t seen in 25 years. Back at the hotel, I packed up for my flight back home and reserved a cab. I went to bed about 3 AM.

Saturday, June 16, 2007

I woke up about 6.25 AM and got ready. I checked out of the hotel. I�m so glad to be heading home. I�ve missed everyone. I have a busy week next week with administrative stuff before I leave for Vietnam on Friday. I arrived in Houston about 4:20 PM local time. My wife and children met me at the airport.

Trip to HANOI, VIETNAM - June 22 � July 1, 2007

Friday, June 22, 2007

I started on the next leg of my travels. This time, I�m headed to Vietnam. I checked in at IAH and boarded Continental Airlines Flight 7 from Houston direct to Narita, Japan. The flight left the gate on schedule at 10:50 Houston time. We are scheduled to arrive in Tokyo Narita airport at 14:20 local time tomorrow (Saturday), a 13 hour 30 minute journey. Slept on the flight, watched some movies, and did a little bit of work.

Saturday June 23, 2007

I arrived in Narita, Tokyo Japan and got through immigrations uneventfully. I took the shuttle to Hilton Narita Hotel and checked in about 3.30 PM. I took a shower and got picked up by Dr Yoshi Kitano (an old friend from the lab days at CHOP). We joined up with his wife and daughters. We all went to a traditional Japanese restaurant for dinner. We had sashimi and I got to try whale, octopus and different types of fish. We also had thin sliced beef that we then steamed in hot spicy water (wasa-wasa). The children were so eager to try out their English on me. I got to learn some more Japanese words and numbers. We got back to the hotel about 11PM. I called home on Skype. My cell phone cannot pick up any signal. I was quite tired.

Thoughts about Tokyo: I was quite surprised that I did not know they drove on the left side of the road. Narita is quite hilly and with lush green vegetation. The roads are somewhat small and not very well landscaped. The hotel was beautiful. The people are very courteous and friendly. I was surprised my Cingular cell phone could not pick up ANY signal. Temp � very warm 28C

Sunday, June 24, 2007

I couldn�t sleep too late because I wanted to call to find out about my flight to Hanoi, Vietnam. I had been notified by the travel agent via email that the flight had been postponed from 11 AM to 6.25 PM. I wanted to verify with the airline but no offices were open in the US or Tokyo. Confirmed the best I could with the information on-line. Vietnamese Airlines does not have up-to-date travel information on their website. I decided not to go out and visit Narita. Stayed in the hotel room and went down for a lunch buffet. I had been afforded a late check-out. Left the hotel at 3PM and went to the airport. The flight to Hanoi had indeed been delayed. I could not check in for the flight until about 5 PM. Not very organized. I bought some souvenirs and headed to the gate. Flight VN 955 departed the gates about 6.45 pm and took off for Hanoi. It�s a 5 � hour flight. I slept most of the time. Didn�t do any work. Arrived 9.45 PM local time (12 hours ahead of Houston time). My host in Hanoi, Vietnam is Nguyen T Liem. He is the Chief of Pediatric Surgery at Hanoi National Hospital for Pediatrics. I had been introduced to him by Dr. Max Langham (Mepmhis, TN) who had spent some time in Hanoi based on his interests in liver resection.

My luggage took a while coming out. The combination lock on it had been removed and replaced with another one. I went through immigrations ok. I was picked up at the airport by one of Dr. Liem�s colleagues � Dr. Son. He took me to the Bao Son Hotel where I checked in. The hotel is just round the corner from the hospital � 5 minutes walk. My cell phone works but I can�t Skype out. Hanoi is a very interesting city. Everything shuts down at night. Everyone seems to get around on motor bikes. There are scores of them. Road signs are virtually non-existent. Traffic lights are not obeyed by the motor bikes. There seems to be a lot of pollution. Many riders cover their hands and bodies and even wear masks, more so the women than the men.

Monday June 25, 2007

I got up early, had a continental breakfast buffet at the hotel and was picked up by Dr. Son to go to the Hanoi National Hospital for Pediatrics. I was there for morning report. I finally got to meet Dr. Nguyen Thanh Liem, my host and the Chief of Pediatric Surgery and entire surgery. He is a distinguished and revered man. I met his deputy, Dr. Han and some other pediatric surgeons, including Dr. Dung (pronounced zung) whose expertise is hepatobiliary. I was taken to the OR. It�s an old hospital originally built by the French. It�s not pretty but functional; not squeaky clean, but tidy. No malodor or garbage. I met the Chief of Anesthesia, Dr. Ung. He was at Boston for 2 months. Everyone is very nice. I got to watch a choledochal cyst excision with laparoscopic hepatico duodenostomy. Quite sleek! Dr Liem took me out to lunch at a fancy restaurant. I did quite well with my chopsticks. I was returned to the hotel. At about 3 PM, Dr. Tho came to take me out to see the first national University of Vietnam. It looks like an old temple/museum. There are statues of Confucius, his students and the first president of the university. These statues are being worshipped!! People bring food, drinks and money and lay it at the base of the raised statues and pray to them. Interestingly, the president f the university got far more attention than Confucius, or even statues of the past kings. There were many turtle statues that people rub on the head and then touch their own heads. This is supposed to grant them luck with exams. I was asked to try but declined. I also declined to take pictures with the statues being worshipped. We went around window shopping. I bought 5 embroidered t- shirts for $10 USD. I went back to the hotel about 6 PM and took a nap. I called home and Skyped. Did not need to eat dinner; I was stuffed. Watched TV most of the night. Did not get to sleep much.

Skipped through the rest of the trip to Hanoi Vietnam. Needless to say I had a wonderful time. In the one week I spent there, I saw four choledochal cyst resections performed laparoscopically. I also saw a modified PSARP where the sphincter was not divided and the bilateral sympathetic ganglionectomy for hyperhidrosis. I gave grand rounds on Surgical Perspectives of Gastroesophageal Reflux Disease. They have one grand rounds in English every other week. There is a big push to have most of their physicians communicate in English. Many of them are fluent in French, having trained in France due to the prior French Influence in northern Vietnam. It was clear that a talk dark skinned man was a rare site in this part of Vietnam. I got curious looks from the young and old alike. At 6�1� I really felt like a giant. Took a trip to Halong Bay. It was spectacular. It�s one of the UNICEF identified nature preserves. Got to see the bay and bought pearls for Toyin. Returned to Houston on a long trip. First 6 hours from Hanoi to Narita. A 9 hour lay over in Narita. I spent most of the time working on my grant. Fourteen hour flight from Narita to Houston. Slept a lot.

SECOND TRAVEL PERIOD

November 2007 - South Africa and Nigeria

The second leg of my trip was planned for November, 2007. I had hoped to go with my wife to Australia and coordinate it with an anesthesiology meeting she had there as well. However, I also wanted to visit Africa. It so happened the early part of November was going to be very busy for the children with our son starting in a new high school, freshmen retreat for the high school, basketball try-outs and practices, etc. My plan was to go to South Africa for a week and then Nigeria for another week. Toyin could not be gone for so long but we thought we could at least meet up in London and then go to Nigeria together. Even this could not be coordinated suitably. It was finally decided that Toyin would stay with the children and we would both go to Hawaii for our wedding anniversary at the end of November.

My journey started from Houston, Texas. I departed Friday November 2, 2007. I took a Continental Airlines flight to London Gatwick. I arrived at LGW at 08:55 local time Nov 3, 2007. It so happens, my brother was on his way to the USA from Nigeria and was stopping over in London for a few days. He met me at the Gatwick airport with his friend. I spent the afternoon with them in London and they took me to London Heathrow airport for my flight to Cape Town, South Africa. I checked in without incident, departed on the 20:35 flight and flew for 11 hours on Virgin Atlantic airlines. I was in economy but fortunately I had an aisle seat. I got some work done on the plane.

CAPE TOWN, SOUTH AFRICA

I arrived at the Cape Town International airport on Sunday Nov 4 2007 at 10:35. My luggage arrived ok and I cleared immigrations without incident. I was met at the arrival hall by Prof. Alastair Millar. He is the head of pediatric surgery at the Red Cross Children�s Hospital in Cape Town and also the Charles F. M. Saint Professor of Paediatric Surgery at the University of Cape Town. I had met Prof. Millar while visiting Great Ormond Street Children�s Hospital in June 2007. He was there giving a lecture as part of the Simpson Smith symposium. He and his wife, Sue had been gracious enough to invite me to stay at their home. Alastair took me to their home. It�s a lovely bungalow in the Cape Town suburb of Newlands. I settled into the guest room. We had tea and a light lunch and I took a nap. Cape Town is 8 hours ahead of Houston. I woke up about 16:00 local time. We had tea and Alastair took me for a driving tour of the city. We drove to many areas and saw a lot of sites, but the weather was really misty and wet, unusual for the spring/ summer in Cape Town. It was also cold. We could not see much of the Table Mountain � a Cape Town highlight � because of the clouds. We came back to the house and had dinner. I called home, replied to some emails and got ready to sleep. I couldn�t sleep for a while.

November 5, 2007

Woke up at 06:15. Had breakfast and then went to Red Cross Children�s Hospital with Prof. Millar.

I got to meet Prof. AB (Sebastian) Van As. He is head of their trauma program. I joined them on trauma rounds. They have the usual pedestrian orthopedic injuries and MVAs. In addition, they have a lot of child sexual abuse. Rape is very common in South Africa an about a third of all the rapes are in girls less than 12 years old. I saw a 7 year girl who had been raped by unknown assailants. They all get routing anti-retroviral therapy (ART) because HIV is endemic in SA. The incidence is 1:10 across the board but 1:3 amongst sexually active individuals. Since routine ART for rape victims was instituted, the sero- conversion rate has been in single digits.

I saw a fascinating device � The LODOX. It stands for low dose x-ray. It�s a machine developed in South Africa initially by the De Beers diamond parent company. Because of the business practices of De Beers, they had to form another company to market it. The design originated form an x-ray machine that was quite and low cost that could do a full body scan quickly. It was initially used to search for hidden diamonds in miners but is now used for trauma in its 4th generation. The company has had trouble getting it marketed and sold. It�s an excellent tool for a quick trauma screen. I t would take the place of routine C- spines, CXR and pelvis. They have the machine right in their trauma resuscitation bay. There is some turf battle with the radiologists as to who reads the images and thus who bills for it. Not an issue in SA but more so for sales in USA. It would be an excellent tool for a busy trauma center or the military. Afterwards, Sebastian took me to their equivalent of Safekids program. They have a huge pediatric trauma data base with about 1200 entries a year for about 15 years now. They are an advocacy group and have been able to correlate a decline in handgun crimes following the establishment of stricter requirements for purchasing guns. I went for coffee with Sebastian and Alastair. Alastair then took me to the adult hospital, Groote Schuur to see the only active James IV member in South Africa � Phillipus Bornman � a GI surgeon. He was delighted to see me wearing my tie. I also got to meet the head of Surgery . We went to see the transplant museum where Christian Barnard did the first heart transplant but it�s closed for renovations in preparation for the 40th anniversary of the event Dec. 9. This was an interesting historical note.

My interest in pediatric surgery actually started from my reading the biography of Christian Barnard in the Reader�s Digest. What fascinated me was not as much the heart transplant that he did, but the fetal dog experiments to document the etiology of intestinal atresias. Interestingly, I also did my general surgical training at the Medical College of Virginia in Richmond where Christian Barnard spent some time learning from Richard Lower before returning to Cape Town to hurriedly perform the first heart transplant. Prof. Millar gave me a book chronicling the events of that time. Apparently, Barnard was not that much liked in Cape Town either. He seemed to be �full of it� and was not considered to be an excellent technical surgeon. He was assisted in those operations by another surgeon. He had a brother who was also a nicer person and surgeon.

We then went home and went with his wife Sue to see the sights. We first went to Boulders� Bay where a large colony of African penguins had taken over the beach. We drove along the waterfront and saw the vineyards etc. We then drove up to cape of Good Hope and onward through the park to Cape Point. This is the point where the cold Antarctic currents meet with the warm western currents from Mozambique. It�s a splendid wild life refuge. We didn�t get to see any whales but saw baboons, ostriches and a snake. It is really not the southernmost tip of Africa as earlier sailors first thought.

Afterwards, we came home, changed quickly and went to dinner with the surgical faculty and spouses. It was lovely evening. I tried the springbok meat. It was gamy and very nice. It was very nicely prepared. We went back to the house. I stayed up late preparing my talk. I feel so sleepy during the day and then can stay up late at night.

Tuesday November 6, 2007

I woke up at 06:15 and got dressed for work. My throat has been sore since the flight over. My voice is still quite raspy. I took some honey and lemon. We set out for the talk. It was a 9 AM grand rounds and was well attended by the pediatric surgeons, neonatologists, radiologists, etc. The talk was titled Fetal Surgery: From the Laboratory to the Theatre. It went very well. The movie played well. It was very well received and there were several questions afterwards. My voice got stronger as the talk progressed. Afterwards, we had tea and I then went with Prof Millar to the oncology conference.

Once that was done, I had the afternoon off. Sue Millar took me to the waterfront. The tour to Robben Island was sold out for days. I asked if there were any cancellations. I was told there were none but to check back. When I returned, I was offered a spot. I took a ferry to Robben Island to visit the maximum security prison for political detainees. It was a fast moving ferry and the Atlantic waves were huge, 20-30ft. It made for a thrilling ride with the wind and splashes of salt water in my face. Robben Island is a beautiful island. The prison tour was conducted by former detainees. It was very well done. We heard about the deplorable living conditions. We saw the prison cell in which Nelson Mandela spent 27 years. It�s smaller than a powder room. He slept on a rug on the floor for the first several years. He had no toilet facilities but a bucket in the corner for solid and liquid waste. He was in solitary confinement for 23 hours of the day. We learnt about segregation even in the prison between blacks and colored. This even included their diet � No jam, less sugar, no bread. Returned to the mainland and spent time at the Robben Island museum reading about the colorful history of the island and how it have been used for political prisoners and a leper colony at various times. Alastair brought me back home. I spent some time working in the abstract for the Wound Healing Society. I went to dinner with another group of surgical faculty. We went for a walk long the pier afterwards. I was returned home about 11PM. Again, I stayed up late, packing and talking with Toyin on Skype. I leave for Johannesburg tomorrow.

Wednesday November 7, 2007

Woke up 06:00. Had breakfast and went to the hospital with Prof. Millar. Sue gave me some gifts for the children. We listened in on the morning report. I took a picture with the group. I then went to visit the burn unit. It�s a very impressive place that they have dedicated to pediatric burns. We took a tour of the various units in the hospital. We stopped by theatre to see a jejunal atresia case. Red Cross War Memorial Children�s Hospital is the only free-standing children�s hospital in South Africa. It was built after the second World War but has been sustained by public funds and some private donation. They see a lot of trauma and are trying to downsize to a tertiary/quaternary facility. They have a noneonatal unit but no ECMO. They do liver and kidney transplants.

I got to the airport about noon hoping to catch an earlier flight to Johannes burg but it was full. My 13:40 flight was delayed a bit. Two-hour flight. I had no luggage problems. I was met at the airport by Professor Peter Beale � Chief of Pediatric Surgery at the University of Witwatersrand and Johannesburg General Hospital.

We sped through traffic to arrive at 17:20 for a 17:15 meeting. I spoke to an audience of general and pediatric surgeons and registrars. The Chief of Surgery was having an attitude. I really didn�t pay any attention to it, but Pete apologized. The talk was on the management of fetal lung lesions. It was well received. Afterwards, I checked into the Sunnyside Park Hotel just adjacent to the Johannesburg General Hospital. Peter Beale�s associate (Originally from Afghanistan) took me to a stage showing of the Lion King. It was spectacular. Even better than the one we had seen in Houston. I got back to the hotel by 11 PM. Again, I stayed up late. I tried to complete work on the acute gastric volvulus paper. Revision due in by November 9.

There are 7 pediatric surgeons in the Jo�burg area. Two work at the Johannesburg General Hospital and 5 at Baragwana Hospital. Johannesburg General Hospital is a huge complex that initially had about 2000 beds. They are now down-sizing to about 900 beds. Peter Beale has been here for about 25 years now. He recently became the chief about 2 years ago. They all have a private practice that they cover as well. Only uninsured patients tend to come to the general hospital. All others go to the private hospitals. Pete covers about 4 and Bob 14 private hospitals. The other pediatric surgeons cover about 6 between themselves. The general hospital facilities are fair. The private hospitals are first class in terms of their facilities, presentation, equipment and overall ambience. I visited the Park Lane Hospital owned by Netcare and also a Med Clinic-owned hospital in Sandton.

Thursday November 8, 2007

I woke up early but didn�t get picked up until about 9 am. I spent the day with Prof. Beale in the theatre. He did a jejunal atresia (type I) and I watched him do a division of posterior urethral valves and bladder neck reconstruction for a child with epispadias. I also went with him to do a circumcision at Parklane Hospital and to see a post-op patient in Med Clinic Sandton. I went to his home and met his wife, daughter and son. We all went out to dinner at a seafood restaurant, Montego Bay in Sandton. Afterwards, we walked through the Sandton Mall and the Nelson Mandela Square. Got back to the hotel about 10 PM. I finally got the revised manuscript for CDH with gastric volvulus submitted. Spoke with Toyin via Skype. I slept off before touching up my talk.

Friday November 9, 2007

Hurriedly got my talk ready. Got to the hospital about 7:50 for the 8:00 AM talk. I was able to set up and got started on time. I saw a flyer of the talk and changed my title accordingly. Gave the latest version of the fetal surgery talk. It was very well received. Lots of questions and commentary at the end. My voice is ok now, Thank God. Afterwards, we had tea. Prof. Gname Pitcher then took me to Soweto to see the Chris Hani Baragwanath Hospital. This is a hospital in what used to be an old army barrack. It has undergone several levels of transformation. There are private-public collaborations e.g. the Johnson & Johnson Burn Unit, etc. These are new modern facilities that are sponsored by entrepreneurs and donors. They have a maternity unit that is a long hall. There are about 23 birthing �suites� which comprise a bed and partitioned rooms with a curtain for privacy. Many women were writhing in the throws of labor so I guess epidural anesthesia is not very common. They deliver about 23,000 births each year. Interestingly, every woman in labor in the birthing suites had a fetal monitor in place. That�s impressive. The neonatal unit has only 12 level 3 beds. Considering the number of deliveries, it�s survival of the fittest. Ethical decisions are made daily about who to resuscitate and offer long term care. There are obviously no attempts to prolong the lives of children with multiple complex anomalies or micro-premies that can tie down beds and resources. It�s impressive how they are able to make limited resources work. They have also been able to partner with the private sector to fund and build some infrastructure that is then run by the hospital. After the tour of Baragwana hospital, I was returned to the Parkside Hotel. I took a nap, ate a buffet lunch at the hotel restaurant and packed up my stuff. I had requested and been granted a late departure. I checked out about 6 PM. Left on a 9.30 PM flight for London Heathrow. Uneventful flight. Slept a bit. Didn�t watch any movies.

Saturday November 10, 2007

Arrived in London about 7 AM local time. I spent the day in London and got on the 10.30 PM Virgin Atlantic flight from Heathrow to Lagos.

NIGERIA

Sunday November 11 � Tuesday November 13, 2007

Arrived safely in Lagos about 6 AM. My luggage took over an hour to come out. Afterwards, I waited for the North American Airlines flight from NY to arrive and found Mrs. Clementina Ojo to collect my mother�s medicines. My brother met me at the airport. We drove from the airport straight towards Akure about 300 miles north east of Lagos, where my family lives. Arrived about 2:30 PM. It was nice being home and seeing my parents and grandmother. I spent the next two days just vacationing with my family and learning about the changes in the health system in Nigeria in general and in Akure in particular. This is even of greater significance considering the health needs of my mother over the last year. Unfortunately, despite the trem3endous potential, the system is still below par.

Wednesday November 14, 2007

Woke up early. Went to Ife about mid-day. Stayed with Prof and Mrs. Balogun (my in-laws) in their new home. It�s a very beautiful place. Mrs. Balogun had organized a reception for me. Many of my old friends from medical school and a few teachers came. It was a nice cozy gathering. Afterwards, I started preparing for my presentation tomorrow.

Thursday November 15, 2007

I woke up a bit late. Mrs. Balogun took me to the hospital and the faculty. We drove through the Obafemi Awolowo University Campus, my alma mater. So many things in the state of disrepair. Poor maintenance. We stopped at the College of Health Sciences. The provost was not in town and neither did we see the dean. We met some of my old teachers � Dr Akintomide (internal medicine) and Dr. Olateju (ophthalmology). We stopped by to see Professor Odesanmi (emeritus professor of pathology). I went on a tour of the hospital. It�s still in a poor state. The wards are dark and dingy. The neonatal unit is small. No ventilators. Most of the neonatal patients carried a diagnosis of birth asphyxia, neonatal sepsis or neonatal jaundice. I visited the intensive care unit. A ventilator on the side was decrepit. The unit was lacking for monitors and state of the art materials. The pediatric surgery unit had about 5 patients � MMC, Wilms� tumor, bowel obstruction, ruptured appendicitis, etc. Not much has changed since I left except that the buildings just look worse. There is the problem of weathering and acid rain. The absence of a maintenance culture also does not help. I had a long talk with the chairman of the medical advisory council of the hospital. He has a lot of bright ideas to revamop the hospital. He also is very optimistic and listened to my comments. The main limitation has been funding for equipment and training. Some grants have recently become available. The future looks promising�but that�s what we heard over 10 years ago.

I returned to the Baloguns� home. My parents arrived to join us for the presentation. We all returned to the hospital for the 4 PM presentation. I had not seen many posters advertising the event. Nevertheless, it had been moved to the cafeteria to allow for a larger audience. My brother was unable to make it in for the presentation. The room was packed full. Standing room only. The power supply failed just before I started but the back-up electricity generator was promptly started. However, the air conditioners did not come on and the place got progressively hotter. There were many consultants, residents and medical students from Surgery, Obstetrics and Gynecology, anesthesiology and pediatrics. The talk went very well and was well received. It was geared towards encouraging and inciting the younger ones to reach for the stars and not allow their environment to limit their potential. The talk received a standing ovation. With the state of the hospital, there are more pressing issues than attacking fetal surgery. Nevertheless, I think the talk hit home. I was awarded a plaque as the distinguished guest lecturer. Nice comments by my Professors � Uche Onwudiegwu (O&G) and Odesanmi (Pathology). We all stayed at the Balogun s� house. Slept late.

Friday November 16, 2007

I sent an email to Dr. Ajuwon of National Hospital Abuja, that it was unlikely I would make it to Abuja on this trip. He understood. I let for Ibadan, and then to Lagos. We would be celebrating the 25th year anniversary of graduating from King�s College Lagos tomorrow. I stayed at my brother�s house in Lagos. Two childhood friends � Ayo Oyewole and Ayo Onafeko came to visit. I visited with other family and friends and returned to the US on Sunday morning.

I retuned to the USA Sunday November 18, 2007.

Final Thoughts

The James IV travel Fellowship offered me a tremendous opportunity to visit various parts of the world. I chose to visit places that were not very typical of prior awardees and found the experience very rewarding. It required me doing a lot of background work, researching the places and identifying contacts. It was a real eye-opening experience.

I have been able top share some of mye expertise with surgeons in these different parts of the world but I think I have learnt even more in return. Moreso, I have established relatiuonships that I hope to nurture for a long time. I have always seen myself as a citizen of the world. This experience truly helped re-inforce that. There are people all over the world in need of care. It is nice to see that there are committed surgeons trying to meet these needs even with much limited resources than we waste in a week. It�s amazing how much can be accomplished with so little when the desire is there. I also realized that some countries possess most of the equipment and resources we can boast of in the US, and even some we don�t have access to. Our delivery of services and care for our patients can only be enriched by reaching beyond our borders to interact with surgeons the world over.