Video From the Experience

Posted by Michael Garrison:

Here is a video I produced during Duke Medicine's 2007 mission to Uganda.

"We Take the Spice Out Of Life"

Michelle Gailiun writes:
I have such mixed emotions about what I've experienced this past week, and it is this man, Dr. Joel Kiryawele, who has helped me gain some understanding about it. One of the things I've witnessed but not talked about much is the cultural differences between the Americans and the Ugandans and how they play out in the realm of patient care. Some of our clinicians have expressed astonishment and even outrage about the seeming lack of urgency and attention they feel the patients here are receiving from their caretakers. It has been very difficult at times and I have wondered about that, too. I asked Dr. Kiryawele to talk about the differences he perceives between us and how they color the way we provide care, and this is a condensed version of what he said:

"The way we handle things is different. Ugandans are soft-spoken and laid back. Time is never so important to them as long as you get something done in the long run. So the way we handle emergencies is different; the way we handle disappointment is different. Here if the patient wakes up and finds that there is still something wrong, it is easier to forgive. Americans are faster, they are more into output - what have I achieved today? Neither extreme is good. The challenge is to find a balance."

"Ugandans have also suffered a lot. I remember when I was a boy going out into the streets and seeing people lying shot, bloody and dead. It leaves a scar. You never knew if the next bullet would be in your own house. So we may look callous, but it is really a survival mechanism. We have learned to take the spice out of life every moment."

So I sit here writing and looking out the window, soaking up the lush and vibrant landscape, knowing that we will have to leave in just a few hours. I know that behind the deep green curtain lies bone-crushing poverty, terrible disease and death. But I also see extraordinary spirit and grace. It is hard to hold all of these things in one embrace, but I will try, and I will will keep Joel's words in mind as we head back home.

We came with much, but we leave with much more.

Robbie "Puka Boy" Diggs

Michelle Gailiun writes:

The applause-o-meter hit 100 last night when Robbie stood up to introduce himself to our hosts at dinner. I think all of us see him as the unsung hero of the mission, because without his expertise, we would have been worthless in the OR.

It was Robbie who stayed up 'til 3:00 a.m. on the Internet the night we got in, trying to see if the converters and transformers we bought would sync up with the equipment that we brought in and that which was already here. It was Robbie who took to the street and spent $250 of his own money buying parts we didn't have. It was Robbie who saved the day when one of the surgical microscopes crashed half way through a procedure. And that's just for starters.

Robbie is truly the "glue" that held everything together when it was literally falling apart. Here he is, fixing an electrical surgical unit - still don't get what this really does, big guy - giving credence to Robbie's contention that, "I can get by with y'all because you don't know a thing about electricity." (Note to Robbie's boss: Think raise/combat pay.)

In a sense, everyone here was heroic at one time or another, and I realize not everyone showed up in the blog postings. I'm pretty sure I didn't get shots of everyone in action, and some people popped up more than once. I hope we can all take some time to post a few favorites in the coming days. And stay tuned....Mike Garrison's video is going to be a knockout. He, like everyone else, has been working like a dog and has gotten great material on EVERYONE!

Another Kind of Miracle

Michelle Gailiun Writes: Get this -- I walk in the recovery room and find Margaret here drawing pictures on a big sheet of paper on her lap. I look closely and there are lots of nurses names and measurements - and a big stack of fabulous fabric nearby. (click on image to zoom)

A dressmaker! Of course! Doesn't every hospital have one? No? This one does. And about everybody in the room has already placed an order. Incredibly, She calls them in and announces they will be ready TOMORROW.

Another miracle. But then again, we've already seen plenty of miracles this week!

Scrub nurse T. Carver and nurse Michael the Angel (he swears it's his given Christian name) selected a lovely floral print (below).

I especially like watching T in the OR because she's not afraid to boss people around and she guards All Things Sterile like a pit bull. Don't know Michael that well, but he had us all roaring and taking his picture tonight at a dinner hosted by some of the hospital and state health leadership.

More Pictures

Michelle Gailiun writes:

Right up to the last day, our docs and nurses were still pumpin' in the OR.

Top - Here's Teresa Cordero doing a little one-on-one with a member of the Ugandan team.

Bottom - Yvonne Carver filled me in on what a circulating nurse does. (She is one.) Basically, she is the link between the sterile surgical arena and the rest of the world. So a circulating nurse can go into a back room like this one and pull out supplies, go check on the patient's family, move scopes and lamps around the rooms...all sorts of useful things, and always busy.

A Lost Dream

Michelle Gailiun writes:
I also had the chance to visit the Uganda Cancer Institute today, where I met this little girl, Salifa Nakiyuka, who had come with her mother from a village far away in Eastern Uganda a few days ago.
The director of the Institute, Dr. Jackson Orem, suspects she has either retinoblastoma or Burkitt's lymphoma. Interestingly, the hospital ( before it became an institute) was originally dedicated to Denis Burkitt, an Irish surgeon who worked here in the 1950s and who was the first to describe the tumor that can lead to huge growths like this one that targets jaws and abdomens.
The Institute is a bleak and dismal place, even though Orem says Case Western Reserve, Johns Hopkins and the Fred Hutchinson Cancer Center all have active research programs here. The NCI (National Cancer Institute) originally funded the place, drawn by the Burkitt's research, but pulled out support during Idi Amin's brutal regime and never looked back.
So here's how cancer treatment works today: A patient comes in, say, with a breast tumor. They can image and stage it. Then, the doctors give the woman a prescription for chemotherapy and tell her she has to go find the drugs somewhere and pay for them, and if she brings them back, they can administer them.
It's a blunderbuss approach, even when it works. They don't have any way of testing tumors here for any markers that can guide treatment. Everyone is automatically put on Tamoxifen, since they can't tell who has a hormone-sensitive tumor and who does not.
Another note...Orem says 60 per cent of the patients here have Kaposi's sarcoma, a complication of HIV infection. I am saying a prayer for Salifa tonight. And tomorrow.

Now For the Not-So-Good News

Michelle Gailiun updates the case of Subra:
I thought I'd first show you little Subra as Dr. Ali Zomorodi adjusted the Mayfield frame around her head, steadying the field where the incisions in her skull and neck would be made.
Subra is 7 years old and has already lost one eye to retinoblastoma - or so everyone believes. She's been to several hospitals before landing here, and unfortunately, no one really knows her diagnosis for sure.
Doctors believed she had a life-threatening aneurysm, and she has been near the top of their to-do list since day one. She and her dad have come from a village far away and have waited six weeks for this day. Surgery began around 3:00 Wednesday afternoon.
Surgeons were surprised and saddened to learn that Subra did not have an aneurysm after all - which might have been "cured" with a well-placed clip. Instead, she has a brain tumor. What kind - they're not sure, but a brain tumor of any type is never good. Doctors took a piece of it to biopsy.
But a nurse told me that a biopsy at the local facility could take a month or more, and the family has no money to go to a private lab that might be able to determine the type of tumor in a matter of days. Radiation is a possible treatment, but they can't begin it without a definitive biopsy report; I am reminded that her pathology report on her earlier eye problem was lost.
Her dad, Wathum tends her with the most tender touch, but she still cries a lot, perhaps missing her mother, perhaps not feeling well, and maybe a little scared, too. Many of us feel quite distraught. I miss her dear, bright smile.