Friday, December 21, 2007
Uganda, Pictures
Arrival: http://www.facebook.com/album.php?aid=16624&l=d283e&id=725887773
The Team: http://www.facebook.com/album.php?aid=16998&l=b2a7f&id=725887773
Mulago Hospital: http://www.facebook.com/album.php?aid=16876&l=7c191&id=725887773
Surgery: http://www.facebook.com/album.php?aid=16990&l=3eae4&id=725887773
"Mother and Child Reunion:" http://www.facebook.com/album.php?aid=17344&l=0b176&id=725887773
Kampala Scenery: http://www.facebook.com/album.php?aid=17333&l=e4559&id=725887773
Out-of-Town Scenery: http://www.facebook.com/album.php?aid=17336&l=2b78e&id=725887773
Animals (1): http://www.facebook.com/album.php?aid=17471&l=4d77f&id=725887773
Animals (2): http://www.facebook.com/album.php?aid=17472&l=c589e&id=725887773
Children: http://www.facebook.com/album.php?aid=17554&l=939e7&id=725887773
Sunday, December 16, 2007
Uganda, Day Ten-Eleven, 8/20-8/21/07
Early to bed, early to rise. This time, we woke up at about 3:30 AM. My alarm clock provided the rude awakening, but the ice-cold shower that greeted me next made it even ruder. Our hotel in the city of Fort Portal had planned for a much smaller group, so myself and a few other comrades ended up bunking in a small bed and breakfast on the outskirts of town the night before. We grabbed some breakfast and were headed back to Kampala in the still-dark morning.
God is so good. I learned this and was reminded of this so many times during my short stay in Uganda. He stayed with me through so many tough situations (like He has all my life) and through so much apprehension and anxiety...A Wonderful Counselor indeed. I saw how little the people have there, how much we as Americans have, and how badly He wants us to rid ourselves of our crutches--the things we have that we worship and idolize and think sustain us when really all we need is His provision. I saw people praising God and rejoicing in the fact that they can know Him and experience Him--even if they didn't have a moped or a car, or a house with a floor, or even shoes. They had no inhibitions and therefore worshiped freely.
Isn't that how it should be? Shouldn't we--who have been given so much more--be that much more grateful? I thank Him for this experience and for the people He provided to team up and do His work. Now that I'm back home, I only hope I don't fall back onto my old crutches--my sources of insulation and security--that keep me from trusting God for every little thing...even a razor and a can of shaving cream...Uganda, Day Nine, 8/19/07
Off again for another early morning game drive where we saw more of the same animals as the day before. However, we would then leave for Fort Portal and then on to Kibale National Forest to track chimpanzees.
The hike was awesome...it felt great to finally break a sweat and get some good exercise. Standing for hours on end in the hospital will tire you out, but this kind of rigorous activity was really just what the doctor ordered--and just what I needed to work off all that matoke!...(a traditional Ugandan "mashed plantain" dish). We headed back to Fort Portal, ate some dinner--easily the best meal of the trip so far--and got to bed early.Uganda, Day Eight, 8/18/07
The game drive was absolutely amazing. These animals are really something to see in their natural habitat. Sorry, Dad, but our "nature shows" don't even come close--no matter how cool I think Marty Stouffer (the guy from "Wild America") is. We watched baboons, impala, water buffalo, water bucks, bush bucks, enormous termite mounds, warthogs, vultures,
and even a pride of lions who had just finished breakfast. We arrived just a little to late to see the kill. By this time, the lions were "fat and happy," very lethargic after gorging themselves on their meal. We took tons of pictures...thanks for the camera Mom and Dad!
After a couple of hours, we made our way to our next stopover, the Mweya Safari Lodge. I've got to say that this may be the most beautiful place on God's Earth. It lay at the end of a game trail and is flanked on almost all sides by Lake Edward to the north and west and The Kazinga Channel to the south. The lodge sits at the top of a huge hill, allowing you to see wild animals and breathtaking scenery for miles in all directions--over land and water.
We had a bite for lunch--complete with the absolute best passion-fruit juice I've never had--then set out for a hippo cruise in the channel. We saw tons (literally) of hippos, rare African fish eagles, more water buffalo, crocodiles, and all kinds of water fowl. The cruise was fantastic, but the slow moving barge with its droning engines made it hard for anyone to stay awake; I even caught Dr. Haglund bobbing his head a few times. We crammed so much activity into our time, and it was starting to catch up with us.
But, again, the best was yet to come. While we were out cruising The Kazinga Channel, our drivers were out scouting those elusive elephants. Upon our arrival back at the docks, we piled back into the vans and headed off into the bush again. A storm was brewing, and just as the heavens opened up with a torrential rain, a mother elephant and her calf showed up from behind a grouping of trees. They were majestic in the rain, basking in it and shaking off the water with those huge ears. What a find!Uganda, Day Seven, 8/17/07
Leaving Mulago was bittersweet...mostly bitter. The surgeons, sisters, and attendants were very sad to see us go. Rashid, an attendant who had befriended me earlier in the week, brought me a gift wrapped in a cardboard box that had once held surgical masks. Inside was a picture of him, some Cadbury chocolates, and a small drinking glass from his home--probably one of the only glasses he owned. I felt completely heart-broken and honored at the same time. I had no idea what to do to thank him. We were changing clothes in the locker room at the time, so I just took off my Duke-blue scrubs and gave them to him. He was overjoyed and gave me a big bear-hug. We proceeded to go through all the new "handshakes" we had learned and practiced that week, and we promised to keep in touch. We finally left to cheers from the theatre workers, and we traveled back to the hotel to finish picking up the bags we had packed the night before.
From there, we piled into minivans and set off for Queen Elizabeth National Park in southwest Uganda. (We would stay the night in Mbarara en route to the park). We stopped to take pictures at the equator, and one of our vans got stranded with engine trouble. The problem was quickly fixed, but little did we know what this little snag was foreshadowing.
This van would have failed inspection years ago in the states! But, such is life in Uganda. There really is no such thing as preventative maintenance here. When something breaks, you use whatever rudimentary tools you can find to fix it, then fix it again, then fix it again until you finally cannot fix it anymore. At that point, you leave said object where it lies and look for another one. So Michael and I assessed the situation and began to change the tire. However, this task proved much more difficult than first imagined. It was pitch-dark, we had no hazard lights, all kinds of traffic were whizzing by us doing 60+, and we were starting to hear the denizens of the bush rustling beyond the roadside ditch. On top of all that, our tire jack would raise the van high enough to remove the flat tire, but not high enough to put on the fully inflated spare. We pulled the van up to some higher ground, thinking we would have a more optimal place to set up the jack, but this didn't work either. Then, we came to an impasse--should we keep calling the other vans to come back and bring another jack that might raise the van enough, or do we improvise and pull a risky maneuver to get the van higher into the air??? We decided that it might be hours before the vans ever realize we were stranded, so we proceeded with our plan (which I do NOT advise anyone doing unless you are absolutely desperate and have no other way out). Michael and I gathered whatever smallish stones we could find in the ditch and made a little mound. We placed the jack on the precarious pile of rocks to get the van a little higher.Uganda, Day Six, 8/16/07
Another day of scrubbing and circulating theatres, and another day of firsts. Senthil (my roomate and our fearless PA) got to do his first bilateral temporal artery resection. He was so pumped that he had done a great job and the case had gone well, and we were all so proud of him! Both vessels were almost totally occluded, or blocked.
The highlight of this evening was the acknowledgment of Robbie Diggs (pictured here on the far left), for whom the entire hall gave a standing ovation for his efforts. Let me tell you about this humble hero from Anson County, NC. Robbie had agreed to go on the trip in support of another biomedical engineer from Duke. When his counterpart was forced to withdraw from the mission days before leaving, Robbie stepped up in a big way. He was constantly seen running around in circles, fixing light sources that had blown out bulbs from power surges, getting taxied around Kampala, hunting down any available transformers with whatever money he had in his pockets, teaching the resident technicians at Mulago how to operate and maintain these machines...He even had to repair our OR microscope--intraoperatively--that had shut down during one of Dr. Zomorodi's complicated brain surgeries. He would never tell you how many impossible challenges he faced and had to overcome, so allow me...this guy is a stud.Tuesday, September 25, 2007
Uganda, Day Five, 8/15/07
However, on this day, I'm afraid that I've been jaded by such experiences; they've stopped seeming so earth-shattering, so incredible. But, having returned home, sinking backwards into old routines, I have a hard time wrapping my mind around all that happened (and continues to happen) there.
We've all begun to experience the different approaches of those at Mulago looking for "help." ...Not medically speaking, but help nonetheless. Some come in the form of letters, others come right out and ask without inhibition. Today, I was having a snack in the "tea room" when a young man came in and started making small talk. Before I knew it, he got up, looked around, and closed the door to shut us in. I was a little aprehensive to say the least, but that's when he began to pour his heart out to me.
"Please come and meet my family! Just 10 minutes!" he said. "You could walk to my home on your break and meet my wife and son!"
I knew then what he wanted. I would end up meeting his family and becoming attached. He might be able to use this attachment in a desperate attempt to get them over to the states.
"I am a very good worker...I can clean, scrub, fix things...I work very hard."
I felt so awful. I knew there was nothing I could do to get this man and his family to America.
As for the cases, they went well. I got to scrub a spine case with Dr. Haglund: a posterior cervical decompression and fusion, C3-7. (I'd been doing mostly general neuro cases in the pediatric theatre until now). I had brought a ton of spinal fusion hardware--instruments, implants, allograft, etc.--and I was finally getting to use it in surgery. This was so weird; in the states I'm only allowed to point at things and tell the surgeons and scrub techs which instruments they needed. I end up "miming" the way the instruments are to be used with my hands. By no means could I EVER scrub in or contaminate the sterile field as an OR consultant in one of my hospitals in the US. There was a little voice in the back of my head saying, "You're not supposed to touch that drill guide!!! What are you doing?!?"
The cases went well, but we were so tired when we got back. I felt terrible for our folks in the ICU and for Senthil, our PA, and for our surgeons. They still had hours to go.
Saturday, September 15, 2007
Uganda, Day Four, 8/14/07
Dr. Ali Zomorodi (theatre 1) had a remarkable case today--heroic is probably a better word. One of his patients--a young boy, maybe 4 years old--had an abscess on his brain stem causing paresis--or near paralysis--on his left side. Before surgery, he was flaccid and paretic, but after Dr. Z meticulously removed the abscess, little Nelson came out with almost full motion!
When his mother came to PACU to see her son, she was beside herself!...and with good reason. She had never seen him move his left arm, and here he was, reaching to her with both!!! We all basically had to stop whatever we were doing and just absorb the moment...got some good pics of this one.Uganda, Day Three, 8/13/07
Our three cases for the day were all hydrocephalus patients--all very young--around 6-7 month-olds. The first two needed shunts, and the third would receive an "EVD" or an external ventricular drain to relieve the intracranial pressure caused by excess cerebrospinal fluid. I ran the table on the first two, and was "first-assist" on the third (taking Senthil's place on this one--he was needed in another room). This first assistant helps the surgeon by suctioning the wound, cauterizing bleeders with the bovie--or "hot knife"--and bayonette instruments, holding retractors, helping with sutures while closing, applying dressings (xeroform, gauze, op-sites), etc.
The pediatric theatre had no air-conditioning, but the doctors were fine with this because ped's rooms are supposed to be hot. Patients lose a lot of body heat via the open wound during surgery. Warm blankets fed by a heater can help, but with the little kids, you really need to be careful because of their tendency to lose body heat faster than adults--hence the need to "keep the heat on." I didn't realize how much of a difference it made to be scrubbed in a room like that with all the extra gowns, gloves, etc.--WOW. I had sweat pouring down my face, back, and legs...and there's nothing you can do about it for hours! You can't scratch your face without contaminating yourself! Talk about a new-found respect for our scrub nurses!We arrived at the hospital at 8:00 that morning and didn't leave until about 10:30 that night (others--PACU nurses, ICU nurses--had to stay even later), and having missed dinner, we were all pretty beat.
Thursday, August 30, 2007
Uganda, Day Two, 8/12/07
This has been without a doubt one of the most special days of my entire life. (How's that for a teaser)? Where do I even start??? We began this Sunday with breakfast at the hotel where Francis, our attentive waiter asked me, "Are you born again? Are you saved?" I found this odd considering the only question he had asked anyone else at the table was whether they wanted more coffee or tea. I forgot that I had my Bible sitting beside my pineapple juice.
We then proceeded out of town, on to the village of Seeta. ...And I thought Mulago Hospital was eye-opening! After an exceedingly bumpy ride, we finally arrived at Pastor Senyonga's orphanage (although they don't use that term). The children came screaming out of the school house and down the hill to greet us.
As we piled out of the bus, they latched on--starving for affection. They literally wouldn't let go! This orphanage consists of children--ages 3-12--whose parents have died of AIDS. The women that care for them and teach them are widows. They live in a smattering of small houses that cost about $15,000 to build.
Senyonga explains that one of the reasons behind the cost is that they are built with the finest corrugated steel roofing in all of Uganda! All in all, if it weren't for this "camp," all of these people would be fending for themselves on the streets of Kampala.
We spoke with them, enjoyed their songs, but mostly listened to one of the teachers report on the childrens' performance in school. She raved about their reading skills, how some were already at an advanced level, and how all dreamed about moving on to an outside secondary school. I'm finding it very difficult to wrap words around this experience. Just too much...
After lunch, we headed back to the hospital to finish setting up the theatres for the week. It was there that Jenny Parker, Augusta Bartis, and I learned that we would be "scrub nurses" for the week in Dr. Parker's pediatric room, Theatre 2. (This person is scrubbed into the OR, runs the "sterile field" with all the instrumentation, and assists the surgeon by holding retractors, maintaining pressure, cauterizing bleeders, etc.). Needless to say, I was a little disconcerted by this news, but hey, what else were we there for? So, Yvonne Carver gave us all a crash-course in sterile technique and all the instruments. We even took some back to the hotel to practice our terminology.Wednesday, August 29, 2007
Uganda, Day One, 8/11/07
We are given a tour of the 1500-bed hospital and all the wards. I am startled at the condition of some of the patients. We made a brief stop in the pediatric ward where many children need shunts (small pumps designed to drain fluid away from the brain) to alleviate the pressure in their heads created by hydrocephalus, an accumulation of cerebrospinal fluid under the dura-mater--the brain's outer-most membrane. The skull continues to grow to accomodate the fluid, and some of these kids--mostly around 6 months to 2 years of age--have 50-60 cm crania. Some cases are so bad that the children have massive pressure sores on the back of their heads because of their inability to move them. Others cannot close their eyes because the skin is stretched so tightly. Many of these patients and their families have trekked across the entire country because they had heard we were coming to Mulago. Some had employed--with little to no success--the services of witch doctors before coming here as a last resort.As we "pressed the flesh" with all the local dignitaries--cameras rolling, reporters prodding, nurses cheering--I can't help noticing a young mother covering up her child in the back corner of the ward. This is not a cheerful day for her.
There is also a banquet held in our honor, hosted by Dr. Mallinga, several doctors from the hospital, and a representative of President H.E. ("His Excellency") General Yoweri Museveni. Dr. Mallinga likens our arrival to that of the Yanks landing at Normandy. "The Americans have landed, and things will not be the same," he states. Our reception at Mulago has been extremely warm and gracious.
We spend the rest of the day trying to find our equipment that had been delivered in crates. To our amazement, not one crate was lost in transit. I don't think you can fly from Raleigh to Atlanta without losing something! We had no tools to de-crate the big stuff, so Robbie Diggs (our hero of an engineer), myself, and a team of men we assumed were hospital employees used a flat-head screwdriver and a random 2-foot rod we found on the floor of the warehouse to pry everything open. We all spent the balance of the day setting up the OR's, or "theatres" as they are called here. We arrive in Uganda, 8/10/07
Thankfully, we had enjoyed relatively uneventful travels. I did, however, hit a snag in the Amsterdam Airport. One of my carry-ons was a cranial reconstruction tray zipped up in a canvas bag--complete with plates, screws, screwdrivers, scissors--yes, scissors--and other random sharp objects. This was obviously not a big hit with the screeners, so of course I got the run-down by the "Dutch Barney Fife's" (hopefully no one in Holland watches Andy Griffith). But hey, I was not about to check this $130,000 bag under the plane just to have it end up in Jakarta or something; I'd ride with it in steerage if I had to. I had to open everything up--microscopic plates and screws spilling everywhere--while even the supervisors were calling in their supervisors. Thank goodness Dr. Schroeder was there to substantiate my alibi as I almost lost one of the most crucial pieces of equipment that we would inevitably need right off the bat in surgery.
As we piled into the bus, I grabbed shot-gun--a position I would later regret. We sped from Entebbe to Kampala (about a 45 minute trip, but probably around 2 hours for us normal law-abiders), narrowly missing mopeds, bicycles, pedestrians, other cars by mere inches. Considering the combination of speed (about 70 km/h), volkswagen-sized potholes, and other "obstacles" challenging our driver, I think the term "white-knuckle-driving" was invented here. Later, we settled in for the night at the plush Kampala Serena Hotel for a much-needed nap.Off to Africa...
So what was the big idea? Update the hospital with new equipment, instrumentation, and modernized techniques, build relationships with their docs and nurses (a.k.a. "sisters") that would facilitate the sharing of ideas--clinically and culturally--on both sides, and hopefully help some people out while we were there.
So why the blog? I wished I could have done this while I was there, but wasn't able to fit my lapper in the suitcase along with the screws, plates, allografts, instruments, and other contraband. Therefore, when I got home, I decided to do one of those "after-the-fact" blogs (many other un-blogged pics are available upon request by the way) to document the things we did, the things we saw, and just how good God is in the heat of it all...
