Team 3 - Day 3: A day of extremes

Today  was a day of extremes.  Unfortunately, we were unable to operate on Sunday so we headed in early to get rounding done on the patients from the previous week.   We walked into the ICU and were happy to see one of our patients Eric Agaba, who had undergone an extensive staged spinal fusion for tuberculosis induced spinal deformity, had been moved to the general wards and was slowly improving.   We were again struck by the lack of resources and difficulty in what we consider to be basic care.  This was illustrated by the lack of simple IV antibiotics and steroids - we had to both provide the medications and the nurses with detailed instructions on how to administer them.  We then moved to the surgical ward which had mercifully been thoroughly cleaned and the patients were listening to a Sunday sermon.  We were immediately greeted by extreme tragedy and celebration.  We got to give fist bumps and hugs to "Frank the Tank" as he headed out to return home.  The joy radiating from this little guy could of lit up the room.   As we were leaving Frank, a  frightened looking mother approached the team asking if we could look at her daughter who had fallen off the back end of a pick up truck 4 days ago.  The mother was accompanied by her other daughter who explained that her sister was heading back to University and seemed not to be doing well. The concern and fear reflected in both of their eyes was undeniable; Dr. Kip and I (Eric) agreed to see her and went to the patient's bedside.   The patient was breathing extremely rapidly and moaning in pain with her leg wrapped in a blood soaked bandage.  The mother immediately handed us the x-rays and explained that her daughter's femur (thigh bone) had been sticking out of her skin after the accident.  The x-rays made our stomachs drop, she had completely fractured both her femur above her knee and her tibia (shin bone) below her knee.  She essentially had an floating knee and was breathing rapidly due to either loss of blood or a blood clot in her lungs.  The overwhelmed intern who admitted her had only wrapped her leg up in a gauze dressing.   Now, 4 days later, she had lost alot of blood, potentially had a blood clot in her lungs, and was in severe respiratory distress.  We immediately sprang into action, Dr. St Clair went to get the patient emergently moved to the ICU.  We looked at this 20 year old girl who had beaten the odds, was attending university with a proud family and potentially bright future in a country where  hopelessness was so common place and prayed as we got to work.  

Dr. St Clair was confronted by the ED physician, who was about to do a bedside craniotomy, and was informed that it violated protocol.  After some convincing he said it would be ok to move her but apparently there was no oxygen available in the ICU.  We were then informed that we could buy it ourselves for 80,000 schillings (about 35 dollars).  Dr. St Clair quickly agreed, sadly while we were jumping through these hoops the patient quit breathing and we were unable to resuscitate her.  Instead of a bright future at university she died today from an injury that would of been surgically fixed with her already discharged if we had known about her 4 days ago.  The sister just looked at me and said in a statement of tragic acceptance that her sister was dead.  To compound this tragedy she was also pregnant.  Everyone on the Team, newbies like me to veterans were devastated by this news.  Part of medical training is learning how to steel yourself against tragedy, to feel and acknowledge it but not to let it dominate you.   In the moments following this senseless tragedy we were all wide eyed and grief stricken as we chorused how this shouldn't have happened, how painfully unnecessary this was, and how we could have saved her if only there had been more time.  Her name was Onvia, instead of a bright future at the local university, she suffered and slowly died from a treatable injury in front of her agonizing family.   I am sure this is difficult to read and I assure you it is difficult to write.  I imagine those of you following this blog are asking why, why did this have to happen.  There are no easy answers.   This is a medical system that is overwhelmed with scarce resources and protocols that can prevent rather than facilitate care.  In a country where the population lives with the reality that one "big hit" such as a fracture is more often than not a life-ending event.  To me it is a unforgettable reminder of the dire need for expanding medical mission trips to serve those like Oniva who deserve a chance at a bright future. 

After leaving the hospital, we talked over some of these points in a vain attempt to bring understanding to how we were feeling.  Our morning was over, we decided to continue with our plans to use our only free afternoon to drive to Queen Elizabeth's park and go on safari.   As we slowly moved out of Mbarara, the land became unbelievably lush with such vibrant shades of green you'd swear it w as from some special effects driven movie.  We didn't talk much, the rolling hills, lush landscape, and clean smelling air slowly helped us let go of our collective hurt and move forward.  After 2 hours of driving, with a level of road disrepair that made us long for our ride from the airport, we finished climbing a mountainside, rounded a corner, and lost our collective breath.    

Extending into the horizon in valley below us was the savannah of Queen Elizabeth's park (second biggest park in Uganda).  Imagine whatever picturesque view of the African savannah you might have and I assure you it would exceed it.  We pulled over, stretched, shot some pictures and inhaled the sweet counterpoint of Uganda's unmatched beauty.  We enthusiastically clamored aboard our vintage suspension free bus and headed down into the savannah.  The next few hours were unforgettable: Brian frolicked with a friendly baboon, we saw a hippo and elephant moving through the bush, numerous antelope, and got to experience off-roading in our team van.   The undisputed epic moment of the trip was watching a leopard lay out and groom itself 15 feet away from us.  A sight that is apparently so rare that even our guide had to stop and take a few pictures. 

As we road back to the hotel in a collective exhausted daze, I couldn't help but reflect on how we had all been taken through the full range of emotions.  And perhaps this typifies the Spine Mission Uganda experience: there is so much that is awe-strikingly beautiful and gives you hope and there is so much despair and hopelessness.   Ultimately, I believe those who participate have a profound feeling of gratitude for the experience and a drive to expand our mission to help those who need our help the most. 

Quote of the day: I wish I had a tiny saddle - spoken by Austin as he watched Brian interact with the baboon.