Uganda Spine Surgery Mission Trip Report 2014

Isador Lieberman MD
www.UgandaSpineSurgeryMission.org
December 2014

Table of Contents
1)
2)
3)
4)

Mission Roster 4
Mission Schedule..4
Daily Reports.5
Epilogues.67

Uganda Mission 2014 roster

Surgeons
1) Izzy Lieberman
2) Paul Holman
3) Selvon St Clair
4) Tom Scharschmidt (Joints)
5) Elizabeth Kerner (Plastics)

Anesthesiologist
Nur Lubis

Assistant Surgeons
Zvi Gorlick
Shane Burch
Phelps Kip

Fellows/residents
Anthony Owusu
Brandon Liebelt
Eric Varley
Erica Fisk (Joints)

Neuro Tech
1) Barton (team 1)
2) Adams-Taylor (team 2)
3) Christopher Martin (team 3)
4)

Equipment Techs
Lance Philips
Rob Davis
Brian Failla

Scrub Techs
Sherri LaCivita
Nadia Mirza
Sherron Wilson
Tom Grodhaus (Joints)

Volunteers
1) Joseph Mpalirwa (team 1)
2) Matt Mclaurin (team 2)
3) Austin Coney (team 3)
4) Joan Coney (team 3)

Uganda Mission 2014 schedule

Dates (arrival/departure, Mbarara)
Surgeon
Assistant
Equip Tech
Scrub Tech
Fellow/Resident
Anaesthesiologist
Neuro Tech
Volunteer
Volunteer

Spine Team 1
July 28 August 5
Lieberman
Gorlick
Phillips
LaCivita
Owusu
Lubis
Barton
Mpalirwa

Spine Team 2
August 4 August 15
Holman
Burch
Davis
Mirza
Liebelt

Spine Team 3
August 15 August 24
St Clair
Kip
Failla
Wilson
Varley

Adams-Taylor
Mclaurin

Martin
Coney
Coney

Uganda Mission 2014 Daily Reports

Departure day (authored by Dr Isador Lieberman)
I must admit, the last three weeks I was on edge. This is the 10th mission. By now I assumed it would
be auto pilot. Yet this is the most ambitious Uganda Mission endeavor since its inception. Five teams (3
spine, 1 trauma/joint & 1 plastics team), 28 volunteers, 3 shipments, and shipping containers that I cant
keep count of. This morning came and a new realization came with it, I cant prepare any more. The
mission is now.
After a week of packing, sorting, collecting and re-packing, Lance and his wife came with their minivan to
my house to pick up the containers and myself. The rest of the team from Dallas, Skylar, Anthony &
Sherri met us at the British Airways check in kiosk. Immediately Anthony set the smooth tone for the
trip. During the check in process, I think he is hitting on the ticket agent, by claiming to have a tattoo of
her name Lydia on his arm. To my astonishment he scores the team an extra baggage waiver by lifting
his Dr Pepper t-shirt to show the name Lydia tattooed on his arm. It remains to be seen how smooth he
is when faced with the overwhelming spine pathology he is soon to witness.
The flight to Heathrow was uneventful, and Heathrow security was as non-compliant as ever. We
persevered and made it to the rendezvous at Huxleys pub in terminal 5. There we were joined by Liz,
then Tom S., Tom G. & Erica, closely followed by Nur. As security delayed us we really had no time to
reacquaint or even meet the new team members.
Just as Heathrow security was unwavering in its reputation, Zvi was too in his arrival. He strolled into
Huxleys, with his duty free bag, with his ever calming demeanor, about 30 seconds after I had made the
decision that we cant wait for him any longer and need to proceed to the boarding gate.
With all team members accounted for, I was no longer on edge and ready for the second nine hour flight.
The arrival at Entebbe was uneventful and on time. As predictable was the fact that one shipping
container with the total joint equipment did not show up. Tom S. hustled to the baggage claim attendant
while we began loading collecting the bags and containers to load onto the bus. As we exited the terminal
I was very much relieved seeing the Mbarara Health Services bus and the remaining team member
Joseph. Joseph even had the bottled water and ground nuts I had asked him to procure for the trip to
Mbarara. Those nuts were even more flavorful now that the team was intact and we were on our way.

Day one and two (July 27 and 28th 2014): KICK OFF! (authored by Joseph Mpalirwa)
London was once again the meeting point for most of the Uganda Spine Surgery Mission team members,
though the time spent there was just a short layover. The team, boasting members from London, Texas,
Ohio, and Toronto boarded the long eight and a half hour flight from London Heathrow to Entebbe,
Uganda. I, the last team member anxiously and excitedly awaited their arrival along with our local bus
drivers. After pondering how we were going to fit all our equipment and luggage in our one bus, we began
a calculated and concerted effort to try and do just that. After a little while, we were able to fit everything
with some (little) room to spare! 1:30 am, after taking a quick moment to relax and refresh, we took in
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the fresh night air and began our long, tiring, but purposeful 5 and a half hour drive down to Mbarara.
At 6:30 am, we arrived, checked in, and after a quick hour and a half nap for some, were back at it for 9
am. We grabbed breakfast and left to unload our equipment and set up at the hospital. After hours of
unloading equipment the orthopedics/trauma team, led by Dr. Thom Scharschmidt, and the plastics team
led by Dr. Elizabeth Kerner walked through the ward to meet and select prospective surgery candidates.
Dr. Lieberman and Dr. Owusu also selected four prospective patients for spinal surgery- two boys, Ezekiel
and Frank with suspected congenital kyphosis, Denise, an 18 year old with severe scoliosis and Enid, a 23
year old with a TB infection affecting her lumbar spine. We booked her for an anterior corpectomy
(removal of the entire vertebral body) and reconstruction for Wednesday.
We concluded our time at the hospital at 4 pm with even more unpacking. During the process we blew
some fuses from the newly donated Stryker drills, but finished our unpacking nevertheless. The team was
tired and running out of steam after a long days work and only having only eaten breakfast. After what
was supposed to be a short journey into town, we settled down for some cold drinks, toasting to a
successful first day and even more fulfilling couple of weeks to come. We headed into the hotel for a
delicious buffet dinner, and some well-deserved rest.
Quote of the day (QOTD) -'ouch that was my nipple'- Tom G. exclaimed, grazing his nipple as he helped
unload some heavy bins from the bus!
Runner up quote of the day (RQOTD): That is true love- Sherri observing the subjects of photograph
below.

A woman props up a man into a comfortable position as he awaits an assessment for his shattered foot.

The team picture just after landing in Entebbe

Transporting our equipment into the O.R

Dr. Kerner dressing a burn victim.

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Dr. Owusu checking some reflexes on Frank, one of the prospective surgery candidates.

Dr. Scharschmidt studying the X-ray of one of his prospective surgery patients.

The team assembles around Dr. Deo as he translates and presents a case to
Dr. Scharschmidt and Dr. Fisk, one of his chief residents.

Day 3, Wed, July 29th- 'The real work begins'

It was a 5:30 am start for the 'brave' ones as Dr. Lieberman, Lance and I went on a four-mile run on the
dark and deserted roads of Mbarara. The stars were still shining, the air still and silent, save for the
sound of our shoes hitting the ground and the occasional scrapes of our shoes as we try and avoid the
numerous bumps and potholes...
7:00 am and we were all ready for breakfast and soon after headed over to the hospital for our first real
day of work, with orthpaedic and plastic surgery cases already scheduled for 8:00 and Dr. Lieberman's
spine clinic (aka the penalty box) scheduled for a 9:00 am start.
Dr. Lieberman, Gorlick and I took some time to come up with a game plan for the day before we headed
to our consult room. We were a little taken back by the multitude of patients eagerly and impatiently
waiting in the hall. We were off to a slow start as patients constantly walked into the closed consult room
interrupting ongoing interviews much to our dismay, but they eventually got the point after some stern
instruction and the interruptions ceased. We quickly picked up the pace, seeing about 43 cases for the
day, many of them follow-up cases from years past...
I later on wandered into the O.R theaters and quickly got recruited by Dr. Kerner to help transport Nadine,
a 28 year old burn victim who had just undergone an extensive 5 1/2 hour surgery to debride her infected
wounds. After some quick planning, and the recruitment of extra hands, we transferred her into a gurney
and prepared to transport her to the ICU, almost failing to notice the four new-born babies lying side by
side with ones head next to its neighbors feet. They lay in a single incubator in the corner of the room
that had apparently started off empty at the beginning of the day! Nadine, the burn victim, was Dr.
Kerner's second surgery patient of the day, the first being a little boy with an eyelid injury sustained from
a motorcycle accident.
After dropping Nadine off at the ICU, Dr Kerner discussed some post- op management and pain
medication options for Denise, settling on some meperidine, as some staff hurried to purchase some
morphine to assist with her longer term pain management. She quickly discussed and decided on the lineup for the next day's operations with Dr. Marvin, one of the local doctors.
We headed back to the O.R and I took in a quick peek into one of the theaters as Drs. Scharschmidt,
Owusu, Fisk and Lubis along with Sherri and Lance worked on their last Ortho patient of the day, intending
to fix his multiple leg and foot fractures that had been sustained from a boda-boda (motorcycle taxi)
accident. They settle on an external fixator (pins and bars outside the leg) for his femur after discovering
a serious, extensive and non-salvageable infection within his lower leg and foot. The plan is to recommend
a BKA (below the knee amputation) for the next day after having the chance to discuss it with his family.
They quickly wind down; this had been their seventh case of the day, having also ran a concurrent clinic,
seeing 27 patients!
We slowly assemble after the rest of the groups finish off their work for the day and head back to the
hotel at 9:30 pm, ordering some late dinner, then trying to curb our impatience and hunger by each
reflecting on our lessons of the day- this being one of our daily rituals. A common theme for the day was
the importance of resourcefulness in a setting like this, realizing that we should not take for granted all
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the resources that are afforded to us at the health care facilities back home and also how much can be
accomplished with so little. We slowly wind down after dinner and head over to bed, ready to do it all
over again the next day
QOTD: Im here to pay for my sins- Lance at 05:27 a.m while lacing up his running shoes.
RQOTD: Have fun in the penalty box- Dr. Mark Kayanjas early morning text message to Dr. Lieberman

There must be an easier way to get to school

Dr. Lieberman and Emmanuel reminiscing over pictures from the 2006 mission

Drs Scharschmidt and Fisk being innovative

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Dr. Owusu trying to find the spine with an extensile approach from the femur

The multi-talented Dr Lance Philips

Dr. Kerner working on Nadine (30% total body burn)

Rebeccas one year follow up, she is doing very well

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James, ready for surgery this year

The penalty box

DAY 4: July 30 2014; And so it continues

It was a slower paced start to the day, only in terms of the volume of patients to be taken care of, but
the work was just as significant, having several lengthy surgeries lined up for the day. Dr. Lieberman and
Dr. Owusu started with their first patient, Enid, with what would turn out to be a six-hour surgery, to
reconstruct her spine destroyed by Tuberculosis.

Enids spine, destroyed by TB.

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Dr. Scharschmidt and Dr. Fisk also begin their case, Jovanis, a Hip arthroplasty. The hours passed by
unnoticed, morning quickly turning to afternoon as the various teams handle setback after setback
Running back to yesterday's consult room to grab some CT requisitions for Dr. Lieberman, I was tracked
down by the mother of Denise, a young girl whom we had seen on our walk through the wards and had
sent for some x-rays on our first day. She tearfully described how she thought we would be back to the
wards to see her daughter, waiting in vain only to find out that we had held our clinic the day before and
that she had missed it. I pulled out my notepad and found Denise's name and the notes that I had scribbled
down and agreed to talk to Dr. Lieberman on her behalf. A little while later, he looked at her X-Rays and
came up with a plan, agreeing to see Denise the next day with tentative surgery scheduled for the next
week. I communicated this to Denises mother and thanked her for her persistence. She continuously
thanked me and reiterated what a great job the team had been doing and how grateful she was for our
presence.
I walked back into the OR where Dr. Lieberman and his team were beginning their second case. As I walked
back out into the OR hallways to observe the other ongoing cases, I was again quickly recruited by Dr.
Kerner who was working on Nadine, the same burn victim that she had been working on the first day. I
helped her position Nadine as she cleaned and dressed her extensive burns, breaking a sweat in the
arduous and lengthy process and taking a lesson in the importance of stamina from one of the local
doctors that Dr. Kerner was working with.
After we transport Nadine back into the ICU, I headed back to Dr. Lieberman's operating theater. I was
just in time to watch them conclude their last case, an anterior cervical discectomy and fusion (removal
of the disc and reconstruction in the neck) while religiously singing the chorus to Neil Diamonds Sweet
Caroline.

Anterior cervical discectomy and fusion.

Next door, Dr. Scharschmidt's team also finished up their last patient, after diligently handling some
unanticipated events with old school tactics.

Team Sparta
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Another crisis was averted quickly after retrieving our driver's lost phone number and we headed back to
the hotel, arriving just after 10 pm; a 14-hour workday!
We concluded the day with another late dinner, and a lesson in capitalizing on one's strengths and also
importantly learning to recognize one's limitations.
QOTD: Scharschmidt to Lieberman: with the reflexes of a cat she caught the code brown, describing
Dr. Fisks efforts to establish a sterile field.
RQOTD: Sister Rose knows how much I love my biscuits and nuts Dr. Lieberman

Skywalker keeping us honest

Gorlick to Owusu: Have you found the spine yet?

TAP: This aint Plano

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If Lance can pass gas, I can take pictures

Old School'

Day 5, Thursday July 31: ' Seasoned pros'

8 am start at the hospital and we found patients already lined up outside the hospital, awaiting their
consults for the day. We got to the OR theaters and the three teams separated, each beginning their
prep routines...
We once again ran into unanticipated setbacks throughout the day, but its day four, and we're all used to
it by now. Nothing is a surprise any more. I was quickly driven into town for a little adventure in search
for some new extension cords to replace those that we had blown out in the O.R. I got back a little while
later, and it was back to business as usual.
Early afternoon, in between cases, Dr. Lieberman and I grabbed some T-shirts and soccer balls generously
donated by FC Dallas to hand out to some of the orphaned children that he has been taking care of for
the past couple of years. The kids lined up and we presented them each with the shirts then coaxed them
to smile and pose for the camera. I did so with the sparse Luganda I know and am thrilled as I realize that
one of the kids speak Swahili, with which I ask him to smile for the camera. He looks at me, surprised and
confused that I spoke his language, but then obliges, grinning cheekily into the camera.
A little while later, I was back observing Dr. Kerner as she finished up with her case. Her patient was maybe
4 years old, and Dr. Kerner had just removed some scar tissue from the little boys cheek, releasing the
contracture. As they finish suturing the patient, he vomited and we realized that he hadnt actually been
fasted before the surgery, but we were also relieved that he had not yet been extubated (removal of the
breathing tube from his wind pipe) so there was minimal risk of aspiration.
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A little later, I walked by Skylar, our neuromonitoring technician and c-arm (x-ray machine) operator
extraordinaire impatiently talking to the manufacturers of the machine after a power outage causes it to
shut down intra-operatively and it refuses to boot back up. The machine was done for the day (and
hopefully not for the whole trip) but the teams manage the rest of the day without it.
I switched back and forth between Dr. Lieberman's last case and that next door, where Dr. Fisk was
performing the BKA (below the knee amputation) that had been scheduled from their last day. The
amputation was as gruesome as it was intriguing and Dr. Fisk took charge as Lance and Marvin assisted.
Watching Dr. Lieberman and Owusu undertake a thoracotomy (opening of the chest to access the spine)
and anterior release, I marveled at the beauty of the human anatomy as I watched the patient's right lung
maximally inflate after being pumped. I also doubled as videographer for both surgeries (this one and the
BKA next door) as we record some video to document the surgeries.
We once again conclude Dr. Lieberman's operating day with another bout of 'Sweet Caroline,' hollering
as a local nurse walks into the room and gives us some concerned looks. All in all, we ended the day having
done three ortho/trauma cases, three plastics cases, and two spine cases. As we tried to leave for dinner,
we found a few more patients in the hallway, who had been waiting all day to see us.
8 oclock finish time, we headed over for dinner, this time at the Agip Motel where they had run out of all
African food (I guess its that popular). We were joined by Dr. Kerners son Alex and his friend Afan, who
also readily joined us in our daily reflection ritual
QOTD: So what are you gonna do without your balls? - Dr. Kerner in reference to the ortho/trauma
team missing the femoral heads of the hip prostheses

I will make new ones, Scharschmidts response to Kerner

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RQOTD: Your comfort is our total interest- Dennis, the Vice President of hospital operations as he and
Dr. Lieberman discuss our transportation schedule.

Dr. Bitariho, Lieberman and Dennis, VP of hospital operations.

I am No longer a spine fellow Dr Owusu

Hallway Clinic

After all youve done to me, all youre giving me is a T-Shirt?

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I guess Ill grow into it

T-Shirts and soccer balls donated by Dallas Football club

Dr. Lubis at her finest

2014 Spine team

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Lieberman and Owusu reviewing the evening consults

Every time I come in here, it looks different

Day 6: Friday August 1, Who turned the lights off?

Prior to breakfast, while still at the hotel, Dr. Lieberman met with his patient from Ethiopia whom he had
operated on at the Texas Plano Health hospital in February. While in Texas, he had undergone a multiple
stage procedure to correct a deep infection and a pseudo-arthrosis (loose hardware, bone not healing).
The patient reported that he was doing exceptionally well and was gratified to be able to have his follow
up appointment in the lobby of the Lakeview resort in Mbarara rather than travel all the way back to
Texas!
It is an interesting start to our day at the hospital with our first power outage at 10 am. Hopefully no
machines are ruined this time, fingers crossed (incidentally, the C-arm fluoroscopy machine is still not
working and is unlikely to be repaired over the span of this mission). I remember Dr. Fisk recounting how
one of the local residents, Marvin, had exclaimed after our short power outage yesterday- 'this is Africa',
then proceeded to describe how he had once performed surgery for hours without electricity. Hopefully
we get our power back soon; luckily we have some generators for the theaters.
Two hours later, the electricity comes back on...
Today Dr. Lieberman operated on 11-year-old James. I'd seen James every day of the week, the first time
in our spine clinic and around the hospital each day after that. Every time I saw him, I waved at him and
said hi. At first he had responded very shyly and quietly, 'I'm fine,' but over the days, his responses would
become more and more enthusiastic. As I stood in the operating theater watching Dr. Lieberman and
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Owusu manipulate and straighten his spine- a breathtaking process that made me think, how do people
even begin to think of doing that- I couldn't help but picture James' face and his timid smile, I could vividly
recall him walking around the hospital, or kicking around the soccer ball that we had handed him some
days before. I couldn't help but think to myself, I really hope I get to see him stand a little taller, I hope I
get to see him smile a little bigger! His lengthy operation concluded a success and he is wheeled to the
ICU as I hope for his speedy recovery.
Dr. Kerner starts her cases later than the other teams as she was constantly interrupted and delayed by
emergency C-section after emergency C-section, but she eventually gets her operating theatre and gets
started.
Dr. Lieberman doesn't start his second patient, three-year-old Ivan, till after 6. Ivan was scheduled for
surgery much earlier but disappeared only to be found hours later; there had been some
miscommunication and his mother had mistakenly been sent to pick up Ivans blood, and she had taken
him with her. Ivan made it back to the OR just in the nick of time before the 6 pm deadline.
Around the same time, Dr. Kerner also starts her last patient, a young girl with massive keloids on her
neck...
I'm back in Dr. Lieberman's O.R just after seven and the lights flicker and turn off again but nobody in the
operating room is phased. It's our fourth power outage of the day. Dr. Lieberman asks me to scrub into
Ivan's surgery and I hurry to the hand-washing station, excited! It's my first time scrubbing into a spine
case and I am thrilled! I assist him, Drs. Owusu and Gorlick, and we try to manipulate little Ivan's spine
slowly and carefully. I watch as his spine becomes straighter with each screw tightening; we only use as
much torque to get correction yet not cut out through his delicate tuberculosis-damaged spine. Four hours
later, we close him up and rush him to the ICU for recovery.
We leave the hospital exhausted at 11:15 pm- a record 15 hours- only after Dr. Lieberman takes care of
the patients he finds patiently waiting to see him in the hallway.
Our final surgery tally of the day: Spine team: 2, Ortho team: 5, Plastics team: 2

Drs Lieberman and Owusu with an Ethiopian patient for follow up in

Uganda after surgery at Texas Health Plano Hospital in Feb 2014

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Jik! It cleans, it sterilizes, it is SPF-50, it even goes well with vodka

Dr. Kerner screwing with Dr. Lieberman

Compassion and concern above and beyond

When the lights go out, the work continues, courtesy of the smartphone
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Pillow pets supplied by Sami Petersen and Shift Scoliosis

Day 7 and 8: A bumpy weekend

Today, the day started with rounds to see the patients who had been operated on and were now
recovering in the ICU. Little Isaac is doing great, as is Kenneth, though he is in a bit of pain. James is also
doing great. He is lying on his side and I greet him with a big smile. 'I'm fine,' he replies, his usual response.
We change all their dressings, and after a quick foray into the adult surgical wards to check on the rest of
the post-op patients, we head back to the operating theaters.
Today's only surgical patient for Dr. Liebermans team is Moreen, 15 years young, with a congenital
scoliosis, and who will be undergoing a correction of her deformity. I get to scrub in once again, and I
actually get to place a fixation screw into her spine. The screws are integral to holding the spine straight
until the fusion consolidates.
We are just finishing with Moreen, putting in her last sutures, when Lance, who was next door comes
bolting into our room, 'We need an anesthesiologist. Ours just bolted out of the door.' Dr. Lubis, our
anesthesiologist extraordinaire runs after him, sensing the panic in his voice. We are all puzzled as to what
is happening and I hope to myself that everything is okay. Tom who is also next door comes in, a second
later, also in a panic, asking for the keys to our storage room. He grabs them, then leaves, leaving us even
more bewildered. As we are practically done with Moreen, Dr. Owusu hands Dr. Gorlick the needle holder
so that he can complete the suturing and rushes next door to see what is happening. We are left
bewildered but praying that everything turns out well! A little while later, Dr. Lubis comes back into the
room, as calm as ever and we breathe a sigh of relief as we can sense that things are fine. She explains
how their spine patient Eric's oxygen saturation (level of oxygen in the blood) had dropped down
unexpectedly to the thirties and had set off a panic in the room as they tried to figure out what was going
on. They were preparing to deal with the worst when they realize that one of the tubes for his airway had
22

somehow gotten disconnected. The tubes are re-connected, his oxygen saturation levels go back up, and
crisis averted. Eric was team Sparta's last surgery of the day and of the entire trip as they leave the next
morning.
Next door, Moreen is finished with her surgery but concern sets in when she wakes up, groggy and cannot
move her legs. Her symptoms are variable and she is still in a daze with a high level of anaesthetic on
board and also injected locally into her back muscles, both of which could be contributing to the
symptoms. Dr. Lieberman decides to wait and watch. We go to home, tired and anxious about Moreen,
and praying for her to recover some movement.
Sunday, our rest day but it's still an 8 o clock start and I find myself chanting to myself the whole while to
the hospital 'please let her move her feet,' in reference to Moreen, our patient from yesterday. She is the
first patient we see when we get to the hospital. She is still not moving her legs, and so Dr. Lieberman
mobilizes the operating team and we immediately take her back to the operating room to prepare for
surgical exploration.
We all do our rounds, first in the ICU then in the wards, and then team Sparta (Ortho/trauma team) takes
off to Entebbe to catch their flights. The rest of us go back into the operating theaters. Dr. Owusu starts
his exploratory surgery on Moreen, discovering and draining a hematoma and then checking to see that
the screws and instrumentation weren't compressing her spinal cord. Skylar simultaneously runs some
neurological monitoring tests on her. A little later, Moreen is done and we wake her up. She is able to
slightly rotate her hips this time and has better sensation in her legs, and maybe a tiny hint of movement.
We wheel her back into the ICU, hoping that she recovers swiftly.
We finish our morning at the hospital and head back to the hotel for the rest of the day, getting in some
rest and relaxation and capping the day off with dinner at the Agip Motel after a few hilarious rounds of
'heads up'

Erics severe kyphoscoliosis

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Eric, getting prepped for his surgery

Joseph placing a spinal screw

Team 1 Day 9 and 10: Our Final Days

Day 9 and I can't believe it's already our last day of surgery! How time flies! Dr. Lieberman, Lance and I
once again begin our day with a 5:15 am run, on our way out bumping into the second team led by Dr.
Holman. They have just driven in through the night from Entebbe and will be taking over where we left
off. We bump into Sherri and Dr. Owusu on our way back, taking their own morning run around the hotel
grounds...
Everyone is in good spirits at breakfast, probably from the afternoon of rest we had yesterday. We
assemble and shortly after take-off for the hospital, ready to take on our last day of surgery. Dr. Lieberman
and the spine team are scheduled for three surgeries, as is team plastics, aka Dr. Kerner. Two local doctors
join her, Dr. Situdwa, a resident, and Dr. Kwikiriza, who is on anesthesia. They are working on a young girl,
releasing contractures of her hand and wrist. Their second case is a young man with large keloids covering
his neck and ear
Dr. Lieberman's three cases of the day go well, despite Skylar's neuromonitoring equipment getting fried
by a power shortage and being out of commission for the rest of the day (luckily this is the last day of
surgery, and team 2 brought their own neuromonitoring equipment)
We conclude our last surgical day earlier than our days before, and after team 2 finishes their day clinic,
we head over to the Agip motel for some well-deserved dinner and another laughter inducing game of
'heads up.'
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Tuesday Aug 6:
It's a bittersweet moment as we head into the hospital for our last morning of rounds. Moreen is getting
better daily, as she gains more function in her legs. It is looking promising. Sylvia, our first surgery of
yesterday is also doing well. Ivan is asleep but doing well after his second surgery to remove the extensive
tuberculosis that was destroying his spine. James is doing much better; he is even able to walk himself to
the bathroom. With his straighter spine, he indeed seems a bit taller; we even coax a great big smile from
him. Kenneth is also recovering well, and seems to have a better understanding of his breathing
exercises
With each patient, we say our goodbyes, and I know I will remember their faces for a long time to come.
I hope to myself that I get to see them again one day, that they will all be living their lives to the fullest,
and that they will be that much happier.
After we do our rounds, we say goodbye to the staff at the hospital, who have been dedicating so much
of their time this week to their patients, learning as much as they could from our teams, in an effort to
improve their skills to serve their communities better. As much as our teams had been working all week,
the local staff had been the first ones to arrive, and many had left only after we had. The anesthesiologist
staff, amongst them Drs. Emmanuel, Joseph and Steven, had all been dedicated to serving their patients
all week, along with the anesthesia residents George, Andrew and Sadiq, who had been just as helpful in
assisting and learning from the only anesthesiologist of our team, Dr. Lubis. Dr. Marvin Mwesigo had been
an integral part of team Sparta, bringing his infectious humor and optimism into the O.R, and teaching us
a thing or two about resourcefulness.
We say goodbye to Sister Rose, Prof. Bitariho and Jones, who had been major pillars that had helped hold
this whole operation together, coordinating and liaising us with all the patients and ensuring that we were
all aware of what was going on with the patients care. They had indeed been the brains of the operation
on the Ugandan side.
We finish packing up at the hospital; with a sigh of relief and a big sense of accomplishment, we officially
pass the reigns to team 2, and leave Mbarara Regional Referral Hospital, hopefully having left our mark.

Joseph finalizing the blog

25

Stella and mom Mary on their follow up visit with Lieberman

the team planning surgery

Final OR day group picture, Lt Rt, Lieberman, Abou, LaCivita, Philips, Owusu, Lubis, Gorlick, Barton,
26

Spine Machine group photo, team 1 & 2 at the Agip Hotel restaurant

Dr Lubis

Dr. Owusu, say what!

27

Appreciative of Dr. Kerners services

Cancel my appointment

Team 2 - Travel and day 1: Rise of the Spine Machine (authored by Matt Mclaurin)
Spine Machine! Spine Machine! Spine Machine! The Uganda Spine Surgery Mission team 2 - with no
correlation to performance - set out on Saturday, August 2nd, with full hearts and optimistic minds. Four
team members, including Nadia Mirza (scrub tech), Laura Adams (neuro-monitoring tech), Dr. Paul
Holman (neurosurgeon), and myself (Matt McLaurin-scribe/pre-med student) coasted through check-in
and security in a brief twenty minutes at Bush Intercontinental Airport, setting the smooth tone for the
trip. We spent some time getting to know each other at Rubys and then parted from Houston for a quick
9-hour flight to London Heathrow Airport. Meeting us there were the two other team members, Dr. Shane
Burch (Ortho/Spine surgeon) from California and Uganda Spine Mission veteran Rob Davis (Spinal
instrumentation guru) from Dallas.
The Houstonians landed in London around 8:30a.m. and didnt waste a minute scuffling through security
(besides Laura and Dr. Holmans elaborate bag searches) to prop up Huxleys Bar and enjoy a few cold
Stellas during the four hour layover. We spend these jet-lagged hours deliriously expressing our
excitement for the weeks to come. Thinking our plane was leaving an hour later than it actually was
28

allowed us to get our workout in for the day- a full-fledged jog to the gate at 12:20 p.m. for our 12:30p.m.
flight. Miraculously, we made it. With little more than a wave to Dr. Burch and Rob, who were already
aboard the plane, we were soaring south towards Entebbe on our second 9-hour flight.
We touched down in Entebbe at 11p.m. on a chilly, starlit evening. The team huddled together after the
flight and some first time introductions were made. With the team finally together, we found our bus
(not an easy task), loaded all of our gear and supplies, and set out on the tiring, teeth-chattering (some
of us didnt prepare for cold weather), but exciting 5-hour drive to the Lakeview Resort in Mbarara (our
home for the next 2 weeks).
Arriving at the resort around 5:15a.m. we unloaded, checked in, and were greeted by the daring few
members of Team Sparta who were heading out for their morning, monkey accompanied run. After
settling down and taking a much-needed nap, we made our way to the hospital and became familiar
with our working environment. We were pleased with what we saw- large operation rooms, lighting,
and a low-tech air conditioning system. What more could we ask for?
Dr. Lieberman took us through the wards while making his rounds and introduced us to post-operative
patients like Eric (the TB kyphosis patient), whom we would continue to monitor throughout our two
weeks here. He also introduced us to Frank, a 13-year old boy with congenital kyphosis who was
scheduled for us to operate on the next day.
After completing rounds with Dr. Lieberman, Dr. Holman and Dr. Burch split up and held a clinic searching
for prospective operable patients. We saw largely adult patients during clinic and found a handful that we
felt to be operative candidates. Other patients were told to get new X-rays and CT scans (many had year
old images; some none at all) which will hopefully reveal issues the team could address. The new patients
would need to be worked into the full surgery schedule that Dr. Lieberman had lined up for us.
After a bitter-sweet last day of surgery for Team Sparta and a full day of clinic for us, it was time to feed
our empty stomachs. The two teams headed to the one and only Agip hotel (where the fish kabob never
disappoints). We were able to hear of the wonderful week experienced/accomplished by the first team
and even fit in a few humorous games of charades. After our festive dinner, it was time to catch some
shut-eye, eagerly anticipating our first day of surgery and two weeks to come.

Dr. Holman and Dr. Burch taking a look at Eriks x-rays

29

Our first team picture after arriving in Entebbe

Team 2 Day 2: Frank The Tank

It was an early 5:30a.m. start for half of the team this morning, Dr. Holman and myself for a quick, yet
exhausting p90X workout (indoors, evading the tree-dwelling monkeys and other dangers) and Laura for
a three mile run with the courageous marathon crew. A great start to our first day of surgery!
After a quick, filling breakfast, we were off to the hospital. We joined Dr. Lieberman on his rounds once
more before his handing off of the baton to team 2. Although we only spent a day and a half with Dr.
Lieberman and the rest of Team Sparta, our parallel vision of the mission to provide the most optimal care
for the patients allowed our teams to collaborate with ease.
Following the rounds, we made our way to the OR. Today was Frank Ts turn on the table, a chance at a
new life. I never expected it to take two attending surgeons forty-five minutes to insert a foley catheter
into in a 13-year-old boy (it has clearly been a while). Where are the nurses? Frank had congenital
kyphosis (he was born with a spine that caused him to lean forward). In order to correct this deformity,
we had to perform a two-level vertebral column resection to allow for room to straighten him upright
with supporting rods and screws. The case went as smoothly as one can hope for, the brief power outages
that merely tampered with the lighting didnt faze the Spine Machine Team. We stitched up around 5p.m.
with a successful first case completed.
Surgery was followed with my first experience in sterilization. Hands on would be an understatement.
With a bucket of cidex bleach, aprons, eye protection, and layers of rubber gloves, Rob and I hand-washed
each instrument using toothbrushes (yes, toothbrushes). It wasnt the easiest task, but a necessary one
for the safety of our patients. We wrapped up the cleaning and left the hospital a little after 6:30p.m.
Tired, yet satisfied with our first day of surgery, we stayed at the resort for a scrumptious buffet dinner
and it was off to bed.
QOD: How many spine surgeons does it take to put in a foley catheter? Nadia

30

Dr. Burch and Dr. Holman operating on young Frank

Franks corrected spine

Team 2 Day 3: The Bakiiga Marathon

Today began with our morning rounds. Among the patients we visited was Frank, the 13-year-old boy we
operated on yesterday. Besides a painful cough (anesthesia related issues), all was well. His back was
straightened with no neurological issues, signs of early success. We assured him that the cough would go
away with time and shared a neat trick with him to breath and expand a rubber glove to strengthen his
lungs. Frank is a trooper and we affectionately nicknamed him Frank the Tank!
After completing rounds, we met with todays surgery candidate and her mother. Denise K. is an 18-yearold female with neglected idiopathic scoliosis (a large curve in her spine that will only continue to worsen
without corrective surgery). Denise informed us that she is a member of the Bakiiga Tribe, a group known
for their strength and courage, and that description is spot on for this fearless woman. We asked her
mother, Why do you want Denise to have this surgery today? She looked at us with animated eyes and
31

began to dance. So she can do this like me! was her response to us midway through her boogie. A few
chuckles and another examination of her deformity later and it was off to the OR.
Surgery began at 10a.m. I scrubbed in alongside Dr. Holman, ready to assist in any way possible- another
first time experience for me. After opening up and exposing the spinous processes (the bumps you can
feel running down your back), the severity of the deformity became more apparent to Dr. Holman and Dr.
Burch. Denises spine was torqued ninety degrees. Some of her anterior vertebral bodies (front parts of
the spine) were actually facing posteriorly (towards her back; the wrong direction). We had our work cut
out for us!
I think the expression, when it rains, it pours is best suited for today. Along with the complexity of the
eleven-hour surgery, there were seven lengthy power outages, and three moments when suction went
out while coagulating (tying) arteries. During the third outage, the anesthesiologist had vanished from the
room and Denises breathing seized. Panic set foot in us all. I frantically ran down the hall searching for
him or any other anesthesiologist that could help. Upon my return, I was glad to hear that she had started
to breath on her own. Thank Goodness. We finally caught a break. The surgery was a success and Denise
was sent to the ICU to recover. We would visit her in the morning to check her status.
We finished the eleven-hour surgery at 9:30p.m, knocked out sterilization, and left the hospital around
10:30p.m. for dinner at the Agip motel.
QOD: I feel like putting an open beer in your backpack is your second bad decision after ordering the
coleslaw Dr. Burch said to Dr. Holman

Denises back

Denise on the OR table

Calling all spinal straightness spirit

Team 2 Day 4: A Day Not Forgotten

The team awoke this morning well rested and ready to get to work. After a quick buffet-style breakfast
we boarded the bus and set out for the hospital. The streets in Mbarara are lined with speed bumps every
quarter mile or so; and when I say street bumps, I mean foot and a half trajectories that launch whoevers
sitting in the back of the bus into midair- Our daily rollercoaster. Lets hope one of us doesnt become the
next patient needing a spine operation!
Upon our 8a.m. arrival at the hospital, Sister Rose dropped some heart-wrenching news on us. The oxygen
supply was depleted and she wasnt sure when the resupply would occur: Quite an eye-opening
experience. Things wed never consider obstacles faced in the United States can shut down every surgery
32

here for the day in a matter of seconds. Oh well, what can we do? was all that was said to us about the
situation and its the sad truth. We sat down with Ttendo, the anesthesiologist, and he explained that he
would personally make the trip to Kampala today to pick the oxygen up (a sigh of relief for us all).
Disappointed that we wouldnt be able to operate, we had to make the best of the day. Dr. Holman, Dr.
Burch, Laura, and myself began our rounds by visiting young Frank, our surgery patient from Tuesday.
Two days after surgery and he tells us that hes already feeling much better. With a little support from
the team, he was able to get out of bed and walk around- his first trek since surgery. Once he was nestled
back in bed, I pulled some fruit snacks out of my backpack and gave them to him: A well-deserved reward
for his accomplishment. His face lit up with an ear-to-ear grin and he gave us a thumbs-up as he tried
them.
On the other side of the ICU was Denise, yesterdays surgery patient. She was in some pain, but thats
expected after an eleven-hour, major corrective surgery. With sensation in all of her extremities, we were
pleased with her status. Laura, who does our neuro-monitoring during surgery, got hands on and changed
out her dressings. It amazes me every day to see the compassion this entire team radiates!
After tending to other patients in the ward, we left the hospital for some team bonding. Pulling into the
resort I noticed a group of local children, varying in age, playing soccer and rugby in an open field. I had
an itch to join them and thats exactly what I did. At first, the boys were very timid, looking away from
me when I asked them questions and giggling when I told them I just wanted to talk, but after a few
minutes the tension eased and I was bombarded with questions. What is the USA like? Why do you
come here? and so forth. The boys and I switched off asking and answering questions about each others
lives and cultures. Eventually, we got onto the topic of dvds and to my surprise they had seen lots of
movies from the states, like the Avengers and Spiderman. I asked them if they had a dvd player and when
they told me, yes, I ran to the resort and grabbed the movie Paul (it was the only one I thought they
would appreciate) that I brought to pass the time on the airplane and a jumbo bag of jerky. They were
ecstatic when I told them it was for them to keep and share! Rugby followed and I learned the hard way
how athletic these boys are (or how out of shape I am).
A couple of hours passed and it was time for me to leave for dinner. I said my goodbyes and went back
to the resort. Those boys changed my life and I hope I impacted them in some way as well. No surgery
was performed today, but I feel as if good was done. The Spine Machine Team spent countless hours
getting to know each other and I got to spend time with a group of incredible children.

QOD: Sorry Dr. Holman, were going to have to cancel your surgery for today. Theres no oxygen or
power. Sister Rose

33

Frank taking his first walk since surgery

Dr. Holman changing Sylvias dressing

Hanging with new friends

34

Team 2 Day 5 and 6: Friday and Saturday: The Fun Continues

Routinely, our day at the hospital began with rounds. Denise, whom we operated on Wednesday, was
able to get up and walk a short distance- a mighty feat. Shes still in some pain but is making a tremendous
recovery! From there we visited patients staying in the wards and Dr. Bitariho introduced us to a new
trauma patient, Namu. He had fallen out of his work-vehicle and fractured bones in his cervical spine. His
neck was stabilized and he was scheduled for surgery on Monday.

Dr. Holman getting the low down on Namu

On our way back to the OR we were met by a large group of Ediths family. Edith, a beautiful five year-oldgirl, was scheduled to have surgery today to fix her Kyphosis and Scoliosis (her spine was curved and bent
forward). However, the family members were having second thoughts about the surgery; they didnt
understand why it was necessary. Dr. Burch explained to them that Ediths spine would progressively
worsen and the surgery would have to be done eventually, only becoming more complex and dangerous
as time elapsed. After a few minutes of comforting and coaxing, the family agreed that surgery was the
right thing to do and Edith was taken in for pre-op.
Dr. Burch found a back brace in the storage/prep/tea room (Ive realized most everything here is multifunctional) and sent me over to the ICU to put it on Denise, hoping it would provide her with support and
ease the pain. Once it was on she reluctantly stated, My pain level is very small and closed her eyes for
a nap before I had left the room. Success.
Go time! At around 9:30a.m. Edith was rolled into the OR with a terror-filled look on her face. While Rob
and Nadia were setting up the instruments for the case, Laura ran to the storage room and brought back
two furry friends (stuffed animals) to calm her nerves. Anesthesia began and she dozed off quickly, her
last sight being Laura holding the animals in front of her.
The surgery was a success with very few complications (by now were used to the power outages) and we
left the hospital around 7:30p.m. We stopped by the local Nakamut superstore, the Costco of Mbarara,
to restock on beverages, snacks, and blank cds (to burn CT scans on) and then went to the Agip for a
dinner full of laughter.

35

Day 6
Wow does time fly by! We all woke up shocked this morning that its already Saturday, day six, and were
halfway through with our two-week escapade in Uganda. We discussed the upcoming cases for the week
while eating a hearty breakfast at the hotel and left for the hospital at 7:30a.m.
Rounds were extra rewarding this morning. As we walked into Franks room, he immediately put on a
contagious smile (his smiles usually dont come easy). Looking over at his mother, she translated his words
to us. He said, These are the people that saved my life and then climbed out of bed, unassisted, and
shook each of our hands in a thankful manner. Seeing Franks ability to regain so much strength after
such a short time period is not only motivation to the other post-operative patients, but to all of us on the
Spine Machine Team as well. Edith, our surgery patient from yesterday, is doing very well this morning.
She wasnt pleased that we had to change out her dressings, but Laura saved the day by pulling a pillow
pet out of her bag and wrapping her petite arms around it. We finished rounds and went in for surgery.

Laura, Frank, and Matt

Edith receiving her new pillow pet

36

Todays lucky surgery candidate was Kenneth. Dr. Lieberman had already completed his anterior
transthoracic releases a week ago and it was time for stage two of surgery consisting of multiple level
corrective fusions. Dr. Holman asked if Id like to scrub in for the case and I excitedly hustled to the storage
room to grab a gown and gloves. During the surgery, multiple ribs were removed to mobilize the spine
and my first job was to make the bone graft out of them. My forearms throbbed but watching the steady
finite adjustments to straighten out Kenneths spine made by Dr. Holman and Dr. Burch intrigued me and
kept my hands moving. We close up ten hours later and hes taken to the ICU to recover.
We left the hospital at 9p.m., stopped by the Agip for dinner, and then stayed up until 4a.m. swapping
stories and celebrating a tremendous first week.

Do you want a motor?

But ma, who are these people?

37

All smiles during Kenneths surgery

Team 2 Day 7: Boda-Boda

It was a later start today for the Spine Machine Team after a festive evening. Dr. Holman, Dr. Burch, and
myself made the trip to the hospital at 10am to make rounds. Along with the patients weve operated
on, we consulted five rainy Saturday night trauma cases including two broken hips, two femur fractures
(one protruding), and one tibia/fibula fracture. Dr. Burch explained the significance of the open femur
fracture to the local surgeons, and reluctantly they already had him scheduled for surgery early in the
week.
We finished up rounds and went back to the resort for our day off (only because the hospital shuts down
on Sundays). We had planned to venture to Lake Mburo National Park for a safari, but it was pouring
down rain so we decided to evade the open-roofed, mosquito-infested jeeps. Instead, once the rain had
halted, we decided to go on team run to explore the Mbarara countryside. We set out in single file line
fashion on the dirt sidewalk, Dr. Burch (an ultramarathon runner) taking the lead and us tailing behind as
closely as our legs enabled.
As we swiftly passed by markets and family-owned shops I was able to soak up the culture of this country
more than ever before. The elated children hollering Mzungu, mzungo! to tell their families that foreign
people were passing their homes while waving at us sent chills down my back. Looking to my side at the
hilly scenery made the first three miles of the run fly by. However, after a cursory first half of the run,
things fell apart rapidly.
I was leading the group on the second half of the run, hill after hill, when I heard a scream and squealing
of tires. Confused, I turned around and saw Nadia skid five to ten feet on the rough side-road we were
traversing. At first, I thought she had tripped and was falling to the ground by mistake, but out of the
corner of my eye I saw a Boda-boda (local taxi motorcycle) fly out of control and I immediately put two
and two together. A reckless Boda-boda driver had hit Nadia. I frantically sprinted back to where she
stood (yes, she was on her feet after being knocked down by a motor vehicle). She was a little shaken up
but after a quick inspection, we determined that it was a fracture-free incident. What a miracle!
Cut up and bruised, we told Nadia to wait with Dr. Holman and Laura while Dr. Burch and I sprinted two
miles back to the resort for help. The front desk concierge, after some persuading, allowed us to use her
38

car to go and pick up Nadia and the rest of the team. Nadia didnt break a single bone and continued to
heighten the teams morale throughout the day. She shocked us all by describing the run as exciting
(bat-woman never gives in). At this point, nothing can stop the Spine Machine
We got back to the resort, tended to Nadias Boda-boda wounds, and un-winded with a casual dinner. A
curveball was thrown at us today and we can only hope that Nadia will have a speedy recovery!
QOD: Lets run during the day today so the boda-boda drivers can see us! Anonymous

Open femur fracture

Matt, can you tell me whats wrong here? Dr. Holman

39

Frank has moved out of the ICU and into the surgery ward

Nadias boda-boda battle wounds

40

Team 2 Days 8 and 9: Trauma Time

Rise and spine! Dr. Holman and I began our chilly Monday morning at 5:30am with a mind-focusing (or
simply exhausting) P90X yoga routine. A quick team breakfast followed and it was off to the hospital to
begin week two. Nadia was offered to sit out for the day and rest after her boda-boda motorcycle beat
down yesterday, but being the champ that she is, she didnt even consider it an option. Talk about a team
player!
With two surgeries lined up for the day, we finished rounds rather quickly and got into the OR at 10am,
only stopping briefly by the CT room to burn new images (Dr. Holmans computer had eaten the original
CD). Our first case of the day was the trauma patient we met on Friday, Namu, who had a jumped facet
(dislocated joint) in his cervical spine. We performed a complication-free anterior cervical discectomy and
fusion on him.
During the turnover of the OR for our next case, I walked outside to catch a cool breeze and visit the ward.
We hadnt seen Frank during our morning rounds and I felt the need to check up on him (always a highlight
of my day). Earlier during the trip, a nurse mentioned that Frank had seen some boys playing with new
soccer balls around the hospital and had asked her where they had gotten them. I knew that the affable
first spinal team had given some out and I was relieved to find an extra in the storage room for Frank! He
loved it!

For me? Frank

Back in the OR the second case of the day had already begun, along with Dr. Holmans 80s Mega
Collection playlist (The Doobie Brothers and spine surgery is quite the combination)! Both Dr. Holman
and Dr. Burch were meticulously operating on young Naomie with Kyphosis, attempting to decompress
the apex of her curved spine and straighten up her forward hunch. The surgery pushed the teams
knowledge and coordination to a new level. Fluctuation in motor-responses and rolling power outages
were among the few hiccups we encountered. However, after six hours of surgery, we closed up with
confidence.
At 10:15pm, we left the hospital and grabbed an Agip hotel fish kabob to fuel our empty tanks and it was
off to bed. Sleep, spine, eat, repeat!
41

Day 9:
This morning the team spent some time discussing the incredible pathology that weve encountered here
in Uganda and how this pathology translates into the strenuous surgeries were performing. Dr. Burch
thoroughly explained the risks associated with these corrective operations, but also pointed out the fact
that in many instances, the patients weve seen whove neglected having surgery have presented with
paralysis. With surgery theres a chance at a normal life. Without surgery early on in a deformities
development, the complexity of the procedure needed will escalate and the chance of permanent
neurological deficit will upsurge. With these words of wisdom, we finished our breakfast and went to the
hospital.
Rounds jump-started our day. Namu, the trauma patient from yesterday, is doing well this morning and
already wants to know when hes free to leave the wards. Hes got at least one recovery day and some
discharge instructions ahead of him. Naomies feeling weak in her legs after her operation yesterday, but
we hope and predict that shell gradually regain her strength.
Dr. Deo found us in the ICU and asked if wed take a look at an ER patient who arrived yesterday. Edson
was presenting a loss of motors and sensation in his legs after lifting a heavy load. A quick scan of his xrays revealed a burst fracture in his lower back take him to the OR! Dr. Burch explained to me that an
injury like this needs to be treated immediately to increase the chance of restoration of feeling and
movement in the legs.
The surgery, a five level fusion, went smoothly and felt like a walk in the park after all of the rare deformity
cases weve completed. Our plan was to perform a second surgery in the afternoon, but an extended
power outage stopped us from turning over the instruments that we would need. Instead, we made
rounds in the ER before heading back to the resort for the night. The team ate dinner, stayed up sharing
stories for hours, and went to bed hoping the power would be back up at the hospital in the morning
enabling a more productive day.
QOD: So now you guys are going to start working on that humpty hump? Rob said while pointing at
Naomies Kyphosis apex.

Say whattt?
42

Naomies Kyphosis apex

Resident Dr. Marvin helping out today

Team 2 Day 10: Oxygen Deprivation

The team was in good spirits this morning, motivated and determined to knock the last two days of surgery
out of the park. Being cut short of a full days work yesterday due to power outages only fueled our
eagerness and lengthened the To do list for today. A minor hindrance that wouldnt throw off the
seasoned Spine Machine Team!
We arrived at the hospital at 8am and after restocking my backpack with dressing supplies, Dr. Holman,
Dr. Burch, and I started our rounds in the ICU. All was well for our post-operative patients except for
Kenneth, whose oxygen tank was completely empty. The nurses told us that the hospital hadnt received
their oxygen delivery today and didnt know when it would arrive. With Kenneth going into respiratory
failure, Dr. Holman sent me back to the operation theatre to find a local resident doctor who could
hopefully catalyze the search for oxygen. I found Dr. Emmanuel prepping for surgery, quickly filled him in
on the situation, and we both sprinted back to the ICU together. He immediately found a hand
resuscitator and began pumping oxygen into Kenneth. Simultaneously, he questioned the nurses on
where there could be oxygen in other areas of the hospital, but much to our dismay, the nurses response
to him was the same. There was no time to wait for the delivery; something had to be done! Dr. Holman
and I scurried to Denises room and took the oxygen tank from there back to Kenneths room (Denise was
stable enough to be off of it). We hooked the tank up to Kenneth and thankfully were able to stabilize
him. The reality of the limited resources here and how that affects the feasible care becomes more
relevant to us every day.
43

A busy morning preceded a long day of surgery. Promise, todays surgical candidate, was diagnosed with
severe Congenital Scoliosis, with an almost ninety-degree curve in her spine. To put things into
perspective, what looked like her scapula was actually her rib cage! I scrubbed in alongside of Dr. Holman,
ready to observe and assist Nadia with her scrub-tech duties. While passing instrument after instrument
to the surgeons, I watched as they delicately tied off nerves, removed vertebral bodies, inserted rods and
screws, and reconfigured Promises spine. Incredible.
The seven-hour surgery flew by and I was taught how to staple up afterwards! Promise was wheeled to
the ICU to recover and we wrapped things up after a long day.
Dr. Marvin, a local resident, joined us at the hotel after dinner for some drinks. We further learned about
each others cultures and broke the news to him that he needs to work on his golf game (he boasted about
his eighty-five stroke, nine hole round). After an eventful day and night, it was off to bed.
QOD: Do you feel that pulsing structure? Thats her aorta. Dr. Burch told me as he gave me an
anatomy lesson

Promise before surgery

Promises CT
44

Rob and Nadia prepping for tomorrows cases

Sanitation Station
45

Team 2 Days 11 and 12: The Finale

The past two weeks have flown by and our last day of surgery in Mbarara has sadly arrived. By 7:50am
we were driving through the Mbarara Regional Hospital gates. To our left, local mothers stood with their
babies firmly strapped onto their backs (a common practice here). To our right, hundreds of boba-boda
taxi drivers were congregated, hoping for a day full of business.
The highlight of rounds this morning was witnessing Edith, who was operated on last Friday, courageously
stand up on her bed after a painful week of recovery. Shell be able to return home in the next few days.
Promise, who was operated on yesterday, is doing well and we hope shell be on her feet soon as well.
After rounds, we divided up into two surgery teams. Dr. Burch, Nadia, and Laura set up in OR 4 and Dr.
Holman, Dr. Marvin, and I in OR 3. Rob had the honor of bouncing back and forth between rooms to
manage the instrumentation (a miniscule task for a man of his capability).
Dr. Burchs crew was operating on Eric, who needed revision of a previous surgerys instrumentation. In
our room, Dr. Holman was performing an anterior cervical discectomy and fusion on the one and only
Revered Sam, who had been patiently waiting the past week for the arrival of the mechanism needed to
fix the C-arm. His family put forth funds to buy the part needed and for this superlative deed, the C-arm
at the Mbarara Regional Hospital will forever be known as the Reverend Sam.
Throughout the day, power outages (every half-hour or so), the lack of functioning suction-tips, and the
searing OR temperatures were among the many obstacles we faced. However, with these being the ninth
and tenth surgeries weve performed under these conditions, we simply werent fazed. Both groups
successfully finished their operations around 4:30pm.
The Dean of the Medical University and many of the local doctors weve worked with in the past two
weeks invited us to a 6pm dinner at the Agip hotel, thanking us for the work weve accomplished and the
commitment of the Spine Surgery Mission to Mbarara. Knowing that a 6pm scheduled dinner in Ugandan
time really meant 6:30-7pm, we werent concerned that we were running a bit behind schedule. Once
there, it was astonishing to hear facts such as in Uganda, a country of over thirty-seven million people,
there are only two orthopedic surgeons in Mbarara (one being Dr. Deo who we worked with throughout
the trip)! These facts really helped us to understand the potent impact weve had in a short two weeks on
the people of Mbarara. Dinner concluded at 9pm and the team relaxed at the resort before catching one
last night of sleep in Uganda.

Day 12
Dr. St. Clair and team 3 arrived at the Lakeview Resort early this morning ready to continue the Mission.
Both teams joined forces to unload the new supplies that they would surely need to complete the busy
week of surgery that lay ahead of them. Rounds were a collaborative effort, allowing team 3 to familiarize
with the post-operative patients they would continue to oversee. Kenneth is showing signs of daily
improvement, as is Denise. Reverend Sam, one of yesterdays surgeries, is less anesthetized today and
can move is feet. Eric, the other surgery completed yesterday, is doing well this morning and we hope
with time, hell regain bowel control. We visit with the rest of our patients and introduce them to the
new team, ensuring them theyre in good hands. With each heart-breaking goodbye, we are comforted
with the thought that our patients have the potential to live much happier lives.
46

We say our goodbyes to our loving friends that have helped us throughout our two-week stay. To Sister
Rose, who has kept things organized and the tearoom stocked with Chipate and Samosas (local
scrumptious cuisine). To Dr. Deo and the local resident doctors, who have gone above and beyond to
assist in any way possible. And finally, to team 3, who will finish the last leg of the 2014 Uganda Spine
Surgery Mission.
Team Spine Machine went back to the resort, loaded up our belongings, and set off on the six-hour trip
back to the Entebbe airport. Along the way, we stopped at the equator for a funnel demonstration and
some touristy shopping.

Tourists for the afternoon

The lengthy bus ride gave me time to reflect on the past two weeks. Two weeks containing some of the
fondest memories of my life and friends I will never forget. We fly out of Entebbe at 1am, overwhelmed
with a sense of achievement and the hope that weve impacted some of the lives here in Mbarara as much
as theyve impacted ours.
QOD: I cant believe I just peed in an African forest. Laura

47

Frank is heading home today

Passing the baton to team 3

48

TEAM 3, Day 1 & 2: The Adventure Begins (authored by Eric Varley & Austin Coney)
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),
Sherron (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
49

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
Agaba, 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 will rarely if ever see. 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.
50

QOD: "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.

Team 3, Day 3 - Preparing for the beast

For our first day on our own, team three hit the ground running, and
without the guidance of team two it was time to step up. The team
felt much more rested after a good night's sleep and nourished by a
hardy breakfast. Except for me (Austin), due to unwittingly taking
the fastest acting laxative known to medicine or lore, the Indian
Chicken Palaka. Aside from my bothersome GI issues, we were firing
on all cylinders today. We had a scheduled OR start time of 0800,
but had assumed that the OR would be running on usual "African
time" with a likely start time of 0930. This, dear reader, was our first
mistake. We arrived to the OR nurse stating flatly "You're late".
Surprised and scrambling we got the morning rolling quickly from
there. We put on our efficiency hats and divided up. Doctors St. Clair
and Kip heading to the OR for a lumbar decompression with the assistance of Sherron and Brian.
For Eric, Joan and I it was time for rounds. These my friends were no ordinary rounds. Right from
the get go we were hindered by basic equipment breakdowns, such as leaky oxygen tanks, which
Eric MacGyvered. It was this kind of ingenuity that allowed us to make forward progress at all.
The conditions were unbelievable. It was clear the staff was
trying to manage the patient load, but were running into
overwhelming road blocks. The ICU had 3 of our patients such
as Eric Agaba, our respiratory distress patient who was doing
much better but taking no narcotics, after a massive two stage
congenital scoliosis correction surgery. The patients' vitals and
lab data required half an hour of searching and were only
partially available. Overall, our ICU patients all seemed to be
improving. We did multiple dressing changes and assessed our
patients but there wasn't much we could do to minimize their
pain beyond showing that we cared with a gentle touch and
encouragement. The Ugandan staff as well as some of the
patients live in fear of forming addiction to pain medications and
are extremely reluctant to use them.

51

We finished up in the ICU and headed to the wards. This

was like nothing I had ever experienced; the patients
were packed into large open rooms with a male and
female ward on either side of the building. The lighting
was relatively non-existent and the insects were
everywhere. The final component was the smell, even
writing this I can't quite shake the odor, it was a mix of
infection, excrement, blood, and severe body odor.
Fortunately, even in this difficult situation there were
definite rays of hope. Each patient had family
surrounding them and doing their best to care for them.
Our little girl Promise was out of the ICU today with improving function in her legs. We also saw
14 year old Mary with severe scoliosis. We couldn't believe this pretty little girl was 14. Because
of her small stature, we thought she was somewhere between 6 and 8 years old. Mary is also
an orphan and life has not been kind to her. Unfortunately, due to the severity of her deformity
it can make her a target for bullying. We reassured Mary that we were going to do our best and
we finished up rounds and met the rest of the team in the operating theater to get our supplies
further organized and prepped for tomorrow. We also saw another patient randomly in the halls
and reassured him that his mild neck pain was a normal part of having a cervical spine fusion. On
our way out the door a nervous looking intern approach us and asked if Eric could glance at his
knee. Eric agreed and saw that the patient a severe open patella fracture with bone sticking out
of the skin, the intern wasn't sure if he should just put gauze on it and leave it. Eric quickly
educated him on the nature of open fractures, as we left the wound was being irrigated,
antibiotics were started, and we boarded him for surgery early next week.
After concluding our time at the hospital we headed back to the hotel where we witnessed a
Ugandan wedding reception in progress. The women wore the most vibrant dresses I've ever
seen and the air of festivity was a sharp counterpoint to our experiences in the wards. Dr. St
Clair also regaled us with some of the details of the Ugandan wedding rituals over beers.
Apparently, the groom gets "roasted" by a designated member of the bridal party, who tells all
manner of insults to prompt the grooms family to bestow gifts upon him until he feels that the
brides worth has been met. We all agreed that this was awesome tradition and would make for
much more entertaining weddings stateside. We then climbed aboard the bus and were off to
the Nakumat Mbarara market, a clearing house of all random home goods that is reminiscent of
a Target. Stocked up on water, coffee, and a couple bottles of spirits, we headed back to the
hotel. At this point we were all fading and in need of catching up on our rest so back to the hotel
we went.
After a brief siesta, we met again for dinner at the Rhino Restaurant at our hotel. Dr. St Clair led
us in a Lieberman tradition of going around the table and discussing what we learned today. For
me, the learning experience was an invaluable and overwhelming epiphany of how real it is for
these destitute people. I had watched videos and read about how terrible the conditions are in
Africa but seeing this first hand literally rendered me speechless. I wasn't sure what to do at first,
52

part of me wanted to run, part of me wanted to cry and part of me wanted to just start hugging
them. I have now had some time to digest what I saw, but what I realized is I will never empathize
with their suffering. It is incomprehensible for me. I am so blessed and lucky enough to even
have the opportunity to be here. I offer my help more as a symbolic token now because I could
never truly alleviate their hurting, but we on team three will give it our best damn shot. For me,
Eric, I also recognized just how much we take for granted in healthcare back in the US. Our team
rounds were like nothing I've ever experienced, almost every encounter required obstacles to
overcome and necessitated creativity and problem solving. For instance, availability of exam
gloves, getting vital signs, or just communicating all required making do. The amazing thing was
despite difficult conditions, the patients were grateful to be there and that gratitude couldn't
help but elevate you. Recognizing this gratitude and using every mental as well physical resource
to problem solve were invaluable lessons for today. After finishing our debriefing we enjoyed an
epic meal of delicious local tilapia and wine. And yes, my (Austin) stomach system held up and I
am feeling both gastro intestinally comfortable and ready for sleep. We rounded out dinner and
sleepily made our way upstairs to get ready for tomorrow.

Team 3, Day 3 - A day of extremes

Today was a day of extremes. Unfortunately, we were unable to
operate on Sunday so we headed in early to get rounding done on
the patients from the previous week. We walked into the ICU and
were happy to see one of our patients Eric Agaba, who had
undergone an extensive staged spinal fusion for tuberculosis
induced spinal deformity, had been moved to the general wards
and was slowly improving. We were again struck by the lack of
resources and difficulty in what we consider to be basic care. This
was illustrated by the lack of simple IV antibiotics and steroids, we
had to both provide the medications and the nurses with detailed
instructions on how to administer them. We then moved to the
surgical ward which had mercifully been thoroughly cleaned and
the patients were listening to a Sunday sermon. We were
immediately greeted by extreme tragedy and celebration. We got
to give fist bumps and hugs to "Frank the Tank" as he headed out to return home. The joy
radiating from this little guy did light up the room.

53

As we were leaving Frank, a frightened looking mother

approached the team asking if we could look at her
daughter who had fallen off the back end of a pickup truck
4 days ago. The mother was accompanied by her other
daughter who explained that her sister was heading back
to University and seemed not to be doing well. The
concern and fear reflected in both of their eyes was
undeniable. Dr. Kip and I (Eric) agreed to see her and went
to the patient's bedside. The patient was breathing
extremely rapidly and moaning in pain with her leg
wrapped in a blood soaked bandage. The mother immediately handed us the x-rays and
explained that her daughter's femur (thigh bone) had been sticking out of her skin after the
accident. The x-rays made our stomachs drop, she had completely fractured both her femur
above her knee and her tibia (shin bone) below her knee. She essentially had a floating knee and
was breathing rapidly due to either loss of blood or a blood clot in her lungs. The overwhelmed
intern who admitted her had only wrapped her leg up in a gauze dressing. Now, 4 days later,
she had lost alot of blood, potentially had a blood clot in her lungs, and was in severe respiratory
distress. We immediately sprang into action, Dr. St Clair went to get the patient emergently
moved to the ICU. We looked at this 20 year old girl who had beaten the odds, was attending
university with a proud family and potentially bright future in a country where hopelessness was
so common place and prayed as we got to work. Dr. St Clair was confronted by the ED physician,
who was about to do a bedside craniotomy, and was informed that it violated protocol. After
some convincing he said it would be ok to move her but apparently there was no oxygen available
in the ICU. We were then informed that we could buy it ourselves for 80,000 schillings (about 35
dollars). Dr. St Clair quickly agreed, sadly while we were jumping through these hoops the patient
quit breathing and we were unable to resuscitate her. Instead of a bright future at university she
died today from an injury that would have been surgically fixed with her already discharged if we
had known about her 4 days ago. The sister just looked at me and said in a statement of tragic
acceptance that her sister was dead. To compound this tragedy she was also pregnant. Everyone
on the Team, newbies like me to veterans were devastated by this news. Part of medical training
is learning how to steel yourself away from tragedy, to feel and acknowledge it but not to let it
dominate you. In the moments following this senseless tragedy we were all wide eyed and grief
stricken as we chorused how this shouldn't have happened, how painfully unnecessary this was,
and how we could have saved her if only there had been more time. Her name was Onvia, instead
of a bright future at the local university, she suffered and slowly died from a treatable injury in
front of her agonizing family. I am sure this is difficult to read and I assure you it is difficult to
write. I imagine those of you following this blog are asking why, why did this have to happen.
There are no easy answers. This is a medical system that is overwhelmed with scarce resources
and protocols that can prevent rather than facilitate care. In a country where the population
lives with the reality that one "big hit" such as a fracture is more often than not a life-ending
event. To me it is a unforgettable reminder of the dire need for expanding medical mission trips
to serve those like Oniva who deserve a chance at a bright future.
54

After leaving the hospital, we talked over some of these points in a

vain attempt to bring understanding to how we were feeling. Our
morning was over, we decided to continue with our plans to use our
only free afternoon to drive to Queen Elizabeth's park and go on
safari. As we slowly moved out of Mbarara, the land became
unbelievably lush with such vibrant shades of green you'd swear it
was from some special effects driven movie. We didn't talk much,
the rolling hills, lush
landscape,
and
clean
smelling air slowly helped us
let go of our collective hurt
and move forward. After 2
hours of driving, with a level of road disrepair that made
us long for our ride from the airport, we finished climbing
a mountainside, rounded a corner, and lost our collective
breath. Extending into the horizon in valley below us was
the savannah of Queen Elizabeth's park (second largest
park in Uganda). Imagine whatever picturesque view of
the African savannah you might have and I assure you it
would exceed it. We pulled over, stretched, shot some
pictures and inhaled the sweet counterpoint of Uganda's
unmatched beauty. We enthusiastically clamored aboard
our vintage suspension free bus and headed down into
the savannah. The next few hours were unforgettable:
Brian frolicked with a friendly baboon, we saw a hippo
and elephant moving through the bush, numerous antelope, and got to experience off-roading
in our team van. The undisputed epic moment of the trip was watching a leopard lay out and
groom itself 15 feet away from us. A sight that is apparently so rare that even our guide had to
stop and take a few pictures.
As we road back to the hotel in a collective exhausted daze,
I couldn't help but reflect on how we had all been taken
through the full range of emotions. And perhaps this
typifies the Spine Mission Uganda experience: there is so
much that is awe-strikingly beautiful and gives you hope
and there is so much despair and hopelessness. Ultimately,
I believe those who participate have a profound feeling of
gratitude for the experience and a drive to expand our
mission to help those who need our help the most.
QOD: I wish I had a tiny saddle - spoken by Austin as he watched Brian interact with the baboon

55

Team 3 Day 5 - Hitting the ground Running

Today was the first long day of surgeries, but certainly not
the last. We had one major congenital scoliosis case and a
lumbar stenosis (narrowing of the spinal canal with
compression of the spinal cord) case. Our first case was a
9 year old boy name Eziekel, whose about the most positive
little human being you've ever met. He was a little nervous
entering the OR but Joan (my Mom) helped calm his nerves
with some coloring. Drs. Kip, St. Clair and Varley worked
tirelessly and flawlessly, with the support of the team, to
perform a T6-L3 posterior instrumented fusion with a T10
hemi-vertebrectomy. This 7 hour surgery demanded all
hands on deck. On the onset of the case we faced a C-arm
issue (intraoperative xray machine that is critical to
determine which vertebrae to instrument). After making a
substantial payment, this unit had just been fixed but now
we had no idea why it wouldn't turn on. Brain Failla, our
Globus Surgical Rep/ X-ray technician / circulator/ sterilization / handy man attacked this
problem and discovered that someone had unplugged a cable within the storage battery likely
looking for another substantial payment to fix it. A quick plug in and the C arm fired up like a
dream. The case was truly a collective effort all the way through. At one point, Chris Martin, our
neuro monitoring guy, caught a slip up that may have resulted in a major consequence - nerve
compression resulting in a foot drop. When the patient became light on the table, due to
anesthesia wearing off, he kicked his leg off the table and due to the drape covering him no one
noticed. Chris's monitoring promptly detected this and we avoided what could have been a
devastating injury to the patient. Joan, my fellow volunteer and mother, was busily filtering
through the totes of medical supplies organizing the antibiotics, dressings, suture, gloves, braces,
etc. in the storage room making it more efficient to locate needed supplies straight away.
Sherron, our registered nurse, was expertly scrubbing with the doctors in the OR and assisting
throughout the procedure. As for myself, I was given the opportunity to shadow Eric Varley, PGY
3 orthopaedic resident. I round with him in the mornings. My backpack has been functioning as
a mobile medical unit stuffed with dressings, tape, antibiotics, gloves, scissors, and don't forget
the hand sanitizer. Also, I kept track of all patient X rays. Eric has taught me to be methodical,
accurate, and conscientious. He has driven the point home that years from now when our
records are reviewed, everything must be legible, organized, and consistent, or all is lost. He is a
wonderful example of all of those traits, and also a natural born teacher and now a great friend.
Our team has blended naturally to become the seamless surgical machine it is.
Our second case was Musa, a 68 year old man with lumbar stenosis, epidural tumor and prostate
cancer. We began the case with Dr. Kip while Dr. St Clair and Dr. Varley attended to the patella
fracture we saw in the wards a day ago. Musa had multiple issues resulting from his undiagnosed
prostate cancer which had spread to most of his spine. He needed a spinal tumor mass debulking,
56

decompression of his spinal canal and instrumented fusion from T10-L1 following this ordeal the
general surgeons came and performed an orchiectomy (removal of the testicles, a common
treatment for prostate cancer), yikes! Needless to say it was a much tougher day for Musa then
any of us. Again the team came together in spectacular manner in order to overcome the
obstacles that Ugandan hospitals pose and help this seriously sick man.
Meanwhile, in OR 3, Dr. Varley and Dr. St Clair were operating
on Julius, the 45 year old man who had a comminuted patellar
fracture, courtesy of-you guessed it, a boda boda accident.
After copious irrigation, Drs. St Clair and Varley repaired it
with heavy sutures and repaired the damage to his knee joint
capsule. Usually, or so I've learned, you have to keep the
patients leg straight in a full leg knee immobilizer.
Unfortunately, we didn't have one so as the surgeons worked
I was tasked with heavily taping straight a hinged knee brace.
The surgery went excellent though hot (there was no AC in
this OR) and one of the Ugandan residents, our man Marvin,
learned how to manage such an open injury. It was
fascinating and saddening to hear that this type of injury
usually requires an amputation and possibly death from a
blood infection. It was again a reminder how important this
work is and how gratified Marvin felt to learn how to manage
such an injury.
Monday was a great day. We all really bonded as a team and were working together very well
to serve the patients of lovely battered Mbarara. We left the hospital and arrived for a late night
group dinner, where, Dr. St Clair reminded us of Dr. Lieberman's tradition of going around the
table to hear each person share lessons they learned from the day. Each perspective was unique
and insightful. We have repeated this tradition as the days have gone on and it is absolutely
amazing how much has changed for us. Our investment in this place, respect for the people, and
future plans to return continues to grow each day. We finished dinner just after midnight, after
another rewarding, great day.
QOD: He just made a little incision, grabbed them, and pluu-mp! - Brian describing the
orchiectomy he walked in on.

57

Team 3 blog. Day 6: Our Mary

This morning and last night seem to be so close together that
they were almost continuous. We got to bed around
12:30AM, out of bed at 6:00 and we left the hotel at 7:15 in
order to get to the hospital and prep for a surgery that would
start roughly around 8. The first patient of the day was
Beatrice, a 59 year old woman with significant lumbar
stenosis (narrowing of the spinal canal with compression of
spinal cord). We preformed L4/L5 lumbar lamonectomies
(removing a portion of the back side of vertebrae to free up
the spinal canal), the case went well and the patient left mumbling her gratitude on the way out
of the OR. The next patient was Mary Glumoshare, a orphaned 14 year old girl with severe
congenital scoliosis. Mary's life has not been an easy one, the difficulty faced by any orphan in
the third is unimaginable. This is compounded by an obvious physical deformity that can make
them a target for bullying. We all collected as a team, prepped
the patient and said a prayer. Mary is a quiet, sweet child with
eyes that stare right through you. Serendipitously, Mary's last
name means "glory to god" and our anesthesiologist decided
today was going to be the day he rocked out to Christian rock
music for the full duration of the 6+ hour case. We were able
to significantly correct her deformity and instrumented her T6
to L3 vertebrae with a hemivertebrectomy (removing half of a
vertebra) at T11. This was no easy task for Dr. St Clair, Dr. Kip
and Dr. Varley who made the case flow by with an air of calm
focus. It was another late night for us but it was all worth our
efforts because the surgery went very well. After cleaning up
the OR and getting prepared for tomorrow we checked in on
Mary who was neurologically intact and on the road to a great recovery.

58

I noticed a Mbarara University surgery resident, Marvin, who

was constantly working hard and had a happy demeanor about
him. I found myself having a deep conversation with him during
a brief break in between surgeries. I told him how impressed I
was with his work ethic and it lead to him telling about himself.
He was truly so humble yet confident when explained to me
"Life in Uganda is hard and you have to work hard to survive".
You see Marvin used to be a farmer, well, he still is a farmer;
that's how he supports himself through residency in addition to
his work here at the hospital. I asked what kind of farm do you
have and his response was "It is very little, I only have thirty
goats and three cows". Blown away by this statement I could
only tell him how impressive that is to someone like me.
Someone who's standards of working hard don't hold a candle
to Marvin's. The people that live in Uganda have so little and
work so hard for what little they have it is hard to comprehend.
We wrapped again around 11:30pm. Had a group dinner this time at the Agip Restaurant and
Hasan, our tireless driver, dined with us. Dr. St Clair preordered for the team. He is always
thinking ahead and taking care of the team. After a relaxed dinner, it was midnight we agreed
we were turning into pumpkins. We hopped aboard our favorite travel bus and headed back to
our temporary home. Another good day under our belts.
QOD: If you dont respect your work, then people wont respect you. Marvin, on the Ugandan
work ethic.

Team 3, Day 7 - Hump Day

My head felt like it just hit the pillow when the alarm rang at
6AM this morning. After almost making the intestinally
devastating mistake of brushing my teeth with tap water, I
showered using the broken hand held shower and ambled
downstairs. Today was another big day for the team and it
started off with our now standard breakfast at the hotel pale
scrambled eggs, sausage, sweet bread, potatoes, coffee, and
some of the most delicious pineapple I've ever had. Washed all
down with Ugandan coffee and a desert of Malerone
anitmalarial medication. We headed into the hospital planning
to do one "smaller" case first followed by a multilevel scoliosis
case. As soon as we hit the OR at 7:30, we had to go into
immediate trouble shooting mode. Our cases had been switched without our knowledge and the
scoliosis case was going first. The instruments we required for both cases had not been sterilized
59

because the power was down and the OR autoclave machine would not work. To top it off we
didn't have an electrocautery pad (essential to reduce blood loss).
These obstacles aren't even considerations in the States but fortunately we had Brian and
Sherron on the team. These two set the standard for team work. While they got to work, Dr. St
Clair and I (Eric) began rounds and got a chance to
see Eziekel sitting up in bed smiling. He was doing
great. The next bed over from him was Mary who
was quiet but wanly smiled with those trusting eyes.
Brian somehow found an autoclave in another
building and managed to get the job done. Sherron
worked her magic and located another bovie pad,
hooked it up, and after a brief delay we were ready
to go. Our first case was Shakira, a little 10 year old
girl with progressive juvenile idiopathic scoliosis who
was brought in by her concerned father from an
outlying village. Dr. St Clair sent me over to help Dr.
Kip position the child and obtain the surgical
exposure. As I have moved through this task, Drs. Kip
and St Clair have helped me continually advance my
surgical skill set. Today Dr. Kip and I each exposed a
side of the spine and I identified the relative anatomy
key for placing instrumentation. Dr. St Clair joined us
and we efficiently moved through the case.
Throughout the case we had Mbarara nursing and medical students come to observe and it was
Sherron's hawk-like eyes that protected the equipment from being contaminated and kept the
patient safe by reminding them to pull their surgical masks over their noses. We placed our
pedicle screws (screws that hold the rods we used to correct the deformity), performed Ponte
osteomties (technique to remove part of the "back" of spine in order to mobilize it for correction),
and then corrected the deformity maneuvering the rods to "straighten" the spine. That's a onesentence summation of an incredibly detailed operation. There are numerous technical pearls I
gleaned from each case, but in a more general sense I appreciated Drs. St Clair and Kip's mastery
of the anatomy and how they used subtle variations to direct each step of the operation. We
completed the case and were gratified to see the child move all of her limbs.
Under Sherron's guidance we helped clean and prepare the room and got our next patient,
Gardenisia, into the room. Gardenisia is a 60 year old local villager who unfortunately has a
cancer of unknown origin with a tumor that was compressing her spinal cord. Starting at about
9:15PM we were able to debulk her tumor, decompress her nerves, and place instrumentation
to stabilize the spine. We finished, cleaned up the room and headed back to the hotel for another
midnight meal. We ate in a haze of exhaustion but with a deep feeling of satisfaction.
Throughout the day the concept of teamwork, which has defined this mission, seemed to be in
continuous display. Not just among the members of Spine mission Uganda team, but the hospital
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staff in general. Andrew and Emmanuel the anesthesiologists

willingly stayed late and ensured every patient moved through
the OR to ICU with the care each one deserved. Sister Rose, the
nurse manager of the OR was essential to orchestrating each case
and was essential in Brian's epic quest to find the autoclave.
Florence, one the OR cleaners, who had no reason to go above
and beyond her job duties, tirelessly worked with us and ensured
all of equipment was available. And Marvin our resident surgeon
/ goat herder extraordinaire who made sure all of orders made it
to the right place and somehow tracked our patients down in
remote villages were all essential to our success. Both the
Ugandan and American teams learned how to function as a unit
and this bedrock was essential to our patient's outcomes.
QOD: Mbarara at night reminds me of San Francisco. an exhausted Eric gazing at the
towns hillside lights at night.

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, Here 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 theyve 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
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patients take their first post-surgical steps with Dr. Kip. In addition
to our medical care, Joan (Team 3s 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 patients
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 patients 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 well 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 couldnt 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 Clairs 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.

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QOD: We are actually done, thats it I need a Nile. Sherron.

Team 3, Day 9 Wrapping it Up

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 patients plan with the
Mbarara staff and physical therapists. Our first big
case of the week Eziekel looked great and was walking
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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 dont 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 postoperative 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 a
little 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.

Team 3, Days 10 & 11 Bon Voyage

Our final days in Mbarara flew by, we were back at the hospital to
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 familys bill and paused for a couple
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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 organrattling 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 havent
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 cant 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 its people. These are a people
who know what hard work and gratitude truly are and you cant
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.
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66

Epilogues 2014
Dr Paul Holman
I was very honored to be asked by Dr. Lieberman to participate in the Uganda Spine Mission in 2014. My
inaugural trip to Kampala in 2012 proved to be an emotional experience with a variety of ups and downs.
In the end, however, the mission was one of the most motivating experiences I have had as a physician.
I was somewhat nervous but also excited by the chance to assemble and lead my own team this year. Dr.
Liebermans vision for a month long presence in the region was ambitious, but anyone who knows Izzy
was surely not surprised by his desire to do more. I was very happy to learn right off the bat that Rob was
going to accompany our group to provide the expertise in managing all of the instrumentation. I got to
know him during the 2012 mission and remembered him to be very kind and knowledgeable, with a great
sense of humor. His contributions this year were amazing and I credit him for making all of the rookies
on the team feel comfortable in their new surroundings and for wearing so many hats to make the Spine
Machine operational. Each of my other fellow team members performed at an exceptional level. I would
like to thank Laura for providing expert neuromonitoring data and functioning not only as the technician,
but also the expert Neurologist. To Nadia, a.k.a. Bat Girl your abilities as OR scrub tech were only
outshined by your toughness and durability. Hit by a motorcycle taxi? No problem! I know I can speak
for all of our team members when I say how impressive a job our scribe Matt did throughout the trip. We
worked him hard and he handled that workload like an excellent 3rd year medical student. (He is, by the
way, only an undergraduate.) I saw a genuine love of people in him and that quality cannot be taught in
a classroom or read in a book. We would all be lucky if he chose to pursue a career in medicine. Last,
but certainly not least, I would like to acknowledge Dr. Shane Burch and thank him again for taking time
out of his busy practice and family life, to donate his skill as a surgeon to the mission and the patients we
cared for. His experience and confidence pushed our goals and expectations of ourselves to a high level.
He was also, if I recall correctly, the first person on the mission to simultaneously order 2 Tuskers and
create a new fad at the famous Agip Restaurant and Motel!
In the end, I will always remember this trip for the people of Uganda who made the trip worth taking. The
local physicians were skilled, motivated, and welcoming. The citizens of Mbarara were kind and one could
not help but be impressed with their local customs and culture. They truly appear to appreciate life and
what their environment has to offer. Most of all, I will remember the patients and their families. They
literally risked their lives and their childrens lives and put their faith in a group of strangers who they
believed really cared. Placing oneself in such a position of vulnerability is not easy to do. I hope that as
time passes, the wounds of our surgeries heal on the surface, heal internally the spinal ailments for which
they chose to have surgery, and most importantly serve as a permanent reminder to our patients that this
group of individuals came to their home because we care about them as our fellow man. I thank our
patients for reinforcing and galvanizing my understanding of why I chose to be a physician and the need
for me to honor the profession and appreciate the daily opportunity to try to make a difference.

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Dr Selvon St Clair
After a long break from the Uganda Spine Surgery Mission, I accepted the invitation to lead my first team.
I have served on several missions before but never as a team leader. During the previous missions, I was
still in residency/fellowship training. As a private practitioner I was very anxious about the length of time
I would be away. However my desire to serve quickly assuaged my anxiety. The minute I landed in
Entebbe and inhaled the charcoal laden Ugandan air, I knew I had made the right decision. Nevertheless,
with the team finally assembled and nestled in for the comfortable 5-hour trip to Mbarara, the enormity
of the moment fully hit me. So while the team fitfully slept, I planned the details of our missions in my
head. In retrospect, I should have joined my team and tried to get some much needed sleep. Although
thoughtful planning can be an asset in Uganda, it is more an exercise in futility or at best humility. Uganda
is unpredictable!
Team 2 provided a thorough sign-out and we were it. It is very rare one gets rewarded before work but
due to scheduling we took the opportunity to visit the Queen Elizabeth National Park, which in retrospect
was fully appreciated by all. Now fully recovered from the jetlag and with a new appreciation for Ugandan
wildlife we bravely entered into the real jungle, that of complex spinal deformity surgery in Uganda. To
my surprise, the facilities in Mbarara were significantly better than anticipated. For the first time we had
intraoperative fluoroscopic imaging capability, once our resident material engineer, electrician, circulator,
and radiation technologist, Brian Failla, worked out the kinks.
My team was outstanding. Everyone worked tirelessly and I couldnt be prouder of the body of work that
we accomplished. Phelps Kip, my co-surgeon and a newbie to Uganda jumped right in and took a
leadership role in the OR while I was busy with the administrative role. Our synergy was refreshing. I
must add here that I now have a new appreciation for Drs Kayanja and Liebermans tireless determination
and administrative focus thats essential to the success of each mission. My inexperience was particularly
highlighted when the first day I failed to send Brian, our materials manager and Shoreh, nurse/scrub tech
extraordinaire, on the first trip to the hospital to get the OR ready. This resulted in a 3 hour delay in getting
the first case started.
As we prepared to leave I remained sadden by all the unfinished orthopaedic work that we had to leave
behind. It remains my hope that next trip I will somehow be able to address this area of orthopaedic care
and have a bigger impact on these patients lives.
I would like to like to thank my team members for a job well done; the Mbarara medical staff,
anesthesiologists Emanuel and Steven, Marvin general surgery resident and all the OR supporting staff
as well as OR nurse manager sister Sarah. Finally, a special thanks to Dr. Lieberman for trusting me to
execute the duties of this mission.

Dr Phelps Kip
Amazing adventure, will do it again. Inspiring team members.

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Dr Elizabeth Kerner
STOICISM; Perhaps it is working in my field of Plastic Surgery and having a predominantly cosmetic
practice, but I generally deal with patients expectations for noticeable change. My patients desire to have
what they do not like altered, improved or removed, as well as gravity fought and aging battled. Stoicism
is not a common theme. In Mbarara I was humbled by the ability of my patients and their families to
accept conditions without complaint and to hope, just a little, that things could be improved. Expectations
were not for perfect, just better. So many things I did they simply bore with just a grimace or a turn of
the head. Of course the little ones cried, well screamed at times. But parents helped to hold them and
never cast a reproachful look at me. I overheard someone say: Ugandans may suffer, but they do not
complain.
COLLABORATION; From families to the OR staff, I was so grateful for the collaborative effort. Coming as a
team of one (does that mean there really is an I in team?), I was pretty lost the first two days trying to
navigate the system. But Dr Situma was my personal angel for the trip. He introduced me to patients,
explained their surgery, lined up cases, assisted in the OR and graciously agreed to see them after I was
gone. So many of the OR staff, nurses, residents, students and anesthesia, came early, stayed late and
answered all my silly questions to help get our patients treated. I like to think a visiting Ugandan surgical
team coming to Plano would get the same respect and enthusiasm. Ward rounds were definitely a
collaborative effort. The nursing Sister brought charts and made dressing supplies magically appear.
Families helped to hold little arms and legs still. Everyone on the ward had something to say about surgical
results, even if a wound was just smelling less and looking better. I am amazed by their trust and
acceptance of a mzungu doctor, especially as language barriers meant they just had to believe I would
do my best. And I hope my efforts have not disappointed.

Dr Anthony Owusu
Having been born in Ghana, West Africa, there were certain aspects of this trip that I thought would not
come as a surprise. Sure mosquitoes biting at every chance, poverty-stricken people with hearts of gold
and genuine intentions were some of the things I expected. Even the occasional power outages did not
surprise me. What did surprise me, however, was the resilience and fortitude of the team I came with,
the team we met there, the team that followed us and lastly, the patients. If someone told me that a
team consisting of physicians, surgical techs, monitoring tech, surgical rep and medical students could do
so much with so little in such a brief time, I would not believe it.
The six-hour ride from Entebbe airport to Mbarara set the tone for the rest of the mission. Although the
ride was somewhat uncomfortable, everyone understood that the mission at hand was far greater than
our comfort. This notion carried us through countless outages, shortages and malfunctions. Nightly, I
was reminded of the significance of our mission during our 'recaps'. I was amazed not only at what we
accomplished but more so at the faith and trust of our patients and their family in us. Many patients
waited patiently for hours to share their stories and be helped, which was a humbling experience.
In the end, I felt a sense of remorse, having such a short time to help, knowing the magnitude of people
who remained with significant diseases. This mission taught me a lot about myself and reminded me of
the grit of the human mind. I am grateful to Dr. Lieberman and the HVO for the opportunity to join. I look
forward to doing it again.
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Dr Tom Scharschmidt
As I look back on the experience of leading a team to Uganda to perform trauma and joint related
orthopedic procedures, the lessons learned, friends made, and appreciation of different practices and
cultures, was invaluable. Although the number of procedures performed was impressive, more
impressive was the problem-solving and out-of-box thinking required to successfully perform the
procedures. Nothing is disposable, everything is re-usable, and nothing is taken for granted.
Also learned from the experience was a deep appreciation for the Ugandan people and culture. All were
welcoming and appreciative, and the hospital staff and physicians were eager to learn and participate in
the care of the patients. The trip taught me patience, creativity, and that our first world problems are
much different and minimal in comparison to third world problems. Power-outages, lack of anesthetic
agents and antibiotics, extreme poverty, and delays in care were common. Despite this, the people were
upbeat and positive, and always thankful. It was truly a remarkable and life-changing experience.
One patient in particular illustrates the experience. The man had lived with a non-union of a hip fracture
for over 10 years. He patiently waited outside of our clinic, encouraging all of the other people waiting to
be seen. We were able to perform his procedure, and he was so appreciative afterward that we had
improved his pain that he was helping us on rounds to care for the other patients! The gratitude was
overwhelming. This was just one of the many examples from the week that shows the attitude of the
Ugandan
people.
I look forward to future missions, both to help as many people as we can as well as to continue my own
personal growth and learn from them!

Dr Nur Lubis
I stumbled upon the Uganda Spine Mission completely by chance one day as I was going through my
emails. On one corner of the HVO newsletter I occasionally received, was a request for an anesthetist
(that's what we are called in the UK) and my first thought was that the dates suits me perfectly. A series
of emails (apparently I responded within 45 minutes of the request being sent) and a Skype conversation
later I was part of the team!
I am not new to working in a resource poor setting but I have to say I was a little apprehensive as I searched
for my new team mates at Heathrow. The 2013 blog I read had a couple of anesthetic near misses and I
wasn't entirely sure what I've let myself into. Spine surgery is complex and to do this in Uganda must be
a challenge.
I was right about the complexity of the cases and the challenging environment but that did not hinder the
team. In fact it was such a pleasure working with like-minded, motivated individuals. Nothing is
impossible, improvisation is key and a happy team makes everything seems easy. What the Uganda Spine
Mission has achieved over the years is truly incredible and I'm privileged to be part of it now and hopefully
in years to come. Even if its just to send my own crate of anaesthesia supplies.

Lastly, I can't believe I am saying this but Izzy has made spine surgery sexy!
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Sherron (Agatha) Wilson RN

Once again, I had the unbelievable opportunity to volunteer as a member of the Uganda Spine Mission
during the final phase of the three part mission this year. Since this was my third Mission, I am considered
a Veteran and it was interesting to study the reactions and responses of the first timers as they
experienced the diverseness of the amazing landscape and the extreme deprivation of its people. They
were not unlike mine, filled with awe, amazement, and disbelief counteracted with anticipation, hope and
gratitude.
Awed at the magnitude of inaccessibility to basic healthcare, coupled with the lack of available physical
space even when that care became accessible. It was not unusual to see patients sleeping in the corridors
on straw mats simply because there were no open beds.
Amazed that we were so well received and the genuine faith and confidence placed in us as Health Care
providers. As the word got around that the "American Doctors" were here, members of the team were
frequently stopped in the hallways and asked to look at X-Rays or MRI'S. Unscheduled consultations
occurred daily.
With the Disbelief that a people have no choice but to accept these conditions as a way of life, I was told
that the patient/doctor ratio is hundreds to one making it virtually impossible to provide adequate care.
On the contrary, there was great expectation as the team assembled; several patients were already on
the surgical schedule and many more waited in anticipation of being added on. This amazing group of
compassionate Health Care Workers, who unselfishly donated their time and expertise, worked long and
tirelessly as there was so much to do in only a few days.
Hope became evident as we interacted with the local Orthopedic Residents, who expressed their
commitment to provide their patients with the best care possible despite the enormous number of
patients. They possess empathy, hunger for knowledge, and a desire to institute change. Sister Rose and
the "theater" team were supportive and helpful in getting instruments wrapped and processed. The
anesthesia team is skilled and also helped with circulating duties. Everyone was engaged in the mission
and did what they could to help.
As I contemplated on the overall outcome of the Mission and the patients' whose lives we have touched
and changed forever, I am eternally grateful to Health Volunteers Overseas, Dr. I Lieberman and the
Uganda Charitable Spine Mission for the privilege afforded me to be a part of this and hopefully future
Missions, and for the unsurpassed quality of healthcare available here in America.

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Sherri LaCivita CST

With this being my third year I am officially now considered a veteran of the trip, yet I still feel the same
excitement and anxiousness as the first. This year we were the first of three surgery teams, the largest
mission so far. We were a team of twelve and very productive, running three OR's daily. It's amazing to
me to bring all of our expertise and experience to this beautiful and poverty stricken country to help in
ways that will forever change someone's life. I am truly blessed to be a small part of such a great mission.
Our team meshed and bonded together as close as family. To share what we learned at the end of every
day at dinner is always a good time. The ortho trauma "Team Sparta" were three hardworking and
dedicated individuals with Great Spirit bringing much laughter to everyone. Plastic "Team of One" Dr
Kerner showed us that she could do it all! The "Spine Team 2014" is all familiar to me, hardworking and
the Best! Nur our anaesthetist well we couldn't have had better, and Joseph our medical student wrote
an amazing blog among doing many other things. Dr LIEBERMAN is a great leader, teacher, and surgeon,
our Silverback".
I am thankful always for this grand opportunity and look forward to many more missions in the future.

Nadia Mirza CST

This experience, being able to see how people with very little, have the capabilities, the strength and
desire to fight for their lively hood, was absolutely breathtaking. Having the group of individuals around
not only on the team that I was in, but also the team before and after, showed me more than just what
surgery is as a definition. These teams and this experience showed me that medicine is hopeful and that
just giving people that option of living a better life makes me speechless. Walking through the surgical
ward and even through the streets of Mbarara, it brings me to tears that the struggles on their life still
gives them a reason to fight and live. Even in the circumstances that are dealt to them, they have such an
admiration for living life and loving it. The little things in life that causes stress should be non-existent.
Enjoy life for what you see and have not for what you could potentially have.
This trip opened my eyes to what I really love doing, which is my job. My job is a surgical technologist. I
do not get the opportunity to see how the patients I work on are affected by what we do with surgery
from start to finish. This trip allowed me to witness the life changes and what we do for these patients.
I am taking back every day by the experience in which I had from this trip. This trip has changed my life
only for the better. I wish that everyone could experience a mission trip. The overall feeling that one gets
coming back is intense and full of gratefulness. I want to thank Dr. Lieberman for giving many people the
experience to have such an amazing, life changing opportunity to help people. I also want to thank Dr.
Holman for asking if I could join him on this mission trip. He has opened my eyes to what doctors do and
why he and many others are so passionate about helping people live a better life. I am able to come out
of this trip with lifetime friendships, a better outlook in life and a want to keep going back and helping
every year.

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Tom Grodhaus
This was my first mission trip; however, I have spent time in underprivileged countries when I was in the
military and I always had all of the equipment that I needed to accomplish the mission. I was under the
impression that we would travel to Uganda and do the same thing that we do every day in surgery; I was
sorely mistaken. Our team prepared for the trip, but all of the equipment that we decided we needed
was not shipped. Back at home it would just be a phone call and everything would be brought to the
operating room, and the case would continue; in Uganda, we had to improvise.
Long days with minimal breaks, not having the proper tools, and having to make adjustments on the fly
combined to produce a lot of stress. Overall I had a great experience that I would never take back; I would
only prepare more to make the trip more productive, mainly by ensuring that all of the equipment was
properly packed for shipment.
Being able to help the people of Uganda was a unique opportunity that was inspiring and educational.
We were able to help many people in need, with the assistance of an appreciative Ugandan staff. I look
forward to many more trips in the future, and being able to teach and to learn from each one. GO TEAM
SPARTA!

Dr Eric Varley
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 cant didnt exist. Instead, lets find a way became our team mantra.
This team dynamic reinforced my deep belief in the power of gratitude. Our patients and their familys
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 Clairs 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
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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.

Dr Erica Fisk
I will remember that I remain a member of society, with special obligations to all my fellow human beings,
those sound of mind and body as well as the infirm. Hippocratic Oath
The role surgery plays in impoverished cultures has been an important issue for me since the day we took
the Hippocratic Oath as graduating medical students. The Ugandan Spine Surgery mission was my first
introduction to international health care and how surgeons could make a global impact in third world
communities. I honestly had no idea what to expect. I searched old blogs from previous trips to help
decide what to pack, what supplies to bring, and to see what surgeries we would be doing. My friends
and family questioned if it was even safe or if the Ebola epidemic had reached the area. Feeling
unprepared as an orthopaedic surgical resident is not a familiar or comfortable position. I quickly realized
there was no adequate way to plan so I relied on the experience of previous spine mission veterans. We
were fortunate to have been part of Team 1, which included Dr. Isador Lieberman and Dr. Thomas
Scharschmidt as our respective spine and trauma team leaders.
The team successfully arrived at Mbarara Regional Hospital, tired after approximately forty hours of
travel. Unfortunately not all of our equipment crates were so lucky. The Ugandan people had been
anticipating our arrival and were anxious to be evaluated by doctors who potentially had the resources to
help them. The wards were overpopulated and run down with an entire room dedicated to Orthopaedic
Cases. It was obvious there was an enormous need for orthopaedic surgical care. We were handed
numerous x-rays of orthopaedic fractures in various stages of healing, saw malunions and non-unions of
femoral neck fractures, encountered multiple patients in reused traction from remote boda-boda
injuries, and even managed Grade III open long bone fractures which had been closed in the ER. It seemed
chaotic. It was difficult to imagine there were so few options for injuries that were otherwise considered
relative emergencies in western countries. Within half a day we had enough trauma cases scheduled for
the week, not including the handfuls of people who had ailments we didnt have enough time to address.
To say we were ill prepared is an understatement. We had to deal with broken drills, lack of fluoroscopy,
no suction, shared electro cautery, variable OR lights, and limited implants. I started making lists of things
the team needed but found it futile because it felt like we needed everything. I eventually stopped
making lists and started focusing on what we had that could work. Fabricating solutions with scarce
supplies challenged our surgical skills. It was exhilarating. Troubleshooting involved using distal radius
plates for tibia plateau fractures, proximal humerus plates for distal femur fractures, disposable hand
drills, managing open injuries with significant bone loss, etc. What I witnessed as a result was a
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remarkable sense of teamwork and profound gratitude from the Ugandan people. There was no room
for a defeatist attitude when so many people were counting on you. Most of us were outside of our
comfort zones dealing with obstacles that required an incredible amount of problem solving and
perseverance. The fortitude of the Ugandan people became our example of true strength and motivated
us to push forward after long demanding days.
After reflecting on our time in Uganda, I realized the opportunity to impact a community comes with
awesome responsibility. It requires humility and the awareness that we cannot play God, nor have the
capacity to fulfill all hope. I can write endlessly about obstacles we faced, but our duty is to share our
experiences, and relay the lessons learned in hope to encourage others to get involved. Collectively we
have the ability to make a meaningful difference in third world health care by providing surgical access to
people who desperately need it. The leadership of the Ugandan Spine Mission is dedicated to making this
a reality.
Lastly, what affected me the most about this is trip was the new relationships made with local Ugandans
and the camaraderie amongst fellow teammates who shared a similar global mindset. I found it inspiring
to be partnered with such talented and selfless people, and also with a health volunteer organization so
focused on their mission. The courage and strength of the Ugandan people will stay with me forever.

Rob Davis
It had the feel of coming home for the holidays from the moment I stepped foot onto Ugandan soil. The
sights and smells opened the floodgates through which memories flowed; quickly filling my mind with
thoughts of my previous trips. Despite the pleasant familiarity I knew this was going to be a different
experience than Id had before.
This, my third year in Uganda, was my opportunity to participate in what became the most ambitious
effort to date for the Uganda Spine Surgery Mission. Of the 4 weeks the mission had a presence at
Mbararas Regional Referral Hospital; the six-person team I was part of was there for nearly two weeks of
it. And while I only knew Dr. Holman from a previous trip, it did not take long for me to get to know the
rest of the crew that he brought with him from Houston, or Dr. Burch, joining us from California. We
quickly found ourselves getting to know one another as we built a strong rapport through our mutual
excitement about the mission and our personal stories. The initial laughs we shared along with an oddly
blistering cold ride from Entebbe to Mbarara, forged a bond that only grew with each day we spent
together. This bond would be the foundation on which our trust in one another, and our abilities was
built, and ultimately shaped itself as an example for our Ugandan counterparts to follow as we all worked
together to provide the highest level of care possible to the patients entrusting us with their care.
When we made our way to the hospital for the initial handoff from the first team there were so many
people Id come to know the previous year waiting with bright smiles and open arms. As I walked through
the halls of the hospital I was overwhelmed by the joy in everyones faces and their excitement that we
were going to have a continued presence over the course of the next several weeks. The thing that
impressed me was the fact that even as we pressed everyone with our daunting pace and high
expectations the initial joy they showed upon our arrival never left. And seemingly with each day (outside
a few days were the precious resource of oxygen was unavailable) that joy and support I saw in everyone
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never wavered. This to me was the most promising development that Id seen over our previous trips
where it seemed that while they were glad we were there to help, they were ready to get back to business
as usual. I think, this is because they may not be used to seeing the same faces year after year which has
caused them to be somewhat skeptical that they are going to get continued interaction and support from
one individual or entity. To me this type of development further corroborates Dr. Liebermans idea that
a sustainable, consistent effort should be made to remain a fixture in the Mbarara community year after
year. I for one will continue to support Dr Lieberman as well as his vision which I believe impacts not only
the lives of the patients treated, but my friends in the Mbarara healthcare community as it relates to their
raised level of expectation regarding not only who can be treated, but the quality of the care they provide.

Chris Martin
While I've been to Africa several times before, and have seen Third-World conditions on many previous
occasions all over the world, this trip, my first for the Uganda Spine Surgery Mission, touched me in a very
personal way. I was fortunate to have a great team, with Uganda veterans Brian Failla and Sherron Wilson,
the compassionate mom and son team of first-time volunteers from the Coney family, and our
surgeons: the eager and enthusiastic resident Eric Varley, Phelps Kip, an experienced ortho surgeon,
and Selvon St. Clair as our team leader. I learned so much in particular from watching Selvon's quiet
intensity, complete dedication, compassion and seasoned experience. He and I spent several deep and
profound conversations discussing the Ugandan situation, my response to it, and how exactly to best help,
and effect lasting rather than transitory change. We didn't solve everything during these discussionsindeed many of the problems are on such a vast scale as to appear intractable- however, his reassurance
and wisdom helped me immensely as I sought to make sense of it all.
When I do neuromonitoring at home, it's a serious and intense responsibility. However, I know that in
the event of some iatrogenic sequela, there will be a mechanism and network of support for the affected
patient, including rehabilitation, orthosis, physical and occupational therapies, etc.
The same is not true in Uganda. Given the lack of resources there, any new-onset deficit is a potentially
lethal outcome. This brought an even greater sense of responsibility, and even pressure, to my role as
the neurophysiologist.
As well, I met and got to know the people on an intimate and personal level like I never had before in my
travels. In particular, one young nursing student, Ninyesigamukama Provia, stood out like a bright beacon:
full of hope, promise and a lovely attitude of faith and coping that allowed her to find happiness each day
in spite of her desperate circumstances. While I tried to teach her some fundamentals of anatomy and
physiology, it was I who learned so much more from her. This is the contradictory nature of Uganda, and
Africa in general. I arrived there hoping to impart some of my "superior" First-World knowledge and
expertise, but left there humbled to have been taught more myself by the dignity, perseverance and
courage of the proud Ugandans I befriended. It was with a powerful sense of honor and emotion that I
received the Banyankole name one Ugandan bestowed upon me, a name which I hope to continue to earn
and be worthy of. He said, "You shall be called Byamugisha- it means Bringer of Blessings".

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Laura Adams
An Understanding of Others
Before being presented with this opportunity I had a strong desire to help people in an extremely bad
situation. It was a feeling that I kept repeating to people in my life. Then Dr. Holman asked me if I would
like to go with him to Uganda to help with surgeries for those in need. I had an overwhelming confirmation
to go. Of course there were things to be considered and worked out before going.
Friends and family asked if I would be safe, where would I stay, what would I being doing? I did not have
an answer to every question, but that was ok. A trip like this, is where you have to be willing to adapt to
your surroundings. I knew it would be a place that was uncomfortable and needing help. What I didn't
know is that this trip was going to give me the greatest understanding of the people that I have been
working with every day in the operating room.
It is interesting what you can come to enjoy given enough time to get used to it. The living quarters and
work environment were very different and lacking in many ways. Yet with a good group of people each
day, anything is possible and absolutely enjoyable.
I had imagined Uganda as a place of awful depression and turmoil. What I found was a country full of
grateful loving people. I couldn't get over how these people managed in their living quarters in the
hospital. They were given pans under their bed to relieve themselves while flies and body odor saturated
the air. This was the place that they would go to in an effort to get better. Instead all I could think was
who of these people will survive this room?
Not all of the hospital was in great despair. The operating rooms or as they call theaters were quite nice.
Some of the rooms were bigger than the ones I was familiar with back home. However, again the need
for cleanliness was ever present. It was difficult reusing items that had been used on a previous patient.
This would never happen in America. Though when your hospital is run by a government that cannot give
you the supplies that you need you will make do with what you have. Unfortunately not every situation
is it possible to find a solution to get by. We found two days where the hospital was out of oxygen. Cases
were cancelled and a patient nearly died. Yet when the staff hears that there is not anymore oxygen they
accept this next hurdle and continue on.
This lack of resources and the acceptance of the staff was shocking. If my hospital at home had this
happen it would have made national news. Imagine a patient having had an extensive surgery only to be
left to suffocate from a lack of simply oxygen. Our patients were only a small group suffering from the
lack of resources that could not be taken care of properly. The patients that are coming into the
emergency room are dying simply because the hospital is out of IV tubing at times. How absolutely
frustrating it is for these physicians that practice medicine this way every day.
When asking the locals what is needed to help this country the reply is a new government. But they are
not sure how this can happen when the last election was in 1984. This land has such rich soil and
wonderful produce. Stunning mountains and vegetation everywhere you look. How is the world
overlooking this wonderful place?

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If you were to ask an American their idea of Africa they would probably say dangerous and ugly. Though
my experience was seeing breathtaking views and loving generous people. I Told one of the workers at
the hotel how happy Ugandans seem to be compared to Americans. He was very confused to hear this.
His reply was that he imagined Americans to have it very easy with a straight path for them.
Why is it then that Americans are so stressed and unhappy? Is it a lack of a strong family support system?
The pressures of our society to be the best? Could it be that we need pressure on a society in order to
make them successful? Though to what extent are we willing to go in order to be successful? The lifestyle
of a Ugandan is typically very simple, walking to where you need to go, growing your own food and even
building your own home. It was rare to see an overweight patient there. Yet in America this was every
patient that was moved to the operating table.
What an interesting understanding if our countries' people could swap places with each other for two
weeks. The joy and awe each group would find in one another would be so inspiring.
As much as it was completely fulfilling to be able to help these people it was truly humbling to be able to
understand my coworkers. Every day we go to our job and work with people that have other rolls. The
operating room is such a great example of this. Each person in the room has a very different job. You
may think that you have an idea of what they do while observing them. However, when it comes time to
literally stand in their flip flops and do the roll it finally hits you what an awesome team you have. This
trip allowed me to have a hands on experience of everyone's position. I had taken for granted the
intelligence and patience that a surgeon needs to complete an operation. The pressure that is felt during
the operation under smoldering bright lights can be very intense. It is so important for the rest of the
team to do their very best and help at all costs to make such an amazing surgery such a success.
It was refreshing to be able to work with the same people every day. In this unique circumstance we were
not only able to work next to each other each day but we had the opportunity to talk about the day after
it was over. How often do you get the opportunity to get to know your coworker and understand how
they felt in the roll that day at work?
I will never forget this trip. My path in life has changed because of it. It gave me the understanding and
confidence to discover more to life. It showed me a part of the world that is a hidden gem. A place with
so much potential yet a people that are blind to it. What a beautiful world this could be if we all helped
one another.

Skylar Barton
"This was my first trip to Uganda and despite all the stories I had heard and warnings I was given, I still
had little knowledge of what I was about to experience.
I will never forget the friendliness of the people of Uganda. When our plane landed in Entebbe, the native
woman next to me, smiled and said, Welcome to my country. Throughout the trip, little children would
wave at us and we were welcomed very graciously everywhere. Even at our hotel restaurant while I was
getting breakfast one morning, one of the hotel staff came up to me and said Thank you for what you
are doing for our people. I knew that this mission had already touched the whole community from
previous years and it was evident by the gratitude of the people.
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To say this trip was humbling is truly an understatement. It is mind blowing to me that these patients
wait in a jam packed ward for days, weeks and sometimes months just to see someone for help. The
selflessness of the families, who are essentially their ailing relatives nurses, was amazing but also eye
opening. We take for granted so many things here in the U.S. that the people of Uganda are suffering
from. For example, so many of the patients that we operated on for tuberculosis of the spine couldve
been treated for less than $50 if it had been caught earlier, yet here they were paralyzed and close to
death. You hear the stories of the cases and the hospital conditions, but until you see it every day that
you are there, it doesn't sink in. I will never forget the looks on some of the patients faces as we made
our trips through the wards.
It was also amazing to me how doctors and staff from Texas, Ohio and Canada could seamlessly all work
in unison for the better of our patients, starting from Day 1. Despite the long days, no one ever wavered
when help was needed. Just as amazing, when the second team came in, the torch was passed and they
picked up right where we left off. There is little time for rest and every member of the teams welcomed
the challenge.
I could not be more proud to be part of such an amazing team and mission. It is evident that the mission
grows and improves every year, but I believe there is still plenty of work to be done. While the mission
was physically draining, it was extremely gratifying and I look forward to helping in any way I can going
forward."

Joan Coney
Earlier this year at work, we had Globus Cares day-which highlights missions supported by Globus. Dr.
Lieberman came and spoke about his ongoing Uganda Spine mission. It was my first time meeting him in
person. Having worked in our grants department for years and being involved from a corporate level, this
was now my opportunity to get personal with it. After his incredible presentation, I asked him if it might
be possible for my 18 year old son and I to join the team for 2014. He said absolutely.
I thought from reading multiple trip reports I would have some idea of what to expect. Logistically, I did.
The big surprise for me is how spending time in Mbarara with the people and Team 3 made me feel.
Mbarara, Uganda is a place of great contrasts. The people there are so completely let down by their
government. It is a place with few second chances. The conscientious people at the hospital, Dr. Deo and
PGY2 Surgical resident Marvin, and the gentlemen who supervises the SICU (he introduced himself to me
as Nalongo-father of twins), Sister Rose, Florence, and many others, all want to take care of their people,
but they have so few resources to do so. They are appreciative of everything! The Uganda Spine mission
provides, and the locals tirelessly step up to work side by side to help, learn, and offer support in every
way they can. They were so open with us about their own struggles to stay positive and empathetic in
light of the overwhelming need and obstacles they face every single day. This mission not only serves the
people and patients of Uganda, it gives much needed emotional support to the local caregivers, in addition
to education and resources.
With our incredible capable team, I admit that I struggled to find my role. My son Austin did most of the
volunteer work-scribe, recorder of X rays; he rounded with the surgeons every day (his backpack now
functioning as a mobile medical unit stuffed with sterile gauzes, bandages, antibiotics, tape, scissors).
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But I did find it. I visited our patients in the afternoons. Some visits were just to give out candy, pillow
pets, or paint nails, or show them a movie on my iPad (Finding Nemo was a hit!) or help get them out of
bed and walking. While I did these things, I got to know them and their family members or care givers
and also see a few things I didnt expect, like 5 children splitting one boiled egg for lunch.
Im so grateful than my son and I were able to be a part of Dr. Liebermans ongoing and expanding mission
and thankful to all who made it possible. Special thanks to veterans Brian Failla our intrepid Globus
equipment specialist and Team 3 leader Dr. Selvon St. Clair for taking good care of our team.
I hope to cross paths again with the mission team members, Mbarara hospital staff, and patients, all of
whom I now consider friends, again in the future and participate in future missions. A part of me will
forever be invested in Uganda. Thank you!!

Austin Coney
The HVO (health volunteers overseas) program gave me a new perspective. I still remember the first time
my mom, Joan Coney volunteer, told me that we were going to Uganda to volunteer with a medical team.
I was little scared, I honestly had no idea what to expect. After some serious planning and lots of shots
we departed with a vague idea of what we would be doing. I left planning on giving my best and getting
nothing in return, instead I gave more than my best and received something I cannot put into words.
While in Mbarara I participated with a group of highly skilled professionals in order to bring advanced
health care to the destitute patients that would otherwise be neglected by the current medical care
system in place. We operated on one to three people a day and we went on rounds every morning to
check on their status and make sure the hospital was executing the doctors orders. My take away from
this experience was massive; I literally almost feel guilty because I went on a volunteer mission not
expecting anything in return yet Im coming away from it with so much. One of the things I was exposed
to is the brutal 14 hour work day. Im glad that happened because I feel it gave me a sense of the value
for hard work. I saw what happens to a person when they break their femur and receive little to no
attention at all in a hospital; she had a pulmonary embolism (blood clot in the lungs) and coded. I shared
the excitement and joy with parents, family and doctors alike, while watching a young girl take her first
steps with a straight spine. I heard the sounds of patients moaning in the days that followed surgery. To
sum it all up I saw some amazing things and in some cases some terrible things. I loved being part of a
team whose mission was to help. I learned a lot about what it means to be a decent person in general.
Just being in the atmosphere of the genuine, goodhearted, high caliber people that were on Team Three,
was an experience in itself. As a high school senior I dont often find myself spending lots of time with
surgeons, neuro-monitoring specialists, reps or nurses, so for me personally it was very different from
home; and I loved every second of it.
Now being at home, looking back on it all from the comfort of my living room couch it seems surreal that
the people I saw less than a month ago are still there, in Uganda; there is no rest for the weary. Those
people I came to know remain in that reality, while I simply came back to America to enjoy my first world
education and luxuries. Mary is still a teenage orphan; Marvin is still working long days as a resident only
to go home and manage his farm; they still live with the struggles that accompany life in Uganda. Even
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now some of them are in hospital beds. However, Id like to think that because of our efforts our friends
back in Uganda are a little better off. I would just like to say thank you to the organizers and sponsors
that made it possible for myself and everyone else on the teams to go and be a part of this incredible
cause.

Matt McLaurin
I had no idea what to expect when Dr. Holman invited me on the trip to Uganda. Being a college student,
freshly out of a sophomore-slump of confusion regarding what to do in life, this first-hand experience
couldnt have presented at a more ideal time. My prior illusion of Mbarara consisted of our team of six
operating in far from optimal conditions, an adobe hut maybe, with insufficient local support. This naive
vision was shattered upon arrival to the Mbarara Regional Referral Hospital. The hospital exceeded my
expectations, a wonderful new facility, and the local doctors and students were eager to assist and learn.
Day 4 made the most significant impact on me. We couldnt operate due to a lack of oxygen and power,
but the day didnt go to waste. I stepped far out of my comfort zone and joined a group of local boys
playing rugby in a field next to our hotel. Along with the sporting, we all sat around and discovered how
much we have in common. A thirst for knowledge, love for family, and compassion for sports were among
a few of our findings. Boys will be boys, no matter what the cultural differences are. It was incredible to
see the young men radiate pure happiness given their circumstances, a truly humbling experience. Ill
never forget these boys and hope to see them again one day.
The entire trip was filled with life lessons and I cant thank the members of the Spine Machine along with
the people of Mbarara enough for all they have taught me. Dr. Holman and Dr. Burch both exemplify
leadership that brought a group of six highly diverse people with different skill sets together to accomplish
miraculous things. Seeing medicine practiced in its purest form has made me realize that I want to
continue down the path to medical school, a personal debate finally resolved. I am extremely thankful to
be a part of the life-changing 2014 Uganda Spine Surgery Mission and will continue to support future
missions in any way possible.

Joseph Mplariwa
The Uganda spine surgery offered me a unique opportunity to reconnect with my continent in a way that
I hadnt in over ten years (I was born in neighboring Rwanda and grown up in Kenya, but spent most of
my adolescence and formative years in Canada). I will admit, my previous experiences in the hospitals in
Kenya as a child had been somewhat traumatizing, and visiting Mulago Hospital a week prior to the
mission had been a bit of an affirmation of some of those experiences and expectations.
I was pleasantly surprised when we set foot in Mbarara Regional Referral Hospital. The wing we were
working in had been recently renovated, so when I walked into the enormous operating theatres I was
quite impressed. Quickly, though, I learned that we still have a long way to go as we walked through the
chaotic and crowded wards, we witnessed family members who had set up camp right beside their loved
ones in order to take care of them throughout their stay in hospital. While this experience contrasted
wildly with the exposure Ive had in North America, it reminded me of the humanity in medicine the reason
that I set out in this career path. I witnessed the resilience of the human spirit and an enduring positivity
despite constant difficulty. I was also inspired by the undying gratitude of a people for however little we
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were able to do for them. I will not forget the faces of the children who we encountered and whose lives
were positively altered by the work of the various teams: James, Moreen, Kenneth, and little Isaac, to
name a few. I will always remember their smiles as we said goodbye and parted ways. Throughout our
time in Mbarara, I was reminded of the solidarity of the human spirit we connected and empathized with
those who were suffering, despite our different life experiences. In a world filled with so much negativity,
I was reminded of the inherent good in all of us. I was deeply impressed by the sacrifices that the staff at
Mbarara hospital made for their patients and community. They were very dedicated and resourceful
despite the many challenges they face. I saw that people who truly believe in a common goal have limitless
bounds irrespective of their circumstances. I will always look back fondly upon my time spent in Mbarara,
and I look forward to returning someday.

Dr. Izzy Lieberman

It is December 2014, a full three months since the mission. I have finally been able to gather my
thoughts about this years efforts. It stands without repeating that the volunteers were all
superb, devoted and selfless in their efforts. Likewise for all those who contributed either in
medical equipment or financial resources. You all know who you are and I thank each and every
one of you or your entities.
The mantra of the Uganda Spine Mission has been to deliver the care and teaching to the end
user. This philosophy has allowed for the successes of the past 9 years. This year we treated
more patients and trained more health professionals that I had ever imagined we could. We
experienced some tragedies and witnessed many astonishing recoveries. Regardless of that we
established a firm foundation with the health care community in Mbarara and at the University
which will continue to flourish in the years to come.
Having had the privilege of practicing medicine in many environments and on many continents I
know firsthand the contrast of extremes between first world and third world medicine. Uganda
represents one end of the extreme whereby care is inconsistent, inefficient and vulnerable to
neglect, with the requisite senseless suffering and delays. North America sits at the other end of
the extreme whereby care is expensive, commercially driven and vulnerable to abuse, again with
the requisite senseless suffering and delays. The answer must lay somewhere in the middle, and
until it is realized I plan to continue working with all those interested in advancing the wellbeing
of our families, friends and fellow human beings around the world.
This years mission has once again re-aligned my universe and reaffirmed what is important to
me.

Thank you all for being a part of the Uganda Spine Surgery Mission.

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