Putti Village

Contributed by Rachelle Lieberman
After our 3.5 hour drive to Mbale, Izzy, Brian, Erin and myself finally pulled up to Putti Village. Putti is a small Jewish village about 10km from Mbale.  We were warmly  welcomed by hundreds of children and adults, and they were very quick to help unload our van for us.
All of the donations after being unloaded.
After that the women of Putti had arranged a performance for us. They sung and danced beautifully in vibrant  dresses. They even made me a dress and managed to get me up to sing and  dance with them.
Next, we began to pass out all of the donations we  brought. We got sanitary pads for the women, toothbrushes for all,  shoes, t-shirts, and coloring books for the kids, and lots of medication that we left with Dr. Martin (the village’s doctor) in Mbale. They were all so grateful for all we brought them!
That night we had Shabbat services led by Rabbi Enosh in the synagogue proceeded by Shabbat  dinner. It was very interesting to see village life in Putti. It is so  simplistic. They barely have electricity, everything is cooked on an open fire, and they all share living quarters.  Erin and I slept in a room with at least 12 other people, and the same can be said for the 2 boys. There  is such a sense of community, it is very refreshing to see. It may be due to a lack of space and infrastructure, but they are happy!
Izzy, Rabbi Enosh and Sarah
Boy playing with tire in Putti.
The next  morning we once again had Shabbat services and then had to take off to head back to Kampala to rejoin the rest of the group. It took us 5 hours to get back to Kampala due to all the traffic jams, but we are used to those by now. We then joined back up with the rest of the group and had a great dinner at a casino close by.

Uganda Spine Mission

July 30, 2012

Uganda Spine Mission Day 5

By Erin Sadler

Day 5 – Finding Our Stride

Today was another day of surgery at both Mulago and Case Hospitals. The team at Mulago came up with a strategy the previous evening to try to circumvent the resistance of the Mulago staff from doing two cases in one day. We figured that we would tackle a shorter case first, so it would only be mid-morning upon completion, leaving lots of time to start a second longer case. This tactic worked, in addition to strong leadership from Liz, one of our surgical techs, and we had a very efficient and productive day with minimal setbacks or obstacles. It is very clear to see that as a team we are starting to find our stride, achieving an immense amount, with great outcomes, in a relatively short amount of time.

Across town at Case, things were a little bit more hectic. At Case, the other half of the team
were operating on a 12 year old boy with kyphoscoliosis, in addition to spina bifida occulta. After a difficult intubation, the procedure went on without complication until, much to the surprise of the team, the hospital’s oxygen supply ran out. Thanks to the prudent supervision from the anesthesia team, what could have been a potential disaster was averted, and thankfully the procedure was completed successfully. There was also a major display of “taking one for the team” from Jason, our neuromonitor. After questioning the signal he was receiving from the patient, he proceeded to hook up and shock himself to ensure the equipment was working properly. We were all very impressed and touched by his dedication to the well-being of the patient, at his own expense.

Izzy and Sister Rose

Just starting the surgery

Z our anesthesiologist


We once again all reconvened at the apartments in the early evening to share our respective experiences of the day. We then proceeded to dinner, at a ‘new’ restaurant that the previous missions hadn’t been to before. Upon arrival, the veterans on the team realized they had been here before for a wonderful reception dinner, and we were all pleasantly surprised by the ambiance and the great menu. Much like our previous evenings, we ate delicious food, drank a few glasses of wine, and shared many laughs around the table. There were several toasts made highlighting the great work of the team, especially those who have really stepped up and provided great leadership, poise in stressful situations, and selflessness in order to provide the best care possible to the patients.

Uganda Spine Mission

July 30, 2012

Uganda Spine Mission Days 3 & 4

Contributed by Rachelle Lieberman

The past two days we have split the team up into 2 groups. One group led by Dr. Holman went to Mulago hospital to operate and the other team led by Dr. Lieberman went to Case hospital.

On day 3 the Mulago team operated on a 23 year old trauma victim who was paralyzed from the shoulders down. They successfully performed a multiple level cervical corpectomy with anterior plating from C5 to T1. The patient was recovered on the spine ward, however, unfortunately through the night the patient developed breathing difficulties presumably due to aspiration (food and fluid entering the lung) which necessitated him being transferred to the ICU. While in the ICU he continued to deteriorate rapidly and despite aggressive recusitative measures did not respond and did not survive. The team was so disappointed that all their efforts were undermined by events out of their control.

Dr. Lieberman’s team finished up the last of the patient exams in the penalty box at Case and Mulago, seeing another 20+ patients.

 Day 4 both teams performed one surgery. Dr. Holman’s team operated on a 22 year old male and performed a T2 laminectomy and removal of osteoblastoma and fusion from T1 to T3. Dr. Lieberman’s group operated on a 19 year old woman with a severely deforming congenital scoliosis and performed an instrumentation correction, fusion and thoracoplasty (rib resection).

 Both teams had a long day and left the hospital satisfied with their accomplishments.

 Back in Dallas, Texas Back Institute was celebrating the graduation of their current spine fellows and the welcome for this years new fellows. Since Ejovi is one of this years fellows (even though he plans on spending another 6 months with TBI) Dr. Lieberman and him joined the party via Skype. It was a late night considering the 8 hour time difference but very much worth the celebration.

Tomorrow is another long day for all. Dr. Holman’s team have 2 surgeries scheduled and Dr. Lieberman’s team has one. Updates on all to come soon!

I talked about the traffic in our last post so I thought I would share a photo from our drive today.

 

Back pain?  Try these at home treatments.

Do you know that 4 out of 5 Americans suffer from low back and neck pain at some point in their life? Many factors can contribute to this type of pain including poor posture, previous injuries, muscle strains or even disc degeneration.  The good news is most back pain and neck pain will get better without surgical intervention.

Try these tips if you find yourself fighting back pain or neck pain.

  1. RELAX – As I mentioned above, most back and neck pain will heal on its own without surgical intervention.  Stressing out about back and neck pain will only add to your discomfort.
  2. ICE – Apply a cold compress to the painful area.  Ice can be used for the first two or three days to help reduce swelling and inflammation and acts as a mild topical pain reliever.  Quick tip: You can easily make your own ice pack using liquid dish detergent and freezer bags.  Just pour detergent in the bag, seal tightly (removing air) and place it in the freezer.  You may want to double bag it just to be safe.
  3. HEAT – Once any swelling/inflammation has subsided you may want to apply heat.  You can take a warm bath or shower or use a heating bad to help increase circulation to the painful area.
  4. OTC PAIN KILLERS –For mild to moderate pain over the counter pain killers like aspirin, ibuprofen or naproxen can be helpful in easing discomfort. (Be sure to follow the suggested use instructions and don’t exceed the recommended daily dosage.)
  5. STRETCH – Stretching will help extend the muscles in your neck and back and help release stress on your back and neck.  For your neck, slowly roll your neck from one side to the other holding on each side for 10 seconds.  Repeat 5-10 times.  For your back, lie face down and put your hands on the floor.  Slowly lift your upper body and slightly arch your back.  Hold for 10 seconds and repeat 5-10 times.

Most importantly, know when to seek MEDICAL ATTENTION.  If pain persists, seek medical attention from a physician.  If you aren’t sure what type of physician you should make an appointment with, call us! Dr. Effat Jehan is our triage specialist at Texas Back Institute and she can help determine what next step is most appropriate for your condition.

Uganda Mission 2012

July 24, 2012

Uganda Day 2

Contributed by Rachelle Lieberman

Today is our second day in Uganda and we are hitting the ground running.  The words “jammed packed” have several meanings for us today.  Our schedule is packed with appointments.  We were at Mulago hospital by 8 am this morning. Immediately we began to examine all the prospective patients for this year.  We also followed up with patients who had surgeries in previous years.

Below is a picture of some of the patients in the spine ward.

    

Izzy with Stella a patient he operated on in 2010 who is doing great!!!

 Izzy examines one of the kids from the orphanage.

 We ended up examining over 40 people in a matter of five hours. Today was undoubtedly another emotional day for all, but the look on the kid’s and parent’s faces when they find out they are going to get the surgery they need makes it all worthwhile!

Doctors examine a patient in the Mulago Spine Ward.

After all the patients were seen we then planned out the entire first week of surgeries as well as some of the second week. It is truly amazing to think about how many lives we are going to touch in just two weeks.

Izzy giving Dr. Nyatti a book Dr. Jack Zigler authored about spine trauma.

When I said earlier our day was jammed, I didn’t just mean at the hospital, I also meant the traffic! We were stuck in multiple traffic jams while traveling back and forth between the hospital, apartment, and dinner. To paint you a picture, imagine a small town with only a stoplight or two.  Sometimes they work, sometimes they don’t.  Now imagine no driving lanes and no rules of the road – other than honking your horn gives you the right of way. This was slightly stressful for those of us on our first trip to Uganda, but it didn’t seem to faze the mission veterans.

We have another full day tomorrow starting at 7:15 am. Two surgeries scheduled on the books so far, as well as lots of other meetings and organizing to do. More to come soon…

Uganda Spine Mission 2012

It is that time of year again when Dr. Lieberman and his team travel to provide spine care for the citizens of Uganda.  This year Dr. Lieberman’s team consists of the following members:

1) Izzy Lieberman (spine surgeon) Dallas

2) Brian Failla (equipment manager) Ft lauderdale

3) Paul Holman (spine surgeon) Houston

4) Krzysztof Kusza (anaesthesia) Poland

5) Zbigniew Szkulmowski (anaesthesia) Poland

6) Ejovi Ughwanogho (spine fellow) Dallas

7) Sherri LaCivita (scrub technician) Dallas

8) Elizabeth Wolhfarth (scrub technician) Ft lauderdale

9) Negozi Akotaobi (physical therapist) Dallas

10) Jason Ehrhardt (monitoring tech) Dallas

11) Rob Davis (equipment manager) Dallas

12) Rachelle Lieberman (teacher) Boulder, CO

13) Erin Sadler (medical student) Toronto

Today’s post was contributed by Erin Sadler.  Enjoy!

Day 1 – Arrival to Entebbe, Kampala

 The team all congregated at Heathrow Terminal 5 for a 9:15 pm departure to Entebbe International Airport.  After some brief introductions the team seemed to quickly mesh well together and a warm dynamic was almost instantly evident. The team this year is quite large with thirteen members with various backgrounds, from the United States, Canada, and Poland. After boarding the plane many of us were exhausted from our travels that brought us to Heathrow, and thus tried our best to take advantage of the 8 hour overnight flight to Entebbe and get some sleep!

We landed in Entebbe at 745 hrs after a few hiccups from the flight deck in their attempt to land with heavy tail winds. We were all pleasantly surprised by the beautiful weather with temperatures in the mid 20s (68 degrees fahrenheit). We all gathered our gear, minus a lost bag from Poland, and made our way to meet our buses that would be responsible for our transportation for the next 2 weeks. We loaded up the buses quickly and began our journey to Kampala. Along the route there was much to be seen and taken in. The first glimpse of the fertile Ugandan landscape, the vibrant Ugandan people everywhere you look, the pop-up stalls along the road, and the many handmade bed frames for sale along the roadside, without any mattress stores in sight kept us all entertained throughout the journey.

 We arrived at the Golf Course Apartments in Kampala where we will be staying for the next 2 weeks. These accommodations are very comfortable and well outfitted to suit our needs. Between the thirteen members of the team there are two apartments.  Once we had moved our luggage in and had a chance to refresh ourselves and brush our teeth for the first time in too long, we were once again off into Kampala to do some shopping to buy food items for breakfasts and other necessities like water, hand sanitizer, and the odd bottle of wine!  One hefty shopping bill later, and buses packed to the brim we headed back to the apartments to unload and organize ourselves before taking off again to go visit the two hospitals we will be working at.

The first hospital we visited was Case Hospital, which is a private hospital, relatively affluent with decent equipment, services and patient care; quite similar to a standard hospital in North America.

Izzy unpacking more surgical equipment.

Conversely, we then went to Mulago Hospital, which is the national public hospital; located on a sprawling campus of single story bunker-like buildings that serve as different wards. We specifically visited the Spine Ward, where we will be performing operations in the theatre, and the Orthopedic Ward.

Some surgical equipment at Case.

The spinal ward at Melago.

 

Supplies at the spinal ward in Melago.

Both were equally eye-opening: wide open rooms with several beds lined up side by side, filled with patients, and more surprising, the patient beds were surrounded by families. It was very interesting to see the dynamic of patient care in the Mulago setting, where the families seem to be the primary care givers despite the inpatient nature of the hospital accommodations. The families were huddled around the patients, sometimes having created a small area near the patient`s bed where they have essentially set up a temporary squatting home, feeding them self-prepared food, bathing them, and really the only people in the hospital providing vigilant care to these patients. Futhermore, the familial presence extends beyond the hospital walls, where as you walk outside you notice families have found a space to call their own on the hospital property and are essentially squatting there as their loved one remains in hospital. As I toured these poorly faciliated wards, I couldn`t help but question how these native Ugandans view us: as foreigners who are coming to try and help, or perhaps do they question our role in their medical care? To continue this enlightening cultural experience, we then went to walk through a nearby slum in Kampala. As a group we walked through narrow dirt alleyways for streets, which were covered in garbarge and had waste water running down the middle, as beautiful friendly people waved and smiled at us through the hanging laundry, and curtained doorways fondly yelling “Muzungu” as we passed them by. This was unlike anything I have ever experienced before in my life, and not because I haven’t seen images like this on television or in other popular media outlets, but I think I was most taken by the joy and sense of community that I felt in this incredibly extreme and impoverished environment. I guess I expected to feel sadder and helplessness, which I definitely did feel, but these negative feelings were overwhelmed by my feeling that although these people live in the most horrific conditions, their sense of community is really quite powerful and uplifting. Moreover, the throngs of beautiful children with toothy grinned smiles from ear to ear was also quite a powerful sight, for there seemed to be such a sense of responsibility of the older children to look after the young, and the spirit of the child was so clearly evident, it outshone any despair that they, or more likely I, was feeling.

Boy from the slums.

Ejovi playing soccer with some of the kids.

Picture of the slums.

As we got into our buses and drove 5 minutes down the road into our plush apartments it became very apparent how contrastingly different Ugandan life can be, just simply a few blocks apart. We couldn’t help but feel incredibly spoiled as we spent the rest of the afternoon cooling off by the pool, and then heading to an amazing Indian restaurant for a lively dinner and some delicious curries. Before everyone fell asleep at the table, we headed home to spend our first night in Kampala, and have sweet dreams of the upcoming days of hard, yet extremely meaningful work to come!

Our group at dinner.

Stay tuned for more updates!

Guest blogger, Anabelle Gutierrez, Workers’ Compensation Specialist, love her job!

Workers’ compensation can be tricky which is why it’s important to have a concierge case manager dedicated to each patient. At Texas Back Institute we realize this and we have a team of dedicated work comp professionals to help each patient through the workers’ compensation process. My name is Anabelle and I am your resource for anything workers’ comp related at Texas Back Institute.

Anabelle and her beautiful nephew.

I love my job! I have worked at Texas Back Institute for several years and I still feel like every day I am going to make a difference in someone’s life.  My goal is to help walk each work comp patient through their treatment process.  When someone is injured on the job and unable to work it can be exceedingly stressful and I want to make sure when it comes to TBI, we make the process as easy as possible.

I strive to provide each one of my patients with individualized care and attentiveness.  I know it’s not only important for our physicians to communicate effectively; I also have to make sure I am keeping an open dialogue with my patients so they always know where we are in the process of their claim. I truly love the days when a patient expresses how much I have helped with their workers’ compensation process. When patients articulate they are able to do things now they couldn’t do before, I know I was part of the team who made it happen! My most memorable day thus far was when a former patient stopped by to let us know how she was doing. Her comment will always stick out in my mind. She said, “Texas Back Institute does get people back to life, look at me I can walk without pain!” I love knowing my job helps people get back to doing the things back pain or neck pain once prevented them from doing.

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