Team 3, Day 8: Our Final Big Case

Today was our last “big day” with Dr. St Clair and we were all determined to make it a good one.  After another 5 hours of sleep, the team assembled downstairs for breakfast.  To any observer it was plain to see that we were tired but also that we were focused on making today a success.  We headed to the hospital for a 7:30AM start for our first case, Jadrass is a 54 year old man with severe L3-5 stenosis and weakness of his left leg which makes it difficult for him to walk more than across a room.  For this case the tireless Mbarara surgical resident Marvin was nominated to work alone alongside Dr. St Clair and get one-on-one education on the surgical technique.  Marvin was excited to be in this position and Dr. Kip, Austin, Joan, and I (Eric) headed out to round.  We were focused on making progress with all of patients this morning.   In the American healthcare delivery system if you order an antibiotic be given, a blood draw for a lab, or order physical therapy to walk with the patient you can generally count on it happening.  This is not true with the Ugandan system, we learned that unless one of us was there to physically witness or assist in whatever order we requested there was maybe a 50% chance of it getting done.  This problem is often compounded by the patients themselves who will deny receiving a medication that they’ve already taken in hopes that another dose will make the treatment more effective.  As we moved through our morning rounds we recognized as the final mission team that part of our service was to ensure consistent progress towards discharge.    

For some patients such as Eziekel this was as simple as removing his bulb drain, for others such as Denise (who was on a ventilator) this was more difficult.  We took time to demonstrate to the physical therapist how to mobilize each patient and it was incredibly gratifying to see some of patients take their first post-surgical steps with Dr. Kip.  In addition to our medical care, Joan (Team 3’s caring volunteer) gave her time to encourage the children and hand out Pillow Pet stuffed animals which all of the children enthusiastically expressed their gratitude.  Witnessing the joy this brought them reinforced how important and appreciated these simple acts of kindness are in a patient’s recovery regardless of how potentially overwhelming their clinical obstacles.  

We completed rounds and headed to the OR where Dr. St Clair and Marvin had just finished up.  Marvin was rightfully proud of their case and kept repeating just how much he learned from the experience.   Which was a good thing because for the second case we placed him across from me as I instructed him on the surgical technique to expose his side of the patient’s spine.  Our final major scoliosis case was Sarah, another adorable 8 year old orphan who was born with a defect in how her vertebrae were formed.  Sarah had an extra half of a vertebra (hemivertebra) that was shaped kind of like a triangle and a partial autofusion of two other vertebra resulting in a significant deformity.  As I worked with Marvin on the initial exposure of the spine, I reflected on how much I had learned and how fulfilling it was to share that knowledge with Marvin.  The old adage “see one, do one, teach one” was exemplified on this mission as we moved efficiently through the case.  Drs. St Clair and Kip progressed smoothly through the case, removing the hemivertebra while maintaining careful control not to damage the fragile nerves.  The case went wonderfully and Sarah was able move all of her extremities afterwards.  The case lasted until late in evening, as we finished cleaning up Sherron (our tireless nurse/scrub tech) remarked that though she had never had one in her life, tonight she needed to unwind with a Nile lager    

We all couldn’t have agreed more and headed to the bus, exhausted but riding high.  We made our way back to the hotel and sat around enjoying dinner and each others company.  Sadly this was Dr. St Clair’s last night with us and we all went around the table discussing what we learned.  The mission had touched all of us in profoundly indelible ways.  Perhaps one of the most memorable speeches came from Martin who spoke on what a privilege it was to work with the team and remarked on all that he had learned.  He reminded us that the mission not only helped patients but that what the Mbarara physicians and staff had gained would help numerous patients to come.  Dr. St Clair concluded that the privilege was truly ours and we headed to bed feeling accomplished and grateful for having completed our final large case. 

Quote of the day: We are actually done, that’s it… I need a Nile. – Sherron.