Uganda Spine Surgery Mission Trip Report 2015

Isador Lieberman MD
www.UgandaSpineSurgeryMission.org
January 2016

Table of Contents
1) Mission Daily Reports.. 3
2) Epilogues.20

Team Rosters
Team 1

Team 2

Team 3

Team 4

I Lieberman

S Burch

P Holman

S St Clair

M Silverstein

E Dalzell

R Arroyo

Kayanja

S Z Gorlick

R Mimran

A Cockrell

L Phillips

S LaCivita

D Thayer Pinkall

N Mirza

C Martin

Z Blumenthal

JP Clark

A Boghani

B Popa

B Faila

H Dennison

J Graffagnini

E Varley

M White

M White

M White

M White

K Zagar

A Wilson

J Lieberman

R Trimba

M Hisey

D Wilson

M Hisey

N Lubis

Mission Statistics
Volunteers = 33, (14 veterans)
Days on the ground = 25
Surgical cases = 44

Uganda Mission 2015 Daily Reports

Departure day, July 3, 2015, (IHL)
When you surround yourself with good people, good things happen
Leading up to this years mission I was terribly delinquent in my planning. My budget was off, my fund
raising was behind, a number of grants were denied, and my blood pressure was at 20,000 ft. As fate
would have it two weeks prior to the mission Dr. Mike Hisey, approached me and asked if he and his son
Matt could still join the trip. This triggered a chain reaction of sky rocketing anxiety. How were we
going to get everyone over, house and feed them, and also take care of the less fortunate whom we
focus on? As fate would have it and Mike hearing about my budget shortfall, he went to work and in
two weeks succeeded to cover the budget shortfall and some. Good people do good things! With this
new found enthusiasm we embarked on this years mission. Team 1 was a 50/50 mix of rookies and
veterans, all equally excited about being in Mbarara. Team 2 was led by Dr Shane Burch, his first year as
a team lead. Team 3 was led by Dr Paul Holman, a multi-year veteran with many frequent flyers on his
team. The closers this year were led by Selvon St Clair, who will be joined by the missions heart and
soul Dr Mark Kayanja. All are great people who have taken the time from their families and friends to
help those less fortunate who are afflicted by spinal ailments. At our first dinner in Uganda, the
veterans told stories from past years and the rookies looked forward to new stories for this year.

Day one and two (July 5 and 6 2015): the arrival and setup
The team formally began the journey together to Uganda after we all met at London Heathrow airport.
This year, 4 separate teams are travelling to Mbarara to provide care. Our team includes: Dr. Izzy
Lieberman (veteran spine leader) and his son Josh (rookie volunteer), Dr. Michael Hisey (rookie spine
leader) and his son Matt (rookie volunteer), Dr. Zvi Gorlick (veteran GP), Dr. Michael Silverstein (veteran
orthopaedic surgery resident), Sherri LaCivita (veteran scrub tech), Brain Failla (veteran equipment rep),
Kari Zagar (rookie Neuromontoring tech), Zoe Blumenthal (rookie volunteer) and Michelle White (rookie
physical therapist). After a long hiatus, I (Mike Silverstein) was both excited and anxious to get to
Uganda and get to work! My last time here was 6 years ago when I was a medical student with limited
knowledge of what was ahead of me. I knew this time around my ability to contribute would be
different, but exciting at the same time.
After a late arrival into Entebbe, we loaded our supplies and luggage into the van. Then we were tasked
with a very long drive to Mbarara. Drs. Lieberman and Hisey were in charge of making sure the bus
stayed on course. It was not a smooth ride to say the least! We finally arrived at the Lake View Hotel at
5:30am on Sunday. All of us took a much needed shower and nap. The team met for lunch a few hours
later then proceeded to the hospital to do some reconnaissance. This was closely followed by a trip to
the Nakumatt (the local Wal-Mart) to stock up on the essentials (water, chocolate and beer).
While at the hospital we unloaded the 19 crates of medical supplies and equipment we brought with us.
According to Lieberman, the hospital was well maintained and hasnt changed much from our previous
mission, with the exception of a newly installed finger-print door lock at the entrance of the surgery
wing. A quick tour of the hospital campus followed. The wards were astonishingly overcrowded, a shear
result of the increased trauma volume. Patients were strewn on beds, on the floor and even under other
patients beds.

Afterwards the team returned to the hotel for a relaxing afternoon. Jet lag caught up with the team, so
we did our best to entertain ourselves to avoid falling asleep too early. This was helped by a surprise
visit from Sister Rose, the head nurse in the operating room. She was able to meet the first-timers for
the mission, and gave us an update on the happenings at the hospital over the last year. A few
members, Brian, Mike and Zvi took a quick cab ride back to the hospital to assist Sister Rose in sorting
the supplies.
The team gathered again for diner at the hotel, the menu being the exact same we had at lunch,
however by then the chicken options were available to order as they had finally thawed out! Most of the
team had chicken dishes, with the exception of Brian who ordered the whole fish and trust us, it was a
WHOLE FISH. With full stomachs we hit the hay, preparing for a long day ahead of set up in anticipation
of starting surgeries!
Day 2 began early for Drs. Lieberman and Hisey, Zoe and Sheri, who started their morning in full stride
with a jog. As the sun rose above Mbarara, the rest of the group joined them for breakfast in full scrubs,
convening and conversing before our departure for the University Hospital to set up shop.
After reuniting with our equipment, we immediately began unloading boxes and stocking the storage
room shelves with all the essential supplies and more! We organized our gear despite knowing very well
that all of these supplies would be exhausted at an alarming rate once surgeries began, forcing us to
wait for the next group to refresh our supply and then get organized all over again. In addition, learning
of the local CT machines state of disrepair was yet another cause for concern, since this would require
us to send patients off-site to get the images vital to their diagnosis.

These quickly became minor worries when we realized that the crowd surrounding the hospital was
here for us, waiting for aid and treatment that they desperately needed, even though we hadnt planned
to see patients until Tuesday, Day 3. Despite this unscheduled clinic, we organized our storage and
equipment and, more importantly, made sure patients would be seen. While team members were on
their way to the clinic, the rest of the team worked on unloading the OR table and putting it together.
Drs. Lieberman, Hisey and Silverstein were able to get 2 exam rooms in the original outpatient area to
start seeing patients. There were over 50 patients waiting to be seen! We organized the list of patients
and decided to see the children first and then the adults. The first patient of the day was a five-year-old
little girl, Ester. Frightened by the prospect of examination, Ester began to cry and hide behind her
mother. Only after we gave her a lollipop did she agree to let us begin the physical exam. Each child
came with their own emotional background, each one more touching than the next. Many of the
children needed further scans and tests before final decisions could be made, but a few were scheduled
for surgery later in the week. The original 40 adult patients swelled to 60 so they were then divided
between Dr. Lieberman and Dr. Hisey, and we still had to ask around 20 patients to return the following
day. Hours followed of slow conversations in broken English and rough translations. While draining, the
clinic experience in Mbarara exposed our rookie volunteers to the hardships of running a hospital in this
part of the world. In one unexpected day of clinic, we almost completely booked an entire week of
surgeries.

Day three (July 7 2015): the divide and conquer

Day 3 began with the usual rush to get through breakfast and get to the hospital for an 8:00 am
operating room start time. On arrival to the hospital the team split up with Dr. Hisey leading the OR
team and Dr. Lieberman proceeding to the penalty box.
On the operating room schedule were two unfortunate patients with broken necks and spinal cord
injuries. The first a young man who was involved in a boda boda collision and had a complete spinal
cord injury below the C5 level. His only chance for survival was if we could stabilize his neck and get him
sitting up in a wheel chair. The second was an older gentleman who (no surprise) came off a boda boda
and sustained multiple injuries including a tibia fracture (lower leg) as well as a femur fracture (thigh
bone). Luckily for him his spinal cord injury, also at the C5 level, was incomplete in that he had some
movement in his left arm and leg and normal movement in his right arm and leg.
Dr Hisey and the surgical team tackled both cases and completed the first case efficiently then
proceeded with the second. The second case was originally planned as a two stage approach from in
front and from behind, however after Dr. Hisey had completed the front part it was evident that the
spine was stable enough and he did not need the additional surgery.
All the while that the surgical half of the team were having fun, Dr. Lieberman, Joshua, Zoe & Michael
continued their dedicated pursuit of truth, justice and the eradication of spinal pathology in Uganda
during the evaluation and triage process in the clinic. After the first three hours the patients blended
into one another and without the help of Jennifer (yes there is a sixth Jennifer in Dr. Liebermans life)
and Benon, the two orthopaedic registrars (equivalent of physician assistants in the US), the team could
not have possibly kept track of the patients, investigations and surgery schedule. After all was done the
team filled up the Team 1 OR schedule and prepped many other patients for teams 2 - 4 to potentially
operate on.

Day four (July 8 2015): hitting the stride

Dr. Lieberman woke up extra early
to lead the entire team in a Pilates
class, but only Zoe and Sherri
showed up, while the rest of the
team were doing the savansana
(aka yoga corpse pose) in bed. The
team did resurrect in time for
breakfast before heading to the
hospital for a long day of surgeries.
When we arrived at the hospital,
Drs. Lieberman and Hisey with
Michael and Zoe went on morning
rounds to check on patients from
surgery yesterday. Both patients
were doing well despite the overcrowded ward conditions with patients on beds and under beds.
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Zvi and Josh made a side trip into town to restock on some supplies for the team. They hit up the
Nakumatt again (African Wal-Mart), and bought enough bottles of water to open a small water park
(well call it Spinal Splash, and thinking well have a giant water slide in the shape of a scoliosis spine).
The two also exchanged more U.S. dollars into Ugandan Shillings and got a great rate from our favorite
money girl Judy, who also happens to have the cutest daughter in the world. The trip went without a
hitch, that is until they realized to return to the bus they had to cross an insanely busy road, full of high
speed trucks and boda bodas (Ugandan dirt bike taxis) while carrying giant boxes of water! There are no
crosswalks in Uganda, yet locals seem to understand the flow of traffic perfectly, unfortunately our two
non-Ugandans didnt. Luckily, with assistance from a couple locals, they were able to navigate the dirt
road death trap safely and reunite with the team to replenish their liquid levels.

Back in the operative theatres, the first case was underway with Dr. Hisey. He was operating on a midaged female who was involved in a boda boda accident and injured her cervical spine. Boda Boda
accidents are the most common cause of spinal trauma in Uganda let that be a lesson to all you kids
out there! Dont ride motorcycles, or at least make sure to wear a helmet and a Kevlar body suit. Dr.
Stan (or Uganda Stan as we affectionately refer to him), a general surgeon with a passion for
orthopaedics and spinal surgery, joined us for the case. The surgery went without a hitch! The team
awarded Dr. Hisey with the Hisey-man trophy for outstanding all around orthopedic performance. The
second case with both Drs. Lieberman and Hisey involved a lady with tuberculosis infection of the spine.
This required an extensive surgery with spinal reconstruction. Despite the long case, the patient did
really well.
Following our OR day, we set up the requisite end of day ad hoc clinic to see the returning orphanage
children as well as some new walk in patients. A few operative cases were added from this. Once clinic
ended, we resorted back to the hotel for dinner and bed.
Quote of the Day: I had an almost quarter life crisis, Zoe Blumenthal (future ob/gyn in the making)
was concerned she would not like her chosen future after hearing all the horridly descriptive details
regarding a caesarean section as described by two senior spine surgeons. The quote of the day also
bleeds into the lesson of the day (pun definitely intended): Zoe confessed she was scared about sitting in
on the caesarean section due to the horror stories from other doctors and fellows. However she didnt
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allow the fear to hold her back, stepping into the room and watching over the entire procedure. To her
delight she didnt find nearly as intimidating or disturbing as described by others. In fact it reinforced her
desires to enter the field!

Day five (July 9 2015): overcoming the challenges

Extra early breakfast this morning for the team as surgery
was scheduled to begin at 7:30. But that didnt stop Dr.
Lieberman from his early morning running routine, where
he was unexpectedly joined by a friendly and fast local, a
17 year old Ugandan boy named Joshua (which also
happens to be the name of Dr. Liebermans only son
although that Joshua doesnt run much).
A brisk cool morning welcomed the team as they arrived at
the hospital to begin prepping the patient for surgery. This
morning the team operated on an 11 year old girl, Jallor,
who suffers from severe progressive idiopathic scoliosis
(idiopathic being code for doctors dont know how it
got there). She was a bit intimidated by the overwhelming
machinery and wires in the OR, but she was greeted kindly
by the team and settled into place for the
anesthesiologists to start their job.

Meanwhile Drs. Hisey and Silverstein popped

over to the ICU and surgical ward to follow up
with patients from days 1 and 2. Everyone
was doing well, recovering faster than even
the docs had anticipated. On the way back
they were inundated with requests from
other Ugandans to review X-rays, including
individuals who have travelled great
distances in hopes of seeing the American
Doctors. The unfortunate reality is that the
team does not have enough time or
resources to treat everyone. Drs. Hisey and
Silverstein did their best to offer what
medical advice and opinions they could
before being pulled back into OR to assist on
young Jallors surgery. Dr. Hiseys son Matt
was also on hand to help the surgeons out!
The surgery was well underway when there was an emergency in the room a music emergency. Dr.
Liebermans iPhone was stuck on a loop playing the same 3 Beatles songs over and over Could have
been worse, at least it wasnt Yoko Ono tunes. A few of the cleaning nurses in the back commented on
how much they enjoyed the songs and said theyd never heard of the Beatles before!
The surgery went well, but was tougher than anticipated, as every time Dr. Lieberman attempted to
straighten the spine there was a loss of signal from the neurological monitor. The team couldnt see
what was going on in the patients brain, but we all knew what was going on in Dr. Liebermans brain
crap crap crap But naturally, Dr. Lieberman kept his cool, and after calmly proceeding through
corrective maneuvers, neural monitoring signals returned to baseline and the team was able to get back
to the back. The case lasted roughly 5 hours, and after wrapping Dr. Lieberman hit up the break room
for a well-deserved hot tea (Houji-Cha Japanese black tea, no milk, no sugar, extra hot. In case you were
wondering).

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Outside the surgery ward, Dr. Lieberman followed up with patients and families from previous days
clinics who returned with new x-rays and CT scans. One of the reviews hit the team particularly hard, a
very kind man, Edward, who actually works at the hotel where we were staying, came to have Dr.
Lieberman review some x-rays. It was brought to the attention of the doctor as well as the patient that
the mans left hip had almost completely deteriorated, and would soon be followed by the right one.
Edward was understandably devastated as he worried about growing medical bills amongst his
impending inability to continue working. Luckily Dr. Lieberman will be getting in touch with the next
team rotating into Uganda, and hopefully plan accordingly for them to bring all the necessary parts,
tools and instruments to help Edward get back on his feet with a surgery free of charge! Hip hip hooray!
Prep began for the second case of the day, Dr. Hiseys surgery for an incorrectly healed spine fracture
resulting from a boda boda accident 6 month prior. The patient, a very nice 29 year old female, was
experiencing significant back pain and discomfort. The case went on without a hitch. It must have
helped that Mike had his Rambo head gear on! This case went into the evening and was the last OR case
in the operative theaters. Following this long day, the team retreated back to base for dinner and bed.

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After diner Dr. Liebermans son presented the team with dessert, a large air bubble chocolate bar!
Unfortunately Josh had left the chocolate bar in the bus during the day, and needless to say, it melted.
However a good half hour in the fridge and our chocolate re-solidified into a nice bubble-less sheet of
chocolate who wants dessert!?
Lesson of the day; over under on Dr Gorlick pinching a French fry off someones plate; 45 seconds
Quote of the day; there is nothing worse than a dongle that does not work, Josh Lieberman lamenting
over the wireless fobs that are meant to give high speed internet access,

Day six (July 10 2015): possible and impossible

Dr. Lieberman was up bright and early this morning, well actually
not so bright as he was up and out the door before sunrise. As he
embarked on his daily morning run, he was joined again by 17
year old local, Joshua, Dr. Liebermans new running partner. The
two ran 8 miles, and Dr. Lieberman took great pride in outpacing
the much younger Ugandan, only to have his hubris shattered
after Joshua revealed that his shoes had no soles, and that the
local was practically running barefoot over dirt, gravel and broken
glass the entire time.
Dr. Lieberman graciously provided young Joshua with the
resources to purchase new shoes (Guess what tomorrow
morning Lieberman is screwed).
The team gathered on the bus and waited an extra 15 minutes for Dr.
Gorlick who was fashionably and predictably late. He had just enough
time to pop into the hotel restaurant and grab a handful of pre-made
mini omelets. One of the hotel attendants ran out after him with a
take-out box as he, in a hurry, had grabbed the runny omelets with his
bare hands.
Despite leaving late, we arrived right on time to the hospital, so no
egg on our face (although there was some on our hands). The team,
led by Nurse Sherri and equipment manager Brian Failla, prepped the
patient and room for Dr. Liebermans morning case. Having a few
surgeries under their belt, the team breezed through set up and broke
skin (made the first incision) at 9:00 am sharp.

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

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With steady hands and help from Drs. Silverstein

and Kisitu (the local orthopedic surgeon), the team
placed 12 screws in 45 minutes. After a few X-rays
and a few additional tweaks, the spine was sitting
completely intact again, realigned to offer the
patient much improved upper body support and
strength.
After Dr. Liebermans successful case Dr. Hisey and
Mike operated on a gentleman for cervical spine
degeneration affecting his working ability on the
farm. The case was full of challenges including a lack
of all necessary instruments, but that didnt hinder the operation in the slightest. They were able to
Macgyver through the surgery, finding creative solutions with a great outcome.
Later that day Dr. Lieberman had a quick check in with Deus, the teen from todays first case. He was
awake and stable, however in quite a bit of pain understandably so. Dr. Lieberman is convinced however
that within 48 hours hell be sitting upright comfortably in a wheel chair. After the patient check in, it
was time once again for Dr. Liebermans favorite part of the day, clinic, or as he so affectionately refers
to it the penalty box. There was only one patient to check in with, a very young girl named Ester who
suffers from neurofibromatosis, a tumor of nerve cell origin which can engulf the spine and put pressure
on the spinal cord and nerves. Updated MRI scans revealed extensive tumors on both sides of her young
spine. They had developed to a level that made surgery impossible, and there are no alternative medical
options available in Uganda to battle the disease. This was a devastating diagnosis for the team and
Esters mother, however young Ester seemed unfazed, continuing to goof around and play with Dr.
Liebermans rolling stool. Ester is an amazing young girl and we hope that her positive attitude will help
carry her to a fun-filled childhood despite the complications that may arise. In fact Dr. Liebermans son
Josh left Ester with some paper and pens so she could continue to draw for fun and hopefully take her
mind off the pain.

Dinner that evening was a blast tonight as the team was joined by two of the hospital staffers, our main
man Uganda Stan, and anesthesiologist Andrew, as well as an eager young UK medical student named
Silas, who is currently getting some hands on training in the Mbarara ER department. It was great to
have these new members discuss their lessons of the day, especially Stan and Andrew as they recounted
what theyve learned from us as a team, witnessing first-hand the camaraderie and support that allows
us to achieve the impossible as Andrew stated in regards to the days first case, a spine that was split
in half. Andrew remarked that when he had first seen the x-rays, he did not believe it could ever be
possible to fix the spine, he was impressed by the commitment of the team, to achieve the impossible.
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Quote of the day: When pressed about his thoughts on the impossible case and observing
Dr. Lieberman strategically rebuild a shattered spine, resident Dr. Silverstein remarked
That was the sweetest spine surgery Ive ever seen
Runner up quote of the day:
From an exchange at the hotel restaurant. The team
favors the whole fish dish at the hotel restaurant,
offered as a medium or large size, yet there seems to
be quite a bit of controversy and confusion regarding
the price and size discrepancy between the two menu
items. The following is the conversation with our
waiter:
Dr. Lieberman: What is the difference between the
medium whole fish and the large whole fish?
Waiter: the price(long pause) sometime

Day seven (July 11 2015): the ravages of TB

Dr. Liebermans alarm went off at 4:30am and he began prepping for his morning run. If you recall the
morning prior Dr. Lieberman was joined on his run by a local 17 year old, Joshua, for whom he supplied
the resources, the day before, to buy new shoes after it was discovered the Ugandans shoes had no
soles. As he was getting his own shoes laced up, Dr. Lieberman thought to himself one of two things was
going to happen on this days run; either Joshua will show up with his old shoes as he spent the money
on other essential items, or he will show up with his entire family, all expecting a new pair of shows. As
Dr. Lieberman arrived at the meeting spot, he discovered that he was COMPLETELY WRONG! Not only
did Joshua have new shoes, but he even brought his entire village with him, 30 plus people! All of
Joshuas friends and families came out to thank Dr. Lieberman! They lined the sides of the dirt roads and
cheered thank you for training our brother! It was a memorable moment for Dr. Lieberman.

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After a quick breakfast (but not omelet hand-grabbing fast) the team headed straight to the hospital.
There was only had one case scheduled for this day, so the team was excited to focus all resources and
attention on the single patient!
The patient was Jostos, a 27 year old
male who farms for a living. He had a TB
infection in the lower lumber spine that
ravaged his L3 vertebral body. Justos
was experiencing quite a bit of pain and
discomfort, and it was preventing him
from doing his work.
The neurological monitoring technician,
Kari was on hand to oversee the
patients vitals and brain activity. Its
been an eventful week for Kari, with
each case presenting its own difficulties
and obstacles, ranging from outdated
equipment to rolling power outages.
Kari was on her toes all week, adapting
lightning quick to the challenges, and
managing to keep the surgeons informed and up to date on all the patients neurological condition
during surgery. Fortunately, after a weeks worth of cases she had figured out the kinks in the system
and this days case went as well as could have been expected.

The team wrapped up surgery around 1pm and packed up for the
day. Its the first afternoon off they had in a week and everyone
was excited to get back to the hotel for some rest and relaxation,
but not without a quick stop at the Nakumatt. There the team
replenished inventory on their greatest necessities Beer and
chocolate! (do not get the impression that we drink a lot, we just
do not trust the water and figure that the alcohol in the beer at
least kills any gut wrenching bacteria)

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Quote of the day: Upon entering the restaurant and seeing the table utensils, Kari remarked you know
youre at the fanciest restaurant in Uganda when they have a pepper grinder.
Runner up quote of the day: Throughout dinner the team kept hearing a buzzer noise coming from
next door. The team joked that they must be shooting an episode of Jeopardy out back, to which Josh
replied Ill take what meat am I eating for 1 million shillings

Day eight (July 12 2015): exploring Uganda

Day eight was the teams off day and overlap day, which meant a much more relaxing start to the day.
Drs. Lieberman and Hisey did pop over to the hospital for a quick round with recovering patients. They
brought Michelle the physical therapist from South Africa who had joined the mission the day before, so
she could meet the Ugandans shell be assisting over the following month! All the patients were excited
to have her here to help in their recovery! Michelle even remained at the hospital to get a jump start on
the physio and hopefully get these folks back on their feet as quickly as possible.
Dr. Lieberman returned to the hotel to lead the entire team in a morning Pilates class. A very confused
group of hotel staffers watched on, whispering, chuckling and even applauding. We would have asked
them to join in, but we dont need any more spine injuries here. Dr. Hisey enjoyed the session, but
noted afterwards that for most of these poses, my stomach gets in the way. Luckily that hasnt
stopped him from kicking a football around with the locals, which hes done on multiple occasions.
The overlap team led by Dr. Shane Burch had finally arrived at
the hotel after a long 26 hours of travel. The two teams met up
quickly, with team A offering little gems of wisdom like make
sure you always carry toilet paper with you and dont order
the Texas chilly burger at the hotel restaurant (team A learned
all these lessons the hard way). The exchange was quick and
team A promptly boarded the van for a day of sightseeing and
touristy shenanigans through the heart of Uganda. Of course
they couldnt hit the road without filling up the tank first. Holy
Shillings! The team thought gas was expensive back home!
The team made the requisite journey to the first
stop at the equator. As tradition would dictate
they all took pictures standing in
the equator markers, one foot in
each hemisphere! There they also
got a demonstration of the
Coriolis effect, the effect of earths
gravity on draining water to spin a
certain direction. The
demonstration was done with large tin funnels.
The team was split on whether the effect is real,
or simply a swindlers trick but it doesnt really
matter cause their shillings went down the drain both ways and backwards.
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Later that day the team visited the crocodile farm

which was only accessible by a 10 km dirt road that
had more bumps than Zoes arms (shes was a real
mosquito magnet). The farm houses over 3000
alligators. 2997 tiny ones, and 3 godzilla sized ones
named Romeo, Juliet and Benjamin you would have
thought theyd go with Tybalt, especially given the
love triangle brewing between the amorous
amphibians. The team took turns handling some of the
smaller ones, Dr. Silverstein was a natural, a regular
old alligator whisperer, having grown up in the lawless swamps of Florida.
Exhausted, dirty and covered in croc poop (which is apparently good luck), the lucky volunteers climbed
back aboard the bus for a long ride home.
Quote of the day: After lunch and prepared to head out to the crocodile farm, the young OBGYN in
training Zoe pronounced lets croc and roll!

Day nine (July 13 2015): the wrap up

A bit of a rushed breakfast this morning as most of the team was sluggish to get up, beat from the
events of the prior day, not to mention the toll of a long weeks work in a foreign country. Although that
didnt stop Dr. Lieberman from his morning run, again joined by local Joshua and now Dr. Burch, team 2
lead surgeon. Both had new shoes, so Dr. Lieberman was double screwed (just like most of his patients).
Both teams crammed into a single van for the hospital, 17 people in total, which is a Uganda Spine
Mission record! They arrived at the hospital and got right to work. Most of team 2 went straight into
clinic, with growing lines of potential patients, theyll had their work cut out for them, as the eager
Ugandans look to the medical team for assistance.
Equipment manager Brian walked some team 2 members through the SPD, the sterilization and
processing department. Its quite a bit different from the way things work back home, as the hospital
here lacks much of the equipment, resources and manpower that make sterilization stateside a much
more efficient process. Here it is more hands on, and there is a significantly greater risk of
contamination or even infection. Knowing the dangers, Brian emphasized the ramifications of a needle
prick or even worse a deeper cut with a used scalpel blade.
Meanwhile in the OR room Mary was being prepped for surgery. Mary is an 11 year old girl who lives in
an orphanage and suffers from kypho-scoliosis which is a forward hunching collapse of the spine. She
had an operation last year, however for whatever reason she failed to fully fuse and consequentially her
hardware failed, necessitating re-instrumentation and another fusion. As they were prepping for
anaesthesia, power at the hospital went out, which meant Mary was forced to wait on the cold OR table
in the intimidating room. Luckily Dr. Liebermans son Josh was on hand to do some drawing with her and
keep her mind off the impending surgery. Power returned, and the team was able to get Mary asleep
and into position for surgery to begin.
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The surgery, already delayed by the power outage, seemed to be taking longer than anticipated. There
was quite a bit of scar tissue surrounding young Marys spine, which was challenging to maneuver
around. But its nothing Dr. Lieberman and the team havent seen before, so with due diligence they
were able to expose the vertebrate and get the screws and rods in place.
The second case was a hardware removal for a 4 year young boy
named Ivan that Dr. Lieberman had operated on during the 2014
mission. That time young Ivan was unable to walk on his own due
to a severe TB infection of the lungs and spine, and sure enough
Ivan came strutting into clinic earlier in the week for his yearly
checkup. Dr. Lieberman seeing the young boy walk on his own
stated that this was one of the most rewarding moments of his 10
years coming to Uganda. This was despite the boy breaking out
into screams of terror upon seeing the Muzungo Doctor who hurt
me last year!
Having grown quite a bit now, Dr. Lieberman found it best suited to remove the corrective hardware and
allow Ivan to continue growing au naturale. The operation was quite simple in comparison to some of
our other corrective cases, so it was a nice change of pace. Everything went well, and Dr. Lieberman
looks forwards to seeing Ivan next year and continuing to monitor his progression.
The final case of the day was a 51 year young woman named Winnie. She had a benign but painful
tumor in her third lumbar vertebra. This required cement fixation to provide pain relief. Dr. Hisey
inserted cement under X-ray guidance, but was challenged by the cement hardening prematurely. It
took all of Dr Lieberman and Sherris help to get the third (and last!) batch of cement ready quickly
enough to fill the vertebra enough, but all turned out well.
The A team finally done with their work in Uganda, as a thanks to Dr. Lieberman for carrying them all
week, had decided to carry him off into the sunset!

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Quote of the day: the team ventured and tried an Indian restaurant for dinner and put in an order for
Naan early because they were starving! Not sure the wait staff got the message because the main
courses came out before they ever got the Indian bread. A bit annoyed with the lack of carbs, Dr. Gorlick
commented so far this has been a non Naan meal

Day ten (July 14 2015): the hand-off

Day ten marked the official hand-off where team A entrusted team B with the patients and equipment.
Team A awoke early for a 4:30 am bus ride to the Queen Elizabeth National park for a day trip lion safari
and chimpanzee trek, on the way back to Entebbe airport. The day trip was an amazing way to
decompress after a 9 days of high energy health care and a wonderful way to fully appreciate all that
Africa has to offer.

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Epilogues 2015
Zoe Blumenthal
I have seen a lot of the world through the small glass lens of my camera. Focused, aimed, shot, and
captured the beauty of a multitude of countries spanning oceans and continents. But for the first time, I
had an experience that made me step back from the lens. There are some moments, some scenes that
cannot seem to be captured through a small pane of glass. This was the sentiment of my experience in
Mbarara, Uganda during my time volunteering for the Uganda Spine Mission. You arrive with an
expectation that the hospital and the health care system would not match the standards of western
medicine, but nothing can prepare you for the reality of the situation. Families camped out on hospital
grounds, knowing if they do not stay and care for their loved one, no one else will. A small hallway
labeled ER filled with screams and sights I could not have imagined. The operating rooms were
sufficient, but the sterilization techniques of the local surgeons certainly were not up to par with what I
imagine the standards are in the west. Clinic, which was my main area of importance as a scribe for our
team was unlike clinics I had shadowed. Lines of people from the city and from far away villages
swarmed the small room the hospital provided for us. While I knew that my presence and assistance
was making a difference, its hard to sit there and feel like you cant help. The look on peoples faces
when they are told that surgery is not an option: pure despair. They arrive with expectations that we
have a cure-all. I loved the opportunity to learn, to interact, and to connect with the people. Nothing,
however, could possibly compare to the experience of walking through the wards. Comparable to what I
imagine early twentieth century Spanish Influenza wards looked like, the beds were packed side-by-side,
mattresses and patients laying underneath the beds, in the narrow aisle down the middle. Family
members crowded around, desperately attempting to catch our attention. Walking through the wards
was my first instance of being ashamed to hold my camera. Some patients detested the presence of a
camera, others begged for a picture. The image that will stand out the most in my memory was one that
I did not capture on film, a burn victim we had previously encountered in the OR. Surrounded by a
mosquito net and wrapped up head to toe, the victim sat amongst the ladies alone with no aid from
family. Her injuries a result of her spouse throwing a pot of boiling oil. A friend of mine in high school
had experienced similar injuries and just the comparison of her treatment to the woman sitting in front
of me was so vastly apparent it almost brought me to tears. The smell is another sensation that will
probably stick with me for the rest of my life. The odor of burning flesh, dwindling life, despair. I suspect
I will have more opportunities to capture the world through the lens of my camera, but it is the
moments that make you step back and just observe that we tend to grow the most.

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Matt Hisey
When my father invited me to join him on a Spinal Surgery Mission to Uganda, I was stunned. I didnt
know anything about Uganda, I didnt know anything about the mission and, unlike my father, an
orthopedic spine surgeon, I didnt know anything about spinal surgery. As I inquired, I realized that the
scope of the endeavor was massive: doctors and volunteers from all across North America would join
forces halfway around the world, many of them meeting each other for the first time, to devote a week
of their lives to caring for strangers in need. I knew immediately that this incredible opportunity could
not be ignored, yet I hesitated to seize it: my imagination created frightening depictions of how
inhospitable and isolated Africa would be, filling my mind with uncertainty and my heart with dread.
Several months later, as I was hauling supply crates into the Mbarara University of Science and
Technologys Hospital on day one of the Uganda Spine Surgery Mission, I was so glad that I had agreed
to come as a volunteer. The reality of the pain and suffering endured by Ugandans was all around me as
men, women, and children gathered in droves, all seeking care desperately. They came before the sun
rose, they packed themselves into stale waiting rooms, they huddled with their suffering loved ones,
and they did everything they could for their chance to be helped. Looking upon this display of
helplessness, not once did I see or hear a display of impatience, anger or greed, nor did I ever meet a
gaze without receiving also a wide smile. It was then that I relinquished all doubts about our mission - it
was then that I knew that the people of Uganda deserved all the aid we could give them.
That same day, we began seeing patients despite not planning to open clinic until our second day:
neither the doctors nor the patients could afford to waste such precious time. Here, I witnessed the
merciless and indiscriminant nature with which fate distributes hardships to the unlucky few. Here, I
met Wilber. Suffering from sudden paralysis of his lower extremities, he entered our humble workspace
in a wheelchair being pushed by his brother. My father, after scrutinizing all medical information at our
disposal, came to the conclusion that Wilber was suffering the symptoms of spinal cord deterioration
resulting from an HIV infection. I watched in dismay as Wilber learned that his paralysis was not
treatable and would spread eventually into his arms and torso, eventually leading to lung failure and his
death. Yet as I looked on, I never saw hope depart from Wilbers eyes. Wilbers fight continued until
the bitter end, Im sure, and I hold much respect, admiration, and pity in my heart for him.
The people whose paths I was fortunate enough to cross in Uganda have left many indelible imprints
upon my character. Each member of our mission endowed me with a unique lesson and perspective to
serve me throughout my life and every Ugandan I met proved to me that the human spirit is stronger
than any adversity. Amongst the bleakness and hardship of Uganda there was not sadness but joy
amongst the Ugandans as they celebrated each beautiful day of their life on this earth. I will be forever
inspired by and indebted to them for this.

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Josh Lieberman
Being the only non-medical on a medical mission, and having little knowledge of the day to day workings
of a hospital or a surgeon, I had no idea what to expect going into this mission. Aside from the appalling
lack of resources, equipment and manpower at the hospital in Mbarara, the most shocking revelation
for me was the sheer emotional nature of a job in medicine, let alone in a third world country. To go into
work every single day knowing full well that you will encounter people who are suffering, people whose
lives will never be the same again, even people you simply cannot help this takes a certain type of
strength. The amount of tragedy, trauma, deformation and disease I saw in one week at Mbarara was
enough to leave me, a perpetually positive person, nearly swallowed in hopelessness. I simply cannot
comprehend having to confront these seemingly insurmountable odds on a daily basis and yet this is
exactly what all the other team members and hospital staffers do.
This mission has given me new perspective into the workings of the world, but even more so the
incredible people who work in medicine. From the top down, doctors to nurses to scrub techs to
hospital receptionists and even hospital janitors, I have a much greater admiration and respect for all
these people, because quite frankly I am not strong enough to handle a job like this, but I sure am glad
there are people who can!

Kari Zagar
Looking back on my trip to Uganda, I experience a wide spectrum of emotions. This was my first mission
trip, and I believe there is no amount of planning that can truly prepare you for this kind of experience.
I always have had a hard time dealing with the "end" of things, but this time seemed exceptionally
difficult. It is hard to wrap my head around what I just went through, but also that it is an experience I
am leaving behind. Our presence in Mbarara was a transient, blissful state of a functioning work
environment in a third world county. Our team, the organization we developed in the hospital, the U.S.
equipment, the comradery between my fellow coworkers- that aren't really my coworkers, all of that is
no longer. It was present for a wonderful week and a half, and as much as I know it left a huge impact, I
think my sorrow is a sense of mourning for something amazing that was, but is not present after our
departure. On the most basic level, it is hard to imagine that some of the people who I have experienced
such profound things with, and developed amazingly deep relationships for such a short period of time, I
may never see again. And on a larger scale, the spine program in Uganda, something I felt so much a
part of, is far away from me now and under development that I am currently not involved in. I imagine it
feels somewhat like raising an infant child and then leaving it blindly in the care of someone else, in an
environment where I am well aware of the lack of resources and necessities that the child will require.
On a larger scale, it is sad and frustrating to think that Mbarara is only a small representation of all the
other poor and underdeveloped countries whose people don't have access to healthcare, and die so
unnecessarily. It seems overwhelming to think about this problem on such a large scale, and defeating
to think that one mission wont fix all of these problems. But recalling the story about the starfish, I
always have to remind myself; we made a difference to that one. For every patient we were able to
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help, is one less family who has to experience tragic mourning, and to that family, that difference is the
world.
In addition, I feel a strong sense of hope, knowing that this mission will grow. It will occur next year, and
the month of healing that this mission offers will again take place, and conditions will continue to
improve. And the mission will continue for years to come, until the transient state of a functional OR in
our small Mbarara hospital becomes a permanent one.
Furthermore, I feel incredibly inspired by this mission, and hopeful for what it will become. It is
empowering to know the difference we have made on so many lives with this mission. I feel so blessed
to have met such great people, but sad to have to add them to the list of people who I will miss. I felt
more a part of this team after 2 weeks than I ever have in any other work environment. This experience
has truly been such a blessing for me- and in some ways it feels selfish because I may have gotten more
out of it than the Ugandan people we helped. I really do feel inspired that we can make a difference, and
we have.
This trip renewed my inspiration, grounded me, and reminded me why I pursued a career in medicine.
Our lives and careers seem to become mundane, no matter how passionate we once were about them.
To be a part of something greater really is refreshing, inspiring, and probably something everyone needs
to experience for the health of their spirit. But I also recognize that so much of engaging in acts of
service is not about the grandiose productions, and lifesaving procedures, but it is about reaching out to
someone and caring for them. In this world there are so many things that make us seem different as
people, but underneath we really are all the same, and we all need love and compassion. This mission
made the world feel much smaller, and gave me a better sense of how interconnected we are in our
human condition, at the mercy of so many elements that we cannot control. It reminded me to live my
life appreciating everything I have, no matter how small or insignificant it may seem.

Brian Failla
This was my sixth trip to Uganda with the Uganda Charitable Spine Mission Trip. Returning to Uganda
this year, I was excited to see this country, so far from home that has now grown familiar. Much less
now is any anxiety about the traveling, what to expect on arrival, exchanging and using the Ugandan
Shilling (money), and a host of other things that on my first trip were cause for wondering and concern.
For me the trip this year could be described as one of antitheses. Achieving more with less. Our smaller
team was able to be more nimble. We accomplished so much in the more minor city of Mbarara which
is so different both in size and hustle and bustle from the capital city of Kampala. Mbarara's local
hospital is a fraction the size of Kampala's Mulago which afforded advantages that were logistic,
organizational and even bureaucratic.
I felt fortunate to have some veterans of the mission along this year. Michael Silverstein was a medical
student when he and I attended our first mission together. He's now more than halfway through his
orthopedic residency. How time flies! As always, the freshmen merged easily with the veteran
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members of the team. It was amazing to once again see different people - age, education, experience so quickly and without hesitation transform into a fluid team with one objective in mind - help patients.
Its a few weeks now that I am back. I think about the trip every day. I wonder about the patients. And, I
try to think of ways I can do a little more or do it a little better next year...

Michael Silverstein
This was my second mission trip to Uganda. My first trip was when I was a 2nd year medical student.
Each trip to Uganda has proven to be a unique experience. However, this time I certainly had a better
understanding of our purpose and the conditions we work in. This allowed me to contribute
immediately without hesitation. I am always amazed to see how a team can come together from
different backgrounds and experiences to create such positive outcomes.
The people of Uganda suffer from trauma injuries and have degenerative conditions just like Americans,
yet the treatment is vastly different. Spending time in clinic once again opened my eyes to this. As an
orthopaedic surgery resident with an interest in spine surgery I want to help everyone. This is not always
possible. A lot of triaging takes place to find those that are in the most desperate need. And with this in
mind, we were certainly able to help many patients that otherwise wouldnt have had a chance of
recovering.
I was able to work with many of the local medical staff at the hospital. One thing is constant; all are
compassionate and want to improve the way care is provided to their community. Working with the
residents allowed for the opportunity to see how they care for patients on a resident level. While the
means of treatment varied, the same goal of patient care remains. Every time I return here, I learn
something new and I know for certain that this will not be my last mission trip in Uganda.

Dr Paul Holman
At the onset of my third trip with the Uganda Spine Mission, my state of emotions was quite different
than it had been in previous years. Although the anxiety of leaving family behind, traveling to Africa
safely, and assuming responsibility as leader of the Houston Methodist team were major issues, my
mind was focused on one important person, Beverly Holman. My mothers quality of life had been
plagued by a variety of health issues over the past several years, even to the point of needing both
spinal and brain surgery. In recent weeks, however, she began to deteriorate from a medical point that
transferring her to hospice became a reality. The thought of being out of the country when she passed
was very distressing to me, even to the point of wondering if going on the mission was the right thing to
do. After a great deal of reflection, the decision to go or not became an easy one for one simple fact:
my mother would want me to go. I had the good fortune to grow up being loved by amazing parents.
A hard-working father with a magnetic personality and a genuine love for good people and an incredibly
intelligent mother who excelled academically during a time when women were in the vast minority in
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the business school at the University of Michigan. Neither were physicians, but they possessed at the
core a quality that I have come to identify in all the best doctors that I know and work with: that is the
quality of selflessness. In a time when selfies and self-promotion in other forms of social media are
becoming engrained as a normal part of everyday life, I am grateful to them both for teaching me how a
humble, giving person is incredibly valuable to friends, family, and even strangers. This quality is
certainly not something that can be learned overnight. God knows that I am far from the perfect
person or physician for that matter, but God did bless me with the role models to emulate. If you take
some time to read the growing list of epilogues in the history of the members of the Uganda Spine
Surgery Mission, you will detect a common theme. It is true that participating in this type of work
brings out the best in both parties. We are doing important things for the children and adults that seek
our medical expertise, but I believe the greater value lies in what we continue to learn from each other
as people living in very different circumstances. In Uganda, when a patient is in need of medical
treatment, his or her family assumes an incredible ownership of the process. We travel thru the wards
and see entire families clinging to their loved ones, sleeping on the floor, providing nursing care, and
scraping together whatever they have financially to pay for tests and medicine. It is also quite apparent
to anyone that comes here that the people are quite happy, embracing their culture, working for a
better life and opportunities for family but seemingly without sacrificing their respect for one another.
This years Houston Methodist team was a true spine machine and I am very grateful to all of my
colleagues and friends for their desire to go above and beyond to provide compassionate medical care
for a wonderful community of patients. I am particularly in debt to Nadia, our expert surgical scrub,
who returned this year despite being hit by a motorcycle during last years trip. It is this type of passion
and dedication that we hope to fuel all of our past volunteers to return and help recruit new colleagues
who want to give back and learn the power of selflessness.

Jon Graffagnini
When I first was told that I would be going to Uganda for a Spine Surgery Mission Trip, I can't honestly
say I was thrilled. I knew I wanted and probably NEEDED a break from the daily "schedule" I had been
keeping over the past 2.5 years. As 7/17 drew closer people kept asking me, "Are you ready? Are you
excited? Did you get your shots??" I am the type of person who does not like to build things up, but as
the weeks turned into days, the feeling of anticipation was very tangible.
We landed at Heathrow Airport and immediately went to Huxley's for some pints and breakfast. Since
our team did not have a designated "scribe" for the blog, the first order of business was
"democratically" deciding who would fill the role. Anthony, our Neuromonitoring (and IT specialist) had
an app called "tap roulette" which would decide everyone's fate. Luckily my index finger did not attract
and colored buzzers so I was spared of the blogging duties, but it was during this 3 hour layover that I
generally started to become excited of what the next 10 days would bring.
After settling in to the Lake View Hotel, and meeting the members of Team 2 for dinner at the Agip I
knew we were going to be in for some great times and also potentially disturbing scenes at the hospital.
The 1st day most of our team went to Clinic to see patients from the previous week and also identify any
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surgical candidates for the week to come. I was shadowing Errin Dalzell during Dr Burch's case so I could
get the lay of the land and how things around the OR worked before, during and after the cases.
As the week went on, everyone got a chance to do things that they never would do back home. I got to
operate the C-Arm, learn how to be a scrub tech and put in a pedicle screw(while being VERY closely
monitored) I kept my own personal quote book for the group which only added to the chemistry of the
Team besides our nightly dinners with our new found friends "World Peace and Tusker Malt"
After our job at the hospital was complete we embarked on a Safari day as well as go on a Chimp Hike.
Finally, I felt like I was on vacation! The whole experience of riding on top of the van with binoculars and
a floppy brimmed hat made me appreciate where I was at that moment. The Chimp hike was a little
more physically challenging, but definitely rewarding.
By the time we got to the equator I could tell most of the team could feel the end of our journey was
really close. It was bitter sweet for me as I knew what awaited me back in Houston, and as much as I had
seen every one on our team on a daily basis, no previous interaction at Methodist could have replicated
what we all were about to go through as a group in Uganda. I feel now that I will have a unique bond
with them even if we never go on another mission trip for the rest of our lives. I cannot express my
gratitude enough for everyone who made this experience possible it will be something I will carry with
me forever.

Dr Izzy Lieberman
This years mission has once again re-aligned my universe and reaffirmed what is important to
me. The 33 volunteers spread over 4 teams overlapped without issue. The pathology was
relentless yet the patients did well. The team members all contributed and I am certain will
continue with their efforts year after year. I would like to thank each and every one of you
reading this report for your direct or in kind contribution, large and small, to the Uganda Spine
Surgery Mission. Please visit the website for more stories, pictures and the daily blog.

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

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