As a new member to the team I planned to get ready for the mission by reading past blogs and trip reports.  I thought that would prepare me for the experience and what to expect.  To be honest, there is no preparation or way I can truly capture this experience in my epilogue.  As detailed in my team 3 blog entries, I am a resident orthopaedic surgeon.  A large part of my training involves teamwork, that nebulous concept we all recognize, but is impossible to create at whim.  I began this mission contemplating how a group of eight individuals, who had never met, could gather in a sleep and resource-deprived setting and become the team that was necessary to serve our patients.  We were lucky to have a couple of mission veterans with us including Dr. St Clair, who had assumed a new role as team leader.  What I experienced was how a group of committed individuals could overcome innumerable obstacles to help those in greatest need.  The words “we can’t” didn’t exist. Instead, “let’s find a way” became our team mantra. This team dynamic reinforced my deep belief in the power of gratitude.  Our patients and their family’s gratitude were expressed in the whispered thank yous of a rural villager to the full embrace of an orphaned child.  There was a shared gratitude between the Ugandan medical staff and our team for how much we all learned. I was routinely amazed by the profound gratitude of the Ugandan people.  The appreciation they expressed for something as small as a used pair of sneakers to the care they provided for their families made me reflect on how essential gratitude is to shaping our perspective. 

I was fortunate to have been a part of Dr. St Clair’s team. It was educational and inspirational to join someone as they assumed a new leadership role.  In particular, my perspective of the mission was deeply affected when we lost a young woman with an open femur fracture on our third day in Mbarara.  I was emotionally prepared to be part of a team who always “saved the day”. This was a different situation. Observing how Dr. St Clair efficiently moved through the obstacles in an attempt to get her appropriate care was impressive. Afterwards, he demonstrated that it was OK to “feel” the loss.  This helped our team use the experience as a constant reminder to push ourselves and use every moment to make the greatest difference possible.  It is this lesson along with countless others from technical surgical pearls, to life lessons in teamwork, gratitude, and integrity that made Spine Uganda a life-changing experience.

To those who contributed to this mission, I wish to express my deepest thanks.  To those that are new to the Mission, I implore you to make a difference in any way you can.  Africa is too often portrayed as a hopelessly deprived continent that is impossible to change.  Change comes slowly; but I promise that you can see and feel it in Mbarara.  Nelson Mandela said that things always seem impossible until they are done.  Be a part of making that change.  Please consider getting involved in Spine Mission Uganda and be the change you wish to see in the world.  

Our final days in Mbarara flew by, we made it into round again on our patients and were lucky to have Marvin join us for a final review of the plan.  He again expressed his thanks and we made arrangements for me to send some orthopaedic surgical textbooks his way for the Mbarara residents.   We also settled up with the private ward – one of the previous teams patients Ken had had issues maintaining adequate blood oxygenation and we needed him more closely monitored in the private ward. 

Unfortunately, Uganda has a two-tiered healthcare system and requires cash payment for closer monitoring.  We took care of the family’s bill and paused for a couple of final photos of the hospital.  Our jobs done for now, we said our goodbyes to the patients and the staff.  With a final glance back we boarded the bus and headed back to the hotel.  

We spent the rest of the day preparing.  We had our final breakfast the following morning.   We all agreed that though breakfast was pretty decent, none of us felt the need to have potatoes and onions anytime in the near future for breakfast.  We loaded up on the bus for another organ-rattling drive through the Ugandan countryside.   We took time to stop at the equator and shoot a couple of photos on either side of the hemisphere.  Having fulfilled our mandatory equatorial tourist obligations we climbed aboard the bus with souvenirs and a greater appreciation for the Ugandan skill at bargaining.   Our final stop before the airport was the Kyber Pass.  This little gem of an Indian restaurant has come to be famous amongst the spine mission teams with Brian and Sherron singing their praises about the best Indian food either person had ever had.  I entered optimistic but doubtful, I had witnessed the intestinal havoc Ugandan Indian cuisine had reeked on my team members.  

Brian et al could not have been more right, no words can describe how delicious this meal was – who knew that Kampala was the destination spot for delicious Indian food.  It was a great way to conclude the trip and we all left with our bellies full ready for 22 hours of flight time.

We arrived at the airport and submitted ourselves to three separate personal searches by the heavily armed airport security.  We made our way through the rain and arrived in the airport terminal just in time for another power outage – a occurrence that is so regular that I haven’t even mentioned it in previous blog entries as it is a given daily event.  We stopped for a final photo and exchanged hugs and contact info.    

We headed to our separate seats on the plane, tired, well-fed, and deeply grateful for the experience.  Throughout this spine mission odyssey we had experienced so much and I have searched for a good way to summarize it for the blog.  The truth is that there is no way I can encapsulate it all.  I thought I had some idea of what I would see and I now realize you can’t really understand it until you experience it.  The desperate need for medical care cannot be overstated.  We saw tremendous tragedy and people die of injuries that are easily treated in the first world.  We also saw the tremendous beauty and pride of Uganda and it’s people.  These are a people who know what hard work  and gratitude truly are and you can’t help but be affected by it.   So we depart, each of us grateful for the experiences we had and people we met.  We also depart committed to returning and hopefully bringing the ethos of spine mission Uganda to our own everyday lives.        

We had our final breakfast this morning as a whole team and greeted Hasan, our intrepid bus driver, for our ride into Mbarara.  It was foggy this morning having cooled down to the low 60s overnight (weather I would not have associated with Uganda prior to this trip) as we cruised into the Hospital.  The boda boda drivers seemed to have no concept of poor visibility as they often would shut off their engines and lights to coast down hills oblivious to what might be in front of them.  We arrived with a single case this morning – we would be putting on our orthopaedic trauma hats and attempting to adjust an external fixator on the leg of previously treated fracture.  The external fixator is a system of large diameter pins placed on either side of a fracture with metal tubes spanning the fracture connecting to the pins.  The patient this morning needed his fixator adjusted as his fracture was maligned.  Dr. Kip and I (Eric) attempted to accomplish this task but unfortunately the fracture had had 4-5 weeks to heal in this position and though we corrected things slightly he would need an open procedure to reduce the malignment.  

Having given it our best shot we met up with Dr. St Clair and the rest of the team to do group rounds and make sure each patient had a long term plan.  Denise, our ICU scoliosis patient operated on by the previous team, was doing better and we weaned down her ventilator settings with hopes she could come off of it in a few days.  We moved deliberately through rounds, distributing antibiotics straight from the bottle to Gardenisia (our cancer patient earlier this week) for a UTI and reviewing each patient’s plan with the Mbarara staff and physical therapists.  

Our first big case of the week Eziekel looked great and was walking around comfortably.  Mary, our second case was tired but feeling much better.  I paused to give her a finger-knitted necklace my 8 year-old daughter had given me as a good luck charm.  We also handed out Cliff protein bars to many of the children – unfortunately these children don’t seem to get an adequate protein supply which is an essential building block to healing.   They were all excited to try something new and we handed out chewing gum to those that were mildly constipated – again simple bowel meds are in short supply at the hospital and improvisation of treatment was key.  Interestingly, there seemed to universal agreement by the kids that spearmint was by far superior to peppermint.  Our other two patients Shakira and Sarah were resting.  While Sarah was still in quite a bit of post-operative pain and frowning at us, she lit right up when she got her pillow pet and her caregiver expressed his gratitude.

We finished up rounds and discussed all the patients with Marvin and Dr. Deyo (his supervising consultant physician).  With everyone understanding the plan, we made our way back to the hotel for a late lunch and a fairwell to Dr. St Clair.  Dr. St Clair took time to touch base with us each individually to review the week.   We had a last lunch of chicken palaka, a questionable meal at best before 30+ hours of traveling, and we all said goodbye as he headed out.  For the rest of the day we all took time to catch alittle sleep and get ready for our own departure.   We met for a team dinner and marveled at how a group of 8 individuals could come together in a completely foreign environment and accomplish so much.   

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.