Day 10 – Ebola?
Today we only had one case booked at Mulago hospital. We all woke up in the morning a little bit unsettled because we had all heard conflicting stories as to what the state of Mulago was in regard to the Ebola situation. Although most of the stories involved New Mulago, which is a part of the greater Mulago hospital, but located a short distance away, we were still not completely clear what was true and what was hearsay As it stood, only half of the team was meant to go to Mulago to work on the case. There definitely seemed to be some tension within the team because it seemed like people were unhappy about this situation, but no one was speaking up. Thankfully, before we headed out, there was a team meeting called where we were told what was shared with Dr. Lieberman from the acting director of Mulago Hospital, and from his perspective it was safe for us to go in and perform the operation.
Off we went in the van, the group of us scheduled to do the case at Mulago. This case was an idiopathic scoliosis instrumentation, reduction and fusion on a 21-year-old female. Despite being slightly nervous about the Ebola situation, we all pulled together as a team and supported each other, mostly with lighthearted humor about the situation, and got through the case very successfully.
Day 11 – Last Day of Surgery at Mulago
Today there were two cases planned, one at each of the hospitals. At Case Hospital, we had planned to perform a difficult procedure on a 3-year-old female with a mass in the cervical region of her spinal cord. Knowing the delicate nature of this procedure, Dr. Holman had organized late last week to have some of his more specialized neurosurgery equipment shipped from the United States to help perform this procedure. Unfortunately, although it appeared that the shipment had arrived in Uganda, it was being held up by customs, and thus we were unable to obtain it. Consequently, this case had to be cancelled. This was such a frustrating outcome, after having planned to perform this procedure, and hopefully make a real difference for this little’s girl life, but instead the Ugandan government prevented this from happening.
While the Case half of the team were dealing with their setbacks, the other half of the team was working on a case at Mulago on a 50-year-old female with a suspected infection in her spine. This group at Mulago also faced their own set of obstacles in trying to undertake this case. When we arrived in the morning we found that the instruments we needed for the procedure had not yet been sterilized, and furthermore, the truck that was supposed to come and pick it all up to take it to where it can be sterilized, was out of gas. As we waited around for the necessary equipment, we rounded on patients, caught up on writing operative reports, grabbed a quick power nap, and Dr. Ughwanogho cracked the whip to ensure our patients were getting their post-operative x-rays after being told that they couldn’t get them because they had to pay for them themselves. Dr. Ughwanogho’s persistence paid off and sure enough, before we knew it we had all of the post-operative x-rays.
Finally, at around 1 pm, we had our instruments sterilized and returned, the patient was ready, and we began the case under the very competent leadership of Dr. Ughwanogho, with assistance from two Ugandan orthopedic residents. There was some uncertainty going into this case because this particular patient had been investigated for an infected process in her spine, but we did not know exactly what we would find. What we did find was a very inflamed spine, with cavitating lesions. Due to the precarious state of this patient’s bones, likely due to underlying osteoporosis, this case took longer than we had anticipated; plus, we had had a considerable late start. Bottom line, it was a late night at Mulago, and when we finally had finished it was around 8 pm.
The rest of the team had gone to an evening reception, hosted by the Mulago administration, but as we had had a long and frustrating day, exhausted and starving, we headed home and went out to grab a late dinner. We eventually met up with the rest of the team at the apartments and discussed the trials and tribulations of the day, but encouraged by the positive outcome for the patient. Moreover, I think this was an important day for Dr. Ughwanogho, as he was able to reaffirm to himself just how talented and competent he is as a young orthopedic surgeon, even in the most adverse conditions.
Day 12 – Last Day in Uganda
Today, our last day in Uganda, was spent operating on a 5-year-old male with congenital scoliosis at Case Hospital. While half of the team was at Case operating, the other half of the team went to Mulago to wrap up any loose ends, check in on post-operative patients, and clean up our equipment. Once we had finished up at Mulago, we bid a bittersweet farewell to this place that had quickly become a home away from home for several of us. Although we had only been there for two weeks it became very apparent to us that we had established very strong and special relationships with the health care staff we had been working alongside; not to mention the relationships we had formed with the patients we had operated on and were now on their way to recovery. To me there was definitely a sentiment of this trip not being long enough. It seemed like just when we were starting to get into the swing of things, and starting to really mesh with the Mulago staff, it was time to go. Afterall, there is always more we could do.
Once we had finished up at Mulago, those of us who were not part of the operating team at Case went home to work on outstanding reports, sorting of the thousands of pictures that will be necessary to supplement the trip report, and catching up on other odds and ends. However, our ability to do work was interrupted by a building-wide power outage. Thankfully a generator was brought in, but only lasted as long as a full tank of gas, and then we were once again powerless. This made for more of relaxing afternoon that we had anticipated, but we were not too upset about that!
The operating team finished up the case successfully and without any complications. Upon their arrival home, we all packed up, sorted out the equipment that would be getting shipped back to the United States, and cleaned up the apartments, as we had an early morning departure on Friday morning. After all of our dirty work was completed, we gathered for our final team dinner at a restaurant called The Lawn. It was a lovely evening, with great food, drink, company and lasting stories and memories shared among us all. As usual we shared our personal lessons, but this time it was the lesson of the trip. Although we all shared very profound and meaningful lessons, it became obvious to me that this trip could never be summed up in a single lesson. Each of us has learned invaluable lessons from our patients, colleagues, from the Ugandan way of life as a whole; and more importantly learned more about ourselves than we probably even know. It is my hope that these lessons and memories remain strong and fresh in my mind for years to come.