TEAM 3 - DAY 1 & 2

Our team began its journey today.  Selvon St Clair (our fearless lead spine surgeon) and Eric Varley (the intrepid orthopaedic resident) met up in the exotic paradise of Detroit Wayne Metro airport.  We started our voyage being informed by the curbside kiosk staff that though Dr. St Clair informed Delta airlines that we were bringing medical supplies whose cost was to be waived, he did not specifically request a "waiver".   After a brief 2 hour discussion, this intuitive discrepancy was sadly not to be resolved.  We entered security with our wallets lighter and our hearts merrier having contributed to the ever-deserving airlines industry.   We connected in Amsterdam and enjoyed a hearty Dutch meal of mini-pancakes and smoothies.  Dr. St Clair and I (Eric) knew we had to find Dr. Kip (our other spine surgeon) but neither of us knew what he looked like.  We moved forward with the plan of walking up to the random middle-aged white guys waiting to board our flight to Uganda.  This strategy paid off and we discovered Dr. Kip decked out in full safari gear ready for an African adventure.  Now off to Uganda to meet the rest of team 3. 

We landed safely in the partially demilitarized Entebbe Airport and quickly realized two things: we had no bus for transportation and the rest of team 3 were delayed out of Heathrow Airport.  An hour and half later, having enjoyed spectacular midnight airport parking lot views, the remainder of team 3 arrived and we all celebrated with hugs, handshakes, and the obligatory group picture.  We were lucky to welcome Brian and Joan (our expert Globus volunteers), Chris (our neuromonitor tech), Sharron (our veteran nurse), and Austin (our enthusiastic but weak stomached high school junior volunteer).  Dr. St Clair stumbled upon our bus driver and after testing the weight limit of our mid-70s party bus, we were off to Mbarara (pronounced "Barara" - though we all agreed it sounded much cooler annunciating the "M").  For the next 4 and half hours (departing at 1:30 AM) we all gritted our teeth and surrendered any feelings of rest, safety, or personal comfort for a rousing shock-free drive over Uganda's questionable highway system.  The number of people out at 3 AM and the complete lack of self preservation exercised by the small motorcycles (called boda bodas) was our first reminder of many that we weren't in Kansas anymore. 

We defied traffic accident statistics and arrived at the Lake View Hotel safe and moderately sound at 6 AM just in time to shower and meet up with an energetic team 2.   Drs. Holman and Burch from Team 2 gave us the basic run down and reminded us to avoid the pork and double check how many beers the hotel charges to our rooms.  Teams 2 and 3 reluctantly re-boarded the bus and were off on a short drive to the hospital. 

When we arrived at Mbarara Regional Hospital you can't help but be immediately struck by just how difficult an environment this is to practice medicine.  The staff who welcomed us were warm and immediately saw to stowing our medical gear.  We got a brief tour of the ORs and then off to the wards to round.  We started our rounds in the ICU where we first met Ken, a 21 year old gentlemen with severe congenital scoliosis.  The severity of this young man's deformity was extreme and he had recently undergone stage II of a thoracolumbar spinal fusion with resection of his vertebral column and resection of several of his ribs.  

This is the sort of case that as a resident is rarely if ever seen.   The surgical treatment you are more often to hear about in a "I was there" heroic story told in the resident's locker room back stateside.  The patient seemed to be improving and we were informed that he had needed to be bag mask ventilated after suffering respiratory failure due to a lack of available oxygen - a resource that is so ubiquitously available you don't even think about it in the United States.   The degree of pathology and the truly jaw-dropping efforts of teams 1 and 2 were to be reiterated throughout the course of this first mornings rounds.   As a resident surgeon, there is a difficult- to-describe mix of feeling excited, incredibly empathetic, slightly overwhelmed and ultimately determined in this type of rarely encountered situation.  We were all impressed by the work of teams 1 and 2 and, though it  wasn't said, we were all focused on concluding this year's spine mission on a high note.  This is my memory of the events earlier today and it should be said that we were now operating on 40+ hours with only a few hours of restful mid-travel sleep.  So of course our next move: clinic.  We arrived at what I can only describe as an open-windowed series of dark exam rooms and found ourselves 6-people deep in the "ortho exam room" which is only slightly larger than a crowded broom closet.  Thus began a blur of an afternoon of clinic.  We saw a mix of patients and ended up having a few get imaging and follow-up with us next year.   We had the assistance of the eager residents at Mbarara of whom all of our teams owe a debt of gratitude.  As clinic wound to a close I caught myself, Austin, and Drs. St Clair and Kip nodding off.  After our last patient Dr. St Clair made the astute observation that we had hit the wall and it was time to bail.  As we waited for our ride in the hospital square we had another few impromptu patient consults.  Our ride mercifully arrived and back to the Hotel for some long awaited, much needed....beers!  We each enjoyed a couple of deliciously cold Nile lagers.  A quick siesta and that brings us to this very moment.  We just finished our first dinner at the hotel's Rhino restaurant where we had our first G.I. causality.  Young Austin, our hopeful but ultimately weak-stomached volunteer, fell to a Indian-chicken induced bout of G.I. distress.  Now with a hearty dose of Cipro and Imodium we all are headed to bed to prepare for the OR tomorrow. 

Quote of the Day: "there are two things you will notice immediately: the smell and the dust" - Selvon St Clair; and dear readers, truer words could not be spoken.