The lessons of the day are a tradition in Uganda. It is the time after the meal when each person reflects on a lesson learned. We took pause that night as we reflected on the days experience and the experience we all had to process. Ninah’s procedure went without complication and the frustration of not obtaining a diagnosis is difficult to describe. Despite years of experience surgery can be a humbling experience. It is difficult to think of what good can come out of such an event. Dr. Burch spoke to team at the end of the night and reminded everyone that this seemed to be one of those random events, difficult to explain. The litany of potential causes for her low blood pressure had been ruled out and in the current setting without diagnostic imaging we would never know. He reminded us that we were a great team and in that darkest of moments remained confident we were there for purpose and the purpose could be met.

It was crystallized the next morning as our next patient was brought into the OR. She was a young seven year old with a severe deformity. As the films were pasted to the frosted window, which acts as a light box, the members of the team took pause. One by one they approached the patient who was scared of the clinical surroundings and odd sights and sounds so foreign to her. One of us held her hand and smiled. Another suggested a song to calm her. In a few moments the six of us were in chorus singing for this little girl letting her know the compassion and respect we had for her and for the procedure she was about to endure.

This was the rarest of moments when the silos are broken, where each member of the team becomes the team and the team becomes greater than the sum of the individuals. It was a time when the purpose of the mission became clear. It was a time when we all realized each of us had travelled great distances to bring knowledge, care and perspective to a remote region and an emerging nation. Despite the challenges of limited resources, limited equipment and the events of the day prior, our team was in unison more so than ever. We all had gained appreciation for what we were asking of ourselves and of our patients. The day’s surgeries went well and we finished early. Our second case, an elderly lady who came to us with lower extremity paralysis from a tumor in her thoracic spine also recovered well and began moving her legs. At home it is often difficult to visualize the essence of medicine as we each get buried under the scope of our responsibilities that force us to work as individuals. However, despite going to Uganda to teach all that we knew, the six of us that day gained as much as we gave. We gained the appreciation and privilege of what it’s like to be on a team working together with a common goal whose purpose is united and focused. 

The day started out just like any other day. It ended with an indescribable feeling of helplessness. 

Half of our team got up for the 5am run with our local running buddy, Joshua. The streets were quiet on this particular morning. The people of the city were just crawling into bed from the previous nights' celebration of the end of Ramadan(??).

We arrived at the hospital excited for another day of surgery and the challenges we would face. As we walked into the theatre we all noticed and eagerly waved hi to our first patient, Ninha. She looked the same as she did when we all first met her in clinic.. Beaming from ear to ear, curious and shy at the same time. Just the cutest. 

So much of spine surgery is algorithmic. Check the films, check the labs, check the levels, confirm the indications. Double check, triple check... Patients put their lives into the physicians hands and our team began this day realizing this privilege. The privilege begins as an opportunity to change people's lives, increase awareness of the possibilities in Ugandan hospitals and to spark innovation and change for the future here in Uganda. 

A complex operation ensued. The operation itself and the correction of Ninha's scoliosis went off without a hitch.

She then developed a complication.

All Nihna wanted was "to be better" 

The day speaks to the layers and layers of things we have at home in North America. We are so fortunate to be blessed with the care we all have. We take the type of healthcare we have at home for granted. This experience was both humbling and eye opening and crystallized the conditions by which the people of Uganda are forced to live. 

Life is short and very precious. Despite the best surgical care in the world it's earth shattering to imagine that something like this could happen to an 11 year old little girl.   

A 5am run with Joshua and then we boarded the shuttle bus by 7:15. We divided and conquered the morning rounds and the preparation for surgery. Promise was brought into the pre-op area of the OR, naked except for the brown blanket shrouding her. She sat on a stool alone in the little room as the anesthesiologist prepared for her case. He started to hum a Bantu lullaby, which seemed to calm her. All motion in the OR stopped as we took note of this simple gesture. As the anesthesiologist left the room to get supplies she became frightened. A hello from members of the team, a smile and then some drawing with Dani Thayer made her smile and put her at ease. It is the simple acts of unexpected compassion that restores faith in humanity and this is often the most powerful medicine. I was once told that “this is not something you learn in a book but it is something your mother teaches you”. Promise was comforted and began her six hours of surgery without complication that included a vertebral column resection and thoracoplasty to correct her spinal deformity.
 
Following surgery, the lost pallet of supplies to furnish our storeroom had arrived thanks to the unrelenting efforts of Errin Dalzell and the support network back home. While we unpacked the pallet, we continued to care for a friendly young woman, named Sharon, which we met during clinic on our first day. Sharon, a shy-eyed young woman with a beaming smile, visited the clinic with difficulty walking, weakness and loss of sensation in her arms and legs that had started several years ago.  At first glance, Sharon's condition had features common to spinal cord damage. Dr. Mimran observed that the cranial nerves that control neck and tongue movement were also abnormal, indicating brainstem compression. The review of the XRAY films revealed an anomaly in the highest cervical segment could account for the neurologic status. Due to the severity of this condition, the surgeons requested a CT films to corroborate their finding definitively and to develop a surgical plan. Sharon and her family did not have the resources to obtain these films, so HVO arranged for the funds and transportation on her behalf. It was also decided that a member of the team 2 should accompany her to ensure that correct films were obtained, expeditiously. J.P. Clark, the neurophysiologist of group 2, escorted Sharon and her sister, Hope, in the team bus, to an offsite private imaging facility in contrast to Mbarara University Hospital where the CT scanner was in a state of disrepair. The CT scan was uneventful but the trip provided the CT scans necessary for Dr. Mimran to confirm that the cervical spine was entering the skull and likely accounted for the brainstem issues. Dr. Burch and Mimran decided that the surgery would require a head and neck surgeon to provide access to the anterior spine through the mouth and would require a transoral approach. Considering the need for this expertise along with the high risk of the spine surgery, they felt that the surgery could not be performed safely in Uganda.

The surgeons met with Hope and Sharon and discussed Sharon's diagnosis.  

The news was disappointing for them not only because they could not get the surgical care they had wished for but considering what was required, there was little hope for surgical care in the future. After a moment to digest the news, Sharon beamed again and expressed her gratitude for the diagnosis and the kindness and compassion our group provided.

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”

UGANDA DAY 8

Today was the team’s off day, which meant a much more relaxing start to the day. Drs. Lieberman and Hisey did pop over to the hospital for a quick round with recovering patients. They brought  Michelle our new physical therapist along so she could meet the Ugandans she’ll be assisting over the next month! All the patients were excited to have her here to help in their recovery! Michelle even remained at the hospital to get a jump start on the physio and hopefully get these folks back on their feet as quickly as possible!

Dr. Lieberman returned to the hotel to lead the entire team in a morning Pilates class. A very confused group of hotel staffers watched on, whispering, chuckling and even applauding. We would have asked them to join in, but we don’t need anymore spine injuries here. Dr. Hisey enjoyed the session, but noted afterwards that “for most of these poses, my stomach gets in the way.” Luckily that hasn’t stopped him from kicking a football around with the locals, which he’s done on multiple occasions!

Team 2 led by Dr. Shane Burch had finally arrived at the hotel after a long 26 hours of travel. The two teams met up quickly, with our team offering little gems of wisdom like “make sure you always carry toilet paper with you” and “don’t order the ‘Texas chilly burger’ at the hotel restaurant” (we learned all these lessons the hard way). The exchange was quick as our team promptly boarded the van en route for a day of sightseeing and touristy shenanigans through the heart of Uganda. But we couldn’t hit the road without filling up the tank first.

Holy Shillings! I thought gas was expensive back home!

Our first stop was the equator. We all took pictures standing in the equator markers, one foot in each hemisphere! We also got a demonstration of the Coriolis effect, the effect of earth’s gravity on draining water to spin a certain direction. The demonstration was done with large tin funnels. The team was split on whether the effect is real, or simply a swindler’s trick… but it doesn’t really matter cause our money went down the drain both ways and backwards.

The team then popped into a roadside restaurant called “what’s your mother?” to which Josh replied “sweet as sugar.” Up first was a sampling of various “chip” dishes (french fries). Cheese chips, Masala chips and regular boring old fried chips. Everybody chipped in to devour the plates. The team promptly finished main courses and downed the moderately cold beers. We’ve come to learn that “cold” is relative term.

Last stop was a crocodile farm which was only accessible by a 10 km dirt road that had more bumps than Zoe’s arms (she’s a real mosquito magnet). The farm houses over 3000 alligators. 2997 tiny ones, and 3 godzilla sized ones named Romeo, Juliet and Benjamin… you would have thought they’d go with Tybalt, especially given the love triangle brewing between the amorous amphibians, but I guess “Benjamin” has a nicer ring to it. The team took turns handling some of the smaller ones, Dr. Silverstein was a natural, a regular old alligator whisperer, having grown up in the lawless swamps of Florida. 

UGANDA DAY 7

Dr. Lieberman’s alarm went off at 4:30am and he began prepping for his morning run. If you recall from our last couple blogs, Dr. Lieberman has been joined each morning on his runs by local 17 year old Joshua, for whom he supplied the resources, the day before, to buy new shoes after it was discovered the Ugandan’s shoes had no soles. Dr. Lieberman thought to himself one of two things is going to happen on todays run; either Joshua will show up with new Nike high top sneakers and completely run laps around me OR Joshua will show up with his entire family, all attempting to outrun the Doctor for a new pair of shows. As Dr. Lieberman arrived at the meeting spot, he discovered that he was COMPLETELY WRONG! Not only did Joshua have new shoes, but he even brought his entire village with him, 30 plus people! All of Joshua’s friends and families came out to thank Dr. Lieberman! They lined the sides of the dirt roads and cheered on the Doctor “thank you for training our brother!” It was a memorable moment for Dr. Lieberman to say the least.

A quick breakfast (but not omelet hand-grabbing fast) and the team headed straight to the hospital. We only had one case today, so the team was excited to focus all resources and attention on the single patient!

Today’s patient was Jostos, a 27 year old male who farms for a living. He has a TB infection in the lower lumber that ate away at his L3 vertebral body. Justos is experiencing quite a bit of pain and discomfort, and it’s preventing him from doing his work.

Our neural monitor Kari was on hand to oversee the patient’s vitals and brain activity. It’s been an eventful week for Kari, with each case presenting it’s own difficulties and obstacles, ranging from outdated equipment to rolling power outages. Kari has been on her toes all weeks, adapting lightning quick to the challenges, and managing to keep the surgeons informed and up to date on all the patient’s vitals! Fortunately, after a week’s worth of cases we’ve figured out the kinks in the system and today’s case went as well as we could have asked for.

The team wrapped up surgery around 1pm and packed up for the day. It’s the first afternoon off we’ve had in a week and everyone is excited to get back to the hotel for some rest and relaxation, but not without a quick stop at our favorite African Walmart first, the Nakumatt. 

The team replenished inventory on our greatest necessities… Beer and chocolate! (do not get the impression that we drink a lot, we just do not trust the water and figure that the alcohol in the beer at least kills any gut wrenching bacteria)

Dr. Lieberman and son used the time off nap. Dr. Hisey and son took a football (soccer ball) out to an adjacent field and kicked the ball around with some local kids. The rest of the team perched themselves on the patio, relaxing, enjoying the cool Ugandan evening, munching on some homemade (well hotel room made) guacamole.

The team reassembled and scuttled into the bus to head out for dinner, our favorite local restaurant the Agip Motel. We were joined by Alex Kerner, the son of Elizabeth Kerner, plastic surgeon and former teammate, as well as his friend Savannah, a Manhattanite spending a year in Uganda as part of Elizabeth Glaser pediatric AIDS foundation. We were also greeted by Michelle White, a physical therapist from South Africa who is coming on board to assist patients with post-op exercise regimens and routines. She is a welcomed member to the team as physical therapy for post-op is almost nonexistent in Uganda. We are confident her contributions will be invaluable in helping the patients rehabilitate and get back to a healthy and productive life!

We have a two way tie today for quote of the day, both coming from our dinner at Agip Motel.

Upon entering the restaurant and seeing our table, Kari remarked “you know you’re at the fanciest restaurant in Uganda when they have a pepper grinder.”

Out next quote came from Josh. Throughout dinner the team kept hearing a “buzzer” noise coming from next door. The team joked that they must be shooting an episode of Jeopardy out back, to which Josh replied “I’ll take “what meat am I eating” for 1 million shillings”

UGANDA DAY 6

Dr. Lieberman was up bright and early this morning, well actually not so bright as he was up and out the door before sunrise. As he embarked on his daily morning run, he was joined again by 17 year old local, Joshua, Dr. Lieberman’s new running partner. The two ran 8 miles, and Dr. Lieberman took great pride in outpacing the much younger Ugandan, only to have his hubris shattered after Joshua revealed that his shoes had no soles, and that the local was practically running barefoot over dirt, gravel and broken glass the entire time.

Dr. Lieberman graciously provided young Joshua with the resources to purchase new shoes… so tomorrow morning Lieberman is screwed.

The team gathered on the bus and waited an extra 15 minutes for Dr. Gorlick who was fashionably and predictably late. He had just enough time to pop into the hotel restaurant and grab a handful of pre-made mini omelets. One of the hotel attendants ran out after him with a take-out box as Zvi, in a hurry, had grabbed the runny omelets with his bare hands.

Despite leaving late, we arrived right on time to the hospital, so no egg on our face (although there was some on our hands). The team, led by Nurse Sherri and equipment manager Brian Failla, prepped the patient and room for Dr. Lieberman’s morning case. Having a few surgeries under their belt, the team breezed through set up and broke skin (made the first incision) at 9:00 am sharp.

The patient was a 17 year old Ugandan teen named Deus, who had an unfortunate accident falling out of a tree. Technically the case was a real doozey, the boy’s spine was essentially split completely in half, having been fractured with the T5 vertebrae dislocated in front of the T6 vertebrate.     

After Dr. Lieberman’s successful case Dr. Hisey and Mike operated on a gentleman for cervical spine degeneration affecting his working ability on the farm. The case was full of challenges including a lack of all necessary instruments, but that didn’t hinder the operation in the slightest. They were able to “Macgyver” through the surgery, finding creative solutions with a great outcome.

Dr. Lieberman had a quick check in with Deus, the teen from today’s first case. He was awake and stable, however in quite a bit of pain understandably so. Dr. Lieberman is convinced however that within 48 hours he’ll be sitting upright comfortably in a wheel chair. After the patient check in, it was time once again for Dr. Lieberman’s favorite part of the day, clinic, or as he so affectionately refers to it “the penalty box.” We only had one patient to check in with, a very young girl named Ester who suffers from neurofibromatosis, a tumor of nerve cell origin which can engulf the spine and put pressure on the spinal cord and nerves. Updated MRI scans revealed extensive tumors on both sides of her young spine. They had developed to a level that made surgery impossible, and there are no alternative medical options available in Uganda to battle the disease. This was a devastating diagnosis for the team and Ester’s mother, however young Ester seemed unfazed, continuing to goof around and play with Dr. Lieberman’s rolling stool. Ester is an amazing young girl and we hope that her positive attitude will help carry her to a fun-filled childhood despite the complications that may arise. In fact Dr. Lieberman’s son Josh left Ester with some paper and pens so she could continue to draw for fun and hopefully take her mind off the pain.

Dinner was a blast tonight as we were joined by two of the hospital staffers, our main man Uganda Stan, and anesthesiologist Andrew, as well as an eager young UK medical student named Silas, who is currently getting some hands on training in the Mbarara ER department. It was great to have these new members discuss their lessons of the day, especially Stan and Andrew as they recounted what they’ve learned from us as a team, witnessing first-hand the camaraderie and support that allows us to “achieve the impossible” as Andrew stated in regards to the day’s first case, a spine that was split in half. Andrew remarked that when he had first seen the x-rays, he did not believe it could ever be possible to fix the spine, and he was completely blown away by the commitment and hard work of the team, all coming together to achieve the impossible.

Along the same vein, today’s quote of the day:

When pressed about his thoughts on the “impossible” case and observing Dr. Lieberman strategically rebuild a shattered spine, resident Dr. Silverstein remarked

“That was the sweetest spine surgery I’ve ever seen”

Runner up quote of the day:
From an exchange at the hotel restaurant. The team favors the whole fish dish at the hotel restaurant, offered as a medium or large size, yet there seems to be quite a bit of controversy and confusion regarding the price and size discrepancy between the two menu items.


The following is the conversation with our waiter:
Dr. Lieberman: What is the difference between the medium and the large fish?

Waiter: the price…(long pause)… sometimes

Extra early breakfast this morning for the team as surgery was scheduled to begin at 7:30. But that didn’t stop Dr. Lieberman from his early morning running routine, where he was unexpectedly joined by a friendly and fast local, a 17 year old Ugandan boy named Joshua (which also happens to be the name of Dr. Lieberman’s only son…although that Joshua doesn’t run much).

A brisk cool morning welcomed the team as they arrived at the hospital to begin prepping the patient for surgery. This morning the team operated on an 11 year old girl, Jallor, who suffers from severe progressive idiopathic scoliosis (“idiopathic” being code for “doctors don’t know how it got there”).

She was a bit intimidated by the overwhelming machinery and wires in the OR, but she was greeted kindly by the team and settled into place for the anesthesiologists to start their job.

 

Meanwhile Drs. Hisey and Silverstein popped over to the ICU and surgical ward to follow up with patients from the first 2 days. Everyone was doing well, and recovering faster than even the doctors had anticipated. On the way back they were inundated with requests from other Ugandans to review X-rays, including individuals who had travelled great distances in hopes of seeing the American doctors. Unfortunately, the reality is that the team does not have enough time or resources to treat everyone, though Drs. Hisey and Silverstein did their best to offer what medical advice and opinions they could before being pulled back into the OR to assist on young Jallor’s surgery. Dr. Hisey’s son Matt was also on hand to help the surgeons out!

The surgery was well underway when there was an emergency in the room… a music emergency. Dr. Lieberman’s iPhone was stuck on a loop playing the same 3 Beatles songs over and over…it could have been worse, at least it wasn’t Yoko Ono tunes. A few of the cleaning nurses in the back commented how much they enjoyed the songs and said they’d never heard of the Beatles before!

 

The surgery went well, but was tougher than anticipated, as every time Dr. Lieberman attempted to straighten the spine there was a loss of signal from the neural monitor. The team couldn’t see what was going on in the patient’s brain, but we all knew what was going on in Dr. Lieberman’s brain: “Crap, crap, crap.” But naturally, Dr. Lieberman kept his cool, and after calmly proceeding through corrective maneuvers, the neural monitoring signals returned to baseline and the team was able to get to the back. The case lasted roughly 5 hours, and after wrapping up, Dr. Lieberman went to the break room for a well-deserved hot tea (Houji-Cha Japanese black tea, no milk, no sugar, extra hot. In case you were wondering).

Outside the surgery ward, Dr. Lieberman followed up with patients and families from previous days of clinics who had returned with new x-rays and CT scans. One of the reviews hit the team particularly hard: a very kind man, Edward, who actually works at the hotel where we were staying. It was brought to the attention of the doctor as well as the patient that the man’s left hip had almost completely deteriorated, and would soon be followed by the right one. Edward was understandably devastated as he worried about growing medical bills amongst his impending inability to continue working. Luckily Dr. Lieberman will be getting in touch with the next team rotating into Uganda, and hopefully plan accordingly for them to bring all the necessary parts, tools and instruments to help Edward get back on his feet with a surgery free of charge! Hip hip hooray!

 

Prep began for the second case of the day, Dr. Hisey’s surgery for an incorrectly healed spine fracture resulting from a Boda Boda accident 6 months prior. The patient, a very nice 29 year old female, was experiencing significant back pain and discomfort.

The case went on without a hitch. It must have helped that Dr. Hisey had his Rambo head gear on! This case went into the evening and was the last OR case in the operative theaters. Following this long day, the team retreated back to base for dinner and bed.

 

 

After dinner Dr. Lieberman’s son presented the team with dessert, a large air bubble chocolate bar! Unfortunately Josh had left the chocolate bar in the bus during the day, and needless to say, it melted. However a good half hour in the fridge and our chocolate re-solidified into a nice bubble-less sheet of chocolate…who wants dessert!?

 

Lesson of the day: over under on Dr. Gorlick pinching a French fry off someone’s plate: 45 seconds.

 

Quote of the day; “there is nothing worse than a dongle that does not work”, Josh Lieberman lamenting over the wireless fobs that are meant to give high speed internet access.