Uganda Spine Surgery Blog- Day 3 and 4

By Erin Sadler
July 26, 2012

On Day 3 (Tuesday July 24) we undertook our first surgical procedure at Mulago Hospital. The team was eager and excited to get started, but we were quickly reminded of the Ugandan culture: slowly, but surely. Arriving at Mulago in the early morning, we anticipated getting started right away, but unfortunately we found that the sterilizer had broken down and the instruments that were required for the case had not been sterilized. This put a slight damper on the schedule, as the team had to wait until the instruments were sent to New Mulago, another affiliated hospital, to be properly sterilized before we could operate.
While half of the team was dealing with setbacks at Mulago, the other half traveled to Case Hospital to see patients in a back pain clinic, and prepare the equipment for a surgical case that would be occurring the following day at Case Hospital. It was an interesting contrast to see the patients in the outpatient back pain clinic in comparison to outpatients at Mulago. While those at Mulago tended to have extreme pathology, they expected so little; whereas the Case patients had relatively milder pathology, yet expected the world.
Upon seeing all of the back pain clinic patients, everyone congregated at Mulago to catch up with how their day had been going, and to see what progress they had been able to make under the extreme conditions of this Hospital and its amenities. It was a relief to learn that the procedure had gone relatively smoothly, but was not without its trials and tribulations in regard to equipment availability and malfunctioning, room and body temperature incompatibilities, and getting started much later than they had anticipated. As they closed up, the team breathed a sigh of relief that the first case of the mission had been completed without too many hiccups, and everyone felt that as a team we were coming together as a very high functioning group, where we are learning each other’s working styles, and building trust and confidence in our working relationships.
After what seemed to be a very long day, we went out for a very animated dinner at a local pizza restaurant. Although the service was as slow as molasses going up a hill, I personally appreciated the leisurely pace of the meal, as we all seemed to be enjoying each other’s company, stories, confessions, and lessons of the day. Today’s lessons coincidentally had a “P” theme, with lessons around the concepts of perseverance, power, polar: for bipolar, pressure, personal lives, Precious, and a few other profound morals of the day.  Once the pizzas finally arrived, we quickly realized they were well worth the wait, and the fresh advocado that adorned most of our pizzas lived up to its reputation. We all delved in to these delicious pies, amid beautiful mood lighting provided to us by several Iphones at the table, as the power had gone out and left us in pitch black darkness.
Day 4 was another day of surgery, where cases were taking place at both Mulago and Case Hospitals simultaneously as the teams had been split up into two groups.  As the Mulago group arrived at the Spine Ward, they were absolutely floored by what they had discovered. They were told that the patient they had operated on the previous day had passed away overnight. This was incredibly shocking and upsetting as the patient had tolerated the procedure incredibly well, was a young man with a good prognosis and was expected to make a promising recovery. Unfortunately, as the team was told through several sources that had been present, it was suspected that the patient had been given food or drink by their family, unbeknownst to them that is dangerous to do with a post-operative patient of this nature. This may have led to aspiration, but ultimately the patient began to have respiratory distress and was transferred to the ICU. Tragically they were unable to resuscitate him, and he passed away in the night.  This was obvious very difficult for us to comprehend, but as a team we understood that unfortunately things can occur that are out of our control, and that is the nature of medicine anywhere you go in the world.
After regrouping, we found ourselves back in the operating theatre of the Spine Ward to do another operation on a suspected osteoblastoma case. Once again, there was never a dull moment in the theatre at Mulago, but upon completion of the case the team felt more comfortable and confident in their ability to adapt to the cultural, time, and equipment differences that exist within the confines of the theatre walls at Mulago.
The other half of the team at Case Hospital also ran into similar setbacks, from repeat blood work delaying the procedure, to equipment failing to work, to recognizing the limits of surgery; needless to say it was also a long day at Case.
The afternoon concluded with seeing some follow ups from Monday, and making operative decisions for the next day at Case Hospital. One small 14 year old boy learned that he would be admitted to have surgery tomorrow.  Such a brave soul, to not even think twice about it, but knowing that this is his best opportunity to try and treat his scoliosis, so diving into it, fearlessly.
Arriving back to the apartments at 7:50 pm, we were given 10 minutes flat to refresh for dinner: stragglers will be left behind! Good thing we’re in Uganda, and glowing with sweat is fashionable, because we were all able to make the aggressive timeline. Thank goodness for our punctuality as it was a delicious buffet dinner. Once again, as a team we started the day, and as a team we ended the day, around a big table, sharing laughter and stories of the day, and always the new lessons that each and every one of us has learned, and will keep with us forever.

Read more of Erin’s blog post and view her beautiful photographs.

Posted by Robyn |