Day 8

Today’s first surgical patient doesn’t have a first name. At least, as far as his medical records at Mbarara are concerned, his first name is C. C is a sixty-five year-old man who is, for all intents and purposes, a wheelchair-bound quadriplegic. Degenerative changes in his cervical spine (his neck) have compressed and damaged the spinal cord, leaving him with paralysis in his legs, a loss of bowel and bladder function, minimal function in his right hand and none in his left that has progressed over three months. Given this clinical picture, I was certainly caught off guard when, while lying flaccid on the operating table awaiting his anesthetic, C asked me whether the operation would allow him to walk again. I passed the question on to Dr. Lieberman anticipating an apologetic response and was astonished to hear that indeed, Dr. Lieberman hoped the operation would accomplish just that.

Similar to Prudence’s operation, Dr. Lieberman approached C’s vertebral column through the side of his neck, navigating around some critical anatomy. He handed me a retractor he was using to push aside a vessel and asked, “What are you holding right now?” “The common carotid,” I replied, referring to the main artery carrying blood to the head. “Correct,” he said, “if you slip, the patient will have a stroke.” Needless to say my hand cramped up a bit while standing there. Unlike most of the operations so far, C’s progressed without any surprises from our hosts (finally, no power outages!) and before we knew it, his decompression (making more room for the spinal cord) and reconstruction (rebuilding and fusing the bones together) was complete.  We were very soon ready for our second patient Ida, who was being walked (yes, walked!) into the OR for her surgery that afternoon.

image 1 Ida walking to OR Ida chose to walk (with some help) to the operating room prior to her surgery

Ida was not a new patient. Dr. Lieberman had operated on her cervical spine (the part in her neck) last year. She now returned with pain, weakness and tingling in her legs caused by spinal stenosis (when the spinal canal is narrowed and compresses the nerves in the cord). Last week, Ida had walked into our clinic slowly and with an unsteady gait, supported by her son who has since not left her side at the hospital for more than 20 minutes to stretch his legs. She wore a kind expression on her face that day that, along with her son’s iconic NY Yankees baseball cap, have made lasting impressions on us. Now, as Ida was assisted onto the surgical bed, I thought about her son who was undoubtedly pacing outside the double doors to the surgical wing, sporting his distinctive cap.

During Ida’s surgery, Dr. Lieberman carved out space around the compressed portions of the spinal cord and secured screws and rods in place to stabilize the spine. The highlight of my week came next, when Dr. Lieberman allowed me to secure a few screws and to help suture the incision. It’s a small thing for a surgeon, but as a medical student it was the first time I would leave my physical mark on a patient. The fact that it was kind-faced Ida who would carry the scars of those stitch marks made it even more meaningful.

Image 2 Ida & fam on private wardIda, her son and niece in the private ward the day after her surgery

The following day, I went to visit Ida and her son in the private surgical wards. Aside from a bit of pain, she was in great shape. As her son walked me out to the corridor, we chatted about their experience throughout his mother’s care. They had tolerated the crowded mini bus system over the 300 kilometer trip from Kampala to see us in Mbarara, only to find themselves completely disoriented and without instruction upon arrival at the hospital. Once admitted (to the private ward, no less), they had to provide their own food, bathing basin and other essentials. There were showers for those in the private ward, but no accommodations for a bed-ridden spine surgery patient. After speaking with Ida’s son, it was clear to me that in Mbarara and perhaps Uganda at large, a patient must be his or her own advocate. Without a middle man to coordinate between patient and doctor, the patient’s own initiative determines the outcome of his or her care. In fact, when it was time for Ida’s surgery, no nurse came to retrieve her. Exasperated, her son walked his mother to the surgical ward and received her stretcher after the operation was complete. The lesson of the day was embedded here: As part of the surgical team, I had a narrow view of our patient’s experience; as far as I knew, she had showed up to our clinic, arrived at the hospital for admission several days prior to surgery, and had made her way to the operating table just as was meant to be. But in between those encounters, Ida and her son had fought to get attention from uninterested nurses and administrators and had navigated a non-intuitive system in their efforts to seek optimal health care.

Day 9

After a surprisingly smooth day yesterday, we had a few curveballs thrown our way today (lest we should get too spoiled with things going as planned!) Our first patient today was Catherine, a 14 year-old girl with a large thoracic kyphosis (an over-pronounced curve in her upper back). Catherine’s condition was consistent with Scheurmann’s disease, a pathology of abnormal bone growth causing wedge-shaped vertebra that exaggerate the normal thoracic kyphosis. With her deformity, Catherine found it painful to carry baskets of food on her head as is common practice here. Dr. Lieberman’s plan was to straighten Catherine’s curve with metal rods anchored to the spine with vertebral screws. There were several power outages throughout the surgery, during which Dr. Lieberman could not use his ultrasonic bone cutter. Nevertheless, he adapted the procedure to the tools that he had until power returned. He would not be derailed by a simple power loss!

Image 3 Catherine Catherine

Image 4 Catherine x-raysCatherine’s x-rays

Our determination to get through the day unscathed met another challenge that afternoon. The autoclave (the machine that sterilizes our equipment between surgeries) failed during its cycle, leaving us potentially still contaminated equipment for the operation. Our second patient, Aguma, who had two level spinal stenosis (narrowing of the spinal canal with compression of the nerves) lay prepped and sleeping on the operating table while Dr. Lieberman, Rob and Sherri brainstormed alternatives. They decided to rerun the sterilization (a 45-minute cycle) while in the meantime proceeding with the operation using alternative tools. Rob scoured the hospital’s sterilized equipment room for substitutes while Sherri went through some of our own tool sets set aside for other procedures. With some creative ingenuity the decompression surgery (laminotomies and foraminotomies) got underway, and 60 minutes into the operation we received our freshly-sterilized equipment.

That evening, the hospital and university invited us to a buffet dinner at the Agip Motel. Those in attendance included the surgical team from the hospital, the university and hospital accountants, and two of the vice deans from the Faculty of Medicine. After the meal, each of our hosts in turn spoke of their gratitude to Dr. Lieberman and his team. They expressed their hope that the continued presence of the mission would allow them to build competence and expertise in spine surgeries, ultimately establishing Mbarara as the pinnacle spine surgery center of East Africa.  After a week of hard work in the operating room, the team was moved to see the appreciation and long-term vision of our host institution. After all, we weren’t simply there to operate on ten patients and call it a week. The mission was established to provide spine care to the less fortunate and train those who serve these patients.  As the saying goes, “Give a man a fish and he will eat for a day. Teach a man to fish and he will eat for a lifetime.”

Image 5 dinner with Hosp & University faculty dinner with hospital and university faculty and staff

After dinner, the team gathered in our hotel lobby and discussed the lessons of the day over a bottle of wine. Today taught us that surgery can be seen as a series of small failures that simply require some creativity and perseverance to overcome. Back home in the US and Canada, the autoclave failure would have resulted in a canceled/delayed surgery. But here in Uganda, with limited time and even more limited resources, we could not afford to delay the operation. Dr. Lieberman, Rob and Sherri went back to basics in the absence of their standard operating procedures, highlighting the importance of fundamentals in medicine. We saw the challenges of the day—the power outages and the autoclave failure—as tests of what a co-ordinated and experienced surgical team could accomplish when forced to improvise.

Day 4

Today was our first full day at the hospital, although “full” is an understatement. When we opened the clinic at 10am, the open-air waiting room was teeming with patients and their families lining rows of benches or sprawled on mats on the floor.

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The team got right to work; Sherry and Rob left to set up our supply room and prepare equipment for surgery the next day. Izzy, Zvi, Danielle and I were joined by the hospital’s own orthopedic surgeon, Dr. Deo. We parked ourselves in a small room with an examining table and brought in the first patient. Over the next ten and a half hours, we screened 67 patients and selected 16 as candidates for surgery pending results from their imaging. It was a long day, and at times a bit trying; after hours of sitting on a bench in a dark, hot, narrow hallway with minimal food and water, patients began pushing their way into the small examining room. They were understandably anxious; many of them had travelled long distances to Mbarara just to be seen by Dr. Lieberman. We explained sympathetically that we were moving as fast as we could, and they would simply have to wait longer. I was astonished by their patience and resilience. Amina, a thin, frail 85-year old woman with chronic back pain from spinal stenosis shuffled slowly into the examining room with a walking stick. The deep wrinkles in her face folded into themselves each time she winced, emphasizing the extent of her pain. For over 5 hours she had waited quietly and without complaint. After his examination, Dr. Lieberman explained to Amina that he could treat her pain through a surgical procedure called a decompression, though the surgery would carry significant risk given her age. This brave elderly woman became our first surgical patient the following morning.

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As the day dragged on we began to appreciate a specific luxury of North American medical care: the process of waiting. To Canadians like myself and Zvi, waiting a month to see a specialist elicits a groan and some exasperated comment about “the drawbacks of universal healthcare.” Waiting over an hour in an air-conditioned waiting room with cushioned seats and a Starbucks in the lobby prompts a similar reaction. Many of these Ugandan patients had lived for over 20 years with back pain. We saw teenagers and 20-somethings with spine deformities that in North America would have been corrected within the first two decades of their lives.  Here, “waiting” is measured in years rather than weeks or months.

For some patients, their long-awaited visit with Dr. Lieberman brought bittersweet news: they were candidates for surgery, but would have to wait even longer. Kenneth, a short 18-year old with a pockmarked face and a big smile, was born with severe scoliosis and has developed restrictive lung disease as a result of his rigid spine. He walks stooped over to the right because his scoliosis forces his left shoulder upwards. Unable to work with his deformity, Kenneth was hoping that an operation would restore his physical mobility and give him “purpose,” as he put it. But to treat Kenneth’s condition the spine surgery team would need three weeks in Uganda, and we only have six operating days here. Dr. Lieberman explained to Kenneth that he would have to wait until next year when there is the possibility of a longer mission.

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67 patients later, we were done for the day. On the drive back to the hotel, we reflected on some of the cases from that day, including Bernadette, a 45 year-old woman who injured her back while pulling a goat tethered to her waist. When one team member wondered aloud why anyone would tie themselves to a goat, Rob kindly provided an answer, as well as our quote of the day: “If you haven’t mutton-busted, you haven’t lived.”

Day 5

A lot was riding on today: our first day in the OR, our chance to test out the facilities and to work alongside new Ugandan colleagues. Today’s successes and failures would mold our expectations of what we can accomplish in a week and would give us a sense of the challenges we would face. For that reason, Dr. Lieberman deliberately selected a relatively straightforward procedure for our first operation, a posterior decompression in which portions of bone are removed to allow more space around a nerve root. We arrived at the hospital around 8:30am and went straight to the operating room to find the anesthesiologist, Dr. Emanuel already prepping the patient, Amina.

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Sherri and Rob snapped into action and began setting up instrument tables and equipment while Izzy and Zvi scrubbed in. It seemed like we were off to a good start….. until the power shut off. We stood in the window-lit operating room with the patient on the ventilator for about 20 minutes until power returned. The rest of the operation went smoothly and two hours later Amina was on her way to the ICU.

 

 

 

 

 

 

 

 

 

 

 

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With a lunchtime clinic scheduled in between surgeries, we barely had time to scarf down our energy bars before heading out to the corridor of waiting patients. One by one, the patients approached Izzy and Zvi holding their X-rays and CT scans. We were able to add two patients to our list of surgical candidates, and sent several more for imaging and follow-up.

In the meantime, Sherri began setting up the OR for the next case, 56 year-old Muhamoud. Muhamoud had severe vertebral lysis caused by tuberculosis in his spine. I was particularly excited for this case because Dr. Lieberman was planning to approach the spine anteriorly (from the patient’s front), navigating around the peritoneum (the space behind the abdominal organs) to the vertebral column. As Dr. Lieberman went to make his incision, he looked up to find that the anesthesiologist had left the room, leaving his nurse anaesthetist in the pilot’s seat. This wasn’t the only hiccup we would encounter that afternoon. As Dr. Lieberman pulled back the iliac vein to find the vertebral column, the nurse anaesthetist tumbled from his chair, grabbed at the ventilator tubing and crashed into the operating room table causing the patient to move. It was simply luck that the vein between Dr. Lieberman’s forceps did not tear.

That night at dinner, the team discussed some of the lessons of the day. Our first two surgeries in new territory were sobering examples of the importance of thinking on your feet. When things don’t go as planned, improvise. Today’s challenges also highlighted some of the prerequisites of good teamwork. Teams of longstanding colleagues (like the Texas team) work like well-oiled machines. They anticipate each other’s moves, communicate effectively, share expectations and have standard procedures that help things move smoothly. When veteran teams join forces with new colleagues (as the Texas team did with the Ugandan anesthesia team), processes that used to be fluid can suddenly become turbulent. Care must be taken to communicate effectively, lay down expectations and establish roles and responsibilities. Perhaps today’s anesthetic troubles were not from a lack of competence, but rather from miscommunication and incongruent standard practices.

Finally, and on a more personal level, I learned today that surgery is far more multidimensional than I had thought. Spine surgeries don’t necessarily need to be approached from the back, just like heart surgeries aren’t always approached from the anterior chest. Each approach involves different anatomy and with that, different challenges, considerations and risks. The human body is sort of like a labyrinth for the surgeon; sometimes, the best way of reaching a point of interest is not necessarily the most direct route.

All in all, our first surgical day was a great success. As a team, we fell naturally into our own roles and got through our first two surgeries with only a couple nicks along the way. It seemed like we could count on a very productive and rewarding week ahead.

Day 1

 

Annnnd we’re off! The 2013 Uganda Spine Surgery Mission officially began on Thursday, August 8 at London Heathrow Airport. This year’s team of six– the smallest team yet– gathered from a smattering of departure cities, including Dallas, Toronto and Tel Aviv. Flying in from Dallas were team lead Dr. Izzy Lieberman, his daughter (and chef extraordinaire) Danielle, and two veteran spine surgery missioners, scrub nurse Sherri LaCivita and medical equipment sales rep Rob Davis. Dr. Zvi Gorlick, a family physician in Toronto, joined the team for the first time, as did I (Jennifer Teichman), a medical student from the University of Toronto.

After a quick caffeine boost at the airport, we dumped our luggage at airport storage and scurried into London for the day. When a two-hour line thwarted our attempt to visit the Sherlock Holmes Museum, we hopped into a cab and found ourselves at Trafalgar Square after a quick drive-by of Buckingham Palace. All six of us clambered up the gigantic lion statues for our first team photo.

Trafalgar Square

 

 

 

Phone Booth

We met Ros Eisen, secretary of the Putti Village Assistance Organization for delectably crispy fish and chips at The Seashell, where Zvi insisted on ordering every dish on the menu that happened to be unavailable that day. Re-energized, we made our way to Big Ben, which several of us were surprised to learn referred to the bells rather than the clock tower itself. Dr. Lieberman surprised us with tickets for the London Eye, which proved to be the highlight of the day. We sipped champagne 40-something stories atop London and congratulated ourselves for a day well-spent. Then, it was back to Heathrow for our 9:00pm flight to Entebbe.

London Eye

 

 

 

 

 

 

 

The 2013 team on the London Eye

Quote of the day: “No time for dresses.”- Dr. Lieberman, after Danielle expressed a desire to change out of her yoga pants and into a dress for our day in London. We mean business!

 

Day 2

 

We touched down in a rainy Entebbe around 7:30am, sleepy-eyed yet itching to get started on the mission! Our collective enthusiasm met its first challenge when my laptop was stolen from the airplane. As a newcomer to the mission, I learned my first lesson of the trip: keep your valuables on you at all times, no exceptions. Our first driver, Eric, then appeared not with the 40-seat bus we thought was to be provided by the Mbrara University of Science and Technology (MUST), but with a small pickup truck and a 6-person van. This was my first hint that things don’t always go as planned in Uganda. We loaded the truck with our bags, piled ourselves into the van and started the bumpy 60 minute drive into Kampala, the capital and largest city in Uganda. Our first stop was Case Medical Centre, a private hospital that served as a base for the mission in previous years. This year, however, we were only there to pick up the medical equipment they had stored for us from last year.  Danielle and I held down the fort by the luggage-laden truck while the rest of the team retrieved the equipment. Rumor has it that while hoisting a big bag of surgical equipment, Zvi lamented Izzy’s choice of profession, and graciously provided us with our first quote of the day: “Why couldn’t you have been an ophthalmologist!?”

Uganda 01

 

After a true feat of space-maximization, the equipment was loaded into the truck and sent off to Mbarara to await our arrival the next day. Meanwhile, we headed to our Kampala accommodations, the Speke Hotel, for a much needed shower and change of clothes. With the whole afternoon still ahead of us, we paid a visit to the Galilee Community General Hospital, a Jewish Hospital in Kampala interested in future collaboration with the Uganda Spine Surgery Mission. We toured the facilities, including the new hospital building currently under construction. It was particularly interesting to learn about some of the considerations given to building and maintaining a small hospital on philanthropic support; the constraints of space, funds, resources and expertise were evident throughout our tour of the main hospital and construction site. Nevertheless, the team agreed that the new hospital promised to be a valuable addition to the community.

The team returned to the hotel to rest before dinner, a good idea since dinner turned out to be a marathon for the stomach and palate. We feasted on delicious Indian cuisine at Khyber Pass, one of two kitchens at the hotel and a favourite of previous incarnations of the Spine Surgery Mission. By the end of the night, several pants buttons were unbuttoned (mine included), and our droopy-eyed procession made its way to bed.

Quote of the day (#2): “I’m so full, I don’t even have room for a tic tac”

Day 3

 

Move in day! We awoke to a beautiful morning in Kampala, and hit the road after a hearty breakfast at the hotel. First stop: The Nakumatt Oasis, the Zeus of all department stores. There, amongst the impeccably clean and organized isles, one can find everything from toothpaste and vodka to washing machines and power tools. It puts Walmart to shame. After stocking up on what is reportedly the world’s best coffee beans, we piled back into the van and continued the five hour trek to Mbarara. Newly paved, the road to Mbarara traverses a landscape of rolling green hills, flat valleys of cultivated land and dirt paths dotted with shacks selling local fruit, meat, fish and potatoes. There was a collective cringe as we passed trailer after trailer of live bulls packed tighter than sardines, their ferocious horns piercing the air above them. Every half hour or so, the serene landscape was broken by the bustle and dirt of a small village with decrepit store fronts ironically painted in advertisements for Coca Cola and Nokia. Within an hour of the ride, our clothes were covered in a thin film of copper-red dirt kicked up by fellow drivers and boda-boda cyclists.

 

equator

We made a pit stop at the Ugandan equator, where we stretched our legs and shopped for local artisan crafts. Like school kids watching their first science experiment, Zvi, Rob and I oo-ed and aw-ed at a demonstration of water spinning in opposite directions in funnels placed on either side of the equator. Cooler still, water placed in a funnel centered on the equator didn’t spin at all as it drained! Call me a nerd….

We arrived at our hotel in Mbarara, the Lakeview, and were pleased to find large, comfortable rooms. Anxious to start our work, we gathered our medical equipment and drove to the Mbarara Regional Referral Hospital, our base for this year’s mission. We were met there by a spectacular surprise: last year, the hospital had opened an entirely new wing including an Intensive Care Unit, Emergency Department and operating theatres. We set to work right away, unloading the equipment from the truck and transporting it to a temporary storage room in the Emergency Department.

 

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Unloaded and eager to explore, we began a tour of the new building. The Emergency Department is a bustling continuum of corridors and open spaces filled with beds and curtains, each bed occupied by a patient and surrounded by family members. The spill-over of family members sit quietly on benches lining the hallways, many of whom carry infants. It seemed many of these families had not been home for days. Passed the Emergency Department, we found the ICU, a stark contrast to the crowded hallways of the ER. The ICU is a quiet space with each bed contained in a separate glass room. Computer monitors displaying patients’ vital signs hang over the beds, much like one would find in any hospital in North America. Already impressed, we then proceeded to the surgical wing. Dr. Lieberman’s expression was that of a kid in a candy shop when he first laid eyes on the operating rooms. Big, bright, clean, well-equipped and windowed… we hadn’t expected anything close to this! The team’s excitement was palpable.

We left the hospital elated and even more motivated to kick off a great week at Mbarare. After an “edible” dinner at the hotel, we headed to bed for a good sleep before our first big day at the hospital.

Quote of the day:

“It’s ok, you can take your skirt off here.. we’re all medical professionals”

“The food is…. edible….”

pink scrubs

 

 

 

 

 

 

 

 

 

 

 

 

Dr. Lieberman’s first glimpse of the OR

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 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!

June is Scoliosis Awareness Month

In honor of this special month we want to share more about our scoliosis and spine tumor center and some facts about scoliosis with you.

 

Dr. Isador Lieberman is our scoliosis and spine tumor specialists and on a daily basis he treats patients who are affected by scoliosis. Below are 5 things Dr. Lieberman wants you to know about scoliosis.

  • In 85% of cases the cause of scoliosis is not known,  although we know there is a familial predisposition.
  • The mother to daughter inheritance rate for scoliosis is 1 in 4 or 25%, father  to daughter is 1 in 10 or 10%,  mother to son is 1 in 10 or 10% and father to son is less than 1 in 20 or 5%.
  • 3% of the people on the planet have a scoliosis curve that measures greater than 10 degrees, although the vast majority do not progress and only require observation.
  • Book bags, sports, sitting slouched do not cause scoliosis.
  • Scoliosis may be associated with back discomfort, however is not associated with debilitating back pain or neurological issues unless some other problem is also present.

Regardless of the extent of the scoliosis a general exercise program and maintenance of bone health is important.

Nikki Miller, a patient of Dr. Lieberman’s, shares her about her struggle with scoliosis and how she was finally able to find relief.

If you have been diagnosed with scoliosis please feel free to share your story in the comments section.

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