Our first day stepping foot into Mbarara Regional Hospital was filled with excitement and eagerness. Each team member was to learn exactly what would be needed to carry on the torch passed by Dr Lieberman’s group.  We began shadowing our respective counterparts, dividing up and conquering collectively. We began by rounding. With a team of all but one made up of Ugandan Spine Mission newbies, the ward was a shocking experience. Smells, sights and sounds never encountered before rushed our senses.

Initial feelings of being overwhelmed by the crowded conditions were short lived as each person dove into their roles. Patients and films were examined, dressings were removed and changed, and a handful of  post op children were lucky enough to be discharged and sent home. This would become our morning routine. Then we went to clinic, an all day clinic. Clinic was HOT! There was no power. At one point there were 12 people in the small room and it was difficult to keep the new patients out while the ones just seen exited. We managed to see 41 patients over 6 hours in that crowded room with only an open window for light. We squeezed a team of 6 Americans, 3 Ugandans and a Canadian into a room the size of a small walk in closet with no electricity. The language barrier became the least of our concerns once we realized we could all understand the Canadian.

So many of our patients were pediatric. The magnitude of the deformities are difficult to describe and have to be visualized to comprehend. These sweet children and their caregivers have very little understanding of their disease. So many have scars from cuts made by traditional healers and present with hope mixed with fear and faith that their spines could be fixed. There is often a struggle between treating the severity of the appearance of the child and their functional limitations.  Promise, a very pretty fourteen year old girl came and stood in front of us in that crowded room. Her deformity was obvious while clothed and magnified on examination. She had pain and wanted her back to look better.

Her procedure would be extreme and require removing ribs and a vertebrae from her spine. As we walked back to the bus that night after a long day of new insights, we contemplated the tasks ahead. We too had hope that what we set out to do would bring a smile to this young girl but faith our team would perform.

The discussion between Holman and Burch captivated the audience during a joint lecture in Las Vegas. It was a description of the experiences from Uganda 2014.  Limited resources and advanced disease states were discussed and described by the intensity and the magnitude of the experience. Then the call came to assemble a fourth team, another team characterized by skill, commitment and compassion to compliment the teams of Holman, Lieberman and St. Clair, representing the expanding presence of the Uganda Spine Mission . 

The team needed to be a team that could service the climate of the operating theatre in Uganda whose members could survive each other for two weeks in austere and pressured conditions. Each member would travel 24 hours straight by air and shuttle to Mbarara. Team 2 was assembled by Dr. Shane Burch who selected Dr. Ronnie Mimran (Neurosurgeon from San Francisco); Dani Thayer (Scribe); Errin Dalzell (Hardware Rep); JP Clark (Neuromonitoring); & Hunter Dennison (Scrub tech extraordinaire). 

Team 2 came together three months ago. Based out of San Francisco, the team quickly bonded and a plan came together to collect supplies and ship more than we could carry-on. The commitment of each member was identified early. A one day session to pack 26 containers of supplies to ship on a pallet and negotiate international shipping regulations ensued. Instrumentation, dressings, sterile gowns, and anything else associated with surgery was packed into the bins, loaded on the pallet and shipped in time to our destination. 

We arrived in Entebbe with earnest. The night was moist. Our enormous duffel bag full of essential equipment could not be found. However the drama started well before we entered Uganda. Our entire shipment of medical supplies was delayed in the UK due to an incorrect shipping code. The pallet of supplies would not arrive until the mission ended. With the loss of our duffel bag we had no supplies to sustain our mission in Uganda.  Arriving without equipment would doom the mission. The ride into Mbarara was long…  rough… long… and filled with danger and we survived.  Rolling into the hotel by 5:30am on Sunday, Shane and Ronnie immediately hopped on the bus with team 1 to head to the hospital to begin to learn about the patients, with the remainder of the team rallying supporters within Medtronic, FedEx, Crane, and Magno who pulled together and then sent a secondary shipment –  and effectively crossed barriers to coordinate our entire pallet to arrive in time for all the major cases.

UGANDA DAY 9

A bit of a rushed breakfast this morning as most of the team was sluggish to get up, beat from the events of yesterday, not to mention the toll of a long week’s work in a foreign country. Although that didn’t stop Dr. Lieberman from his morning run, again joined by local Joshua and now Dr. Burch, team 2 lead surgeon. He also had new shoes, now Dr. Lieberman is double screwed (just like most of his patients).

Both teams crammed into a single van for the hospital, 17 people in total, which is a Uganda Spine Mission record!  We arrived at the hospital and got right to work. Most of team 2 went straight into clinic, with growing lines of potential patients, they’ll have their work cut out for them today, as the eager Ugandans look to the medical team for assistance.

Equipment manager Brian walked some team 2 members through the SPD, the sterilization and processing department. It’s quite a bit different from the way things work back home, as the hospital here lacks much of the equipment, resources and manpower that make sterilization stateside a much more efficient process. Here it is more hands on, and there is a significantly greater risk of contamination or even infection. Knowing the dangers, Brian pointed very forcefully to get his point across.

Meanwhile in the OR room Mary was being prepped for surgery. Mary is an 11 year old girl who lives in an orphanage and suffers from kypho-scoliosis which is a forward hunching collapse of the spine. She had an operation last year, however for whatever reason she failed to fully fuse and consequentially her hardware failed, necessitating re-instrumentation and another fusion. As they were prepping for anaesthesia, power at the hospital went out, which meant Mary was forced to wait on the cold OR table in the intimidating room. Luckily Dr. Lieberman’s son Josh was on hand to do some drawing with her and keep her mind off the impending surgery. Power returned, and the team was able to get Mary asleep and into position for surgery to begin!

The surgery, already delayed by the power outage, seemed to be taking longer than anticipated. There was quite a bit of scar tissue surrounding young Mary’s spine, which is challenging to maneuver around. But it’s nothing Dr. Lieberman and the team haven’t seen before, so with due diligence they were able to expose the vertebrate and get the screws and rods in place.

The second case was a hardware removal for a very young boy named Ivan that Dr. Lieberman had operated on the previous mission. The last time we saw young Ivan he was unable to walk on his own, and sure enough Ivan came strutting into clinic earlier this week for his yearly check up. Dr. Lieberman said seeing the young boy walk on his own was one of the most rewarding moments of his 10 years coming to Uganda… despite the boy breaking out into tears upon seeing the Muzungo Doctor who hurt me last year!


Having grown quite a bit now, Dr. Lieberman found it best suited to remove the corrective hardware and allow Ivan to continue growing au naturale. The operation was quite simple in comparison to some of our other corrective cases, so it was a nice change of pace. Everything went well, and we look forward to seeing Ivan next year and continuing to monitor his progression!

The final case of the day was a 51 year young woman named Winnie.  She had a benign but painful tumor in her third lumbar vertebra. This required cement fixation to provide pain relief. Dr. Hisey inserted cement under X-ray guidance, but was challenged by the cement hardening in under 45 seconds! It took all of Dr Lieberman and Sherri’s help to get the third (and last!) batch of cement ready quickly enough to fill the the vertebra enough, but all turned out well.


We were finally done with our work in Uganda! As a thanks to Dr. Lieberman for carrying us all week, we decided to carry him off into the sunset!

Quote of the day:

We tried an Indian restaurant for dinner and put in an order for Na’an early because we were starving! We’re not sure they got the message though because our main courses came out before we ever got the Indian bread. A bit annoyed with the lack of carbs, Zvi commented “so far this has been a non Na’an meal”