2011 Uganda Spine Surgery Mission Blog
DAY 12 – Thursday August 25th:
It seemed as though the second week flew by and the final day had come at last. Ngozi had been invited to give a lecture for the Physiotherapists in the New Mulago hospital, where some of our more difficult ICU patients had passed through. Compared to the spinal ward, the New Mulago was the Bellagio. It had been established in the 1970s by Idi Amin, the Ugandan President, as a military hospital and it was considered among the most prominent hospitals in East Africa. In reality however, the Mulago hospital, like the spinal ward, is now in serious need of “rehabilitation.” The team really appreciated Ngozi’s didactic teaching and demonstrations and insisted on exchanging contact information for future correspondence. Ngozi was relieved and delighted that she had gone from rejected to respected in terms of the value of her services and relationships with local physiotherapists on the spine mission and her patients. She even got a wave out of B.A., the 7 year-old girl from Monday who wouldn’t crack a smile.
Having already completed 16 surgeries, we expected a smooth final day in Kampala. But, as you may have guessed, fate struck us once again and the Mulagosystem tried to siphon off our last bit of energy. We arrived eager and early just to learn that the water supply to the autoclave had been disrupted, so the surgical tools could not be sterilized. We waited three hours for the water to come back on, and were finally able to start at 12:05pm.
The procedure was for M.W., a 51 year-old female school teacher with mechanical back pain with radiation to her legs since an accident in 2001. Two years ago she had a decompression procedure but had no substantial pain relief. She wore a back brace and used a cane with only minor relief of symptoms. Recently she had been experiencing right arm weakness and right-sided neck discomfort presumably due to neck problems. An MRI showed degenerative changes and narrowing of the spinal canal and intervertebral foramina (the opening where the nerves exit the spine). The team, with the help of interested local orthopedics residents and students, conducted a posterior L4-5 lumbar decompression and fusion. They approached from the back, removed part of the lamina (back wall of the vertebrae)and the arthritic facet joints, gently moved the nerves aside (this low, called the caudaequina, or horses tail) while working to remove the disc and replace it with bone graft and a cage. They also inserted screws to maintain the spinal column stability until the bone fusion consolidated. Despite the late start the team still completed the case efficiently and all went well.
At the end of these two anxiety provoking, yet gratifying weeks, we were ready to return home, but all struggled with the thought of leaving behind so many in need.Despite the emotions , as we left to pack our equipment and get ready for the trip home, patients expressed their deepest gratitudeand pleaded for our contacts so they could keep us informed on their progress.
The team still however had one final challenge, get the equipment packed and collected from two hospitals and loaded onto Mr. Metu’s truck (the local shipper) to be sent home, all in time for a celebratory dinner . Brian worked effortlessly to catalogue and box the gear while we shuttled boxes up and down stairs to the shipping van. Lieberman set a challenge, “dinner at the Lawns by 8pm.”We arrived at 7:55, for a fine meal of Ostrich burgers and Chili Crocodile, serenaded by the clapping of rain on the wooden roof. At dinner we shared our thoughts and feelings, our perspectives on the value of the mission and how we could continue to improve future missions. We spoke of the strength andbrother(& sister)-hood of the human spirit, our impact and how the Ugandans continue to learn from us, and we from them.
Quote of the Day:
“The behavior of the Uganda peoples is like video games. They think they have three lives. But this is not true. They have only one.” – Kris, on the whimsical attitudes and reckless standards sometimes encountered in the equipment, protocols, and patient care guidelines in Uganda’s health care system.
This year’s mission set the standard for productivity, emotions and future goals. New lessons were learned and old lessons were re-affirmed. The veterans were solid and the rookies were dependable.
I am consistently reminded of how many good people there are on this planet. Likewise I am constantly reminded of just how much need there is throughout the world. I strongly suggest that if anyone reading this message has even the slightest inclination to become involved or contribute to such a mission, please seriously consider the opportunity and take the leap to participate. It will change your mindset and your life.
Personally I will remember this mission as the most special on three accounts. I had the privilege of having my mother (Noemi Lieberman) accompany the team and myself on part of this mission; I was accompanied by three of my most respected colleagues (Kayanja, Siemionow & St Clair); and I was able, with the help of many, fulfill my promise to deliver a sefer Torah to the isolated Jewish congregation in the village of Putti.
By virtue of my position I tend to undeservedly get the all the credit for these missions. It is impossible for me to ever fully acknowledge all those who have contributed to the success of this mission. Please rest assured that I will I never take for granted all those who have contributed along the way.
1) 13 participants (including 2 anaesthesiologists and a physical therapist), two teams, clinics and surgeries at both Mulago and Case hospitals
2) Delivery of over $200,000 worth of medical supplies, divided by need to both Mulago and Case Hopsitals
3) Distribution of 200 Kinder Kits (school bags) to children
4) 17 complex spinal reconstruction surgeries
5) Daily teaching of residents, scoliosis lecture to staff and orthopaedic residents, physical therapy lecture to therapists
6) Delivery, training and donation of BPAP breathing assistance machines to Spine ward at Mulago (courtesy of DrSkulmowski&Kusza)
7) Formalize collaboration agreement between Case Hospital and Uganda Spine Mission for future care of the less fortunate
8) 8 surgeries scheduled for August 2012
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