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.

"Oh yes, I am! How about you...um...Francis?"

"Oh yes please, thank you sir!" he replied with an ear-to-ear grin.

From there we met Pastor Senyonga for a trip to Mandela National Stadium--the official football stadium of Uganda. It's magnificent for this area--reminiscent of old Fulton County Stadium in Atlanta. His church is growing at such a rate that he plans on buying the stadium for the congregation and actually renting it out to the national soccer team!

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...

On to Pastor Senyonga's church. Talk about charismatic! We were seated in the first three rows, and before we knew it, we were being asked to come up on stage. Senyonga spoke about our purpose on the trip, allowed Dr. Haglund to address everyone, and then, they prayed over us...and I mean PRAYED OVER US! Imagine about 4,000-5,000 people--spread out as far as you can see--wailing at the top of their lungs in prayer for you...unbelievable!

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.

We finished the day with a nice reception back at the hotel thrown by Dr. Mallinga. It was there that I met some of the few neurosurgeons in all of Uganda, Dr.'s John, Joel, Hussein, and Michael (hopefully they'll forgive me for forgetting last names). We would be getting our hands dirty with these guys throughout the week at Mulago, so we bonded pretty quickly.

Uganda, Day One, 8/11/07

We have finally made it to the hospital we have heard so much about over the last year. This is our first view of anything in daylight: the city, the facilities at the hospital, the people. Wow, the people...they are beautiful, but their faces are hardened by their world. Their stares are stern and blank, but reverent. However, many of them break into grins when you smile at them.

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

After about 27 hours combined travel time (Raleigh-Detroit-Amsterdam-Entebbe, Uganda), we shuffled through customs, showed our yellow fever immunization records, and picked up our bags at the scant Entebbe International Airport "terminal"--wide-eyed the whole time. We were finally on African soil. There to meet us were Pastor Jackson Senyonga (Dr. Haglund's contact throughout the planning stages of the trip), Dr. Stephen Mallinga, the Ugandan Minister of Health, and several doctors and nurses ("sisters") from the hospital.

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...

On Thursday, August 9, 2007, a team of 29 rag-tag medical types (all-stars, really) embarked on a surgical missions trip that would land them in Mulago Hospital in Kampala, Uganda for the next week-and-a-half. To reference, Mulago was immortalized in the 2006 film "The Last King of Scotland." The crew--led by Dr. Michael Haglund, MD, PhD--consisted of neurosurgeons, anesthesiologists, nurse anesthetists, scrub nurses, floor/ICU nurses, engineers, and a few gophers like me.

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...