Teamwork

A quick team picture in our busy ICU!

Day 5

Bill, perfusionist Extraordinaire, hard as work.

Phew! Now that everyone has completed their CHEX from Uganda, we are all breathing a bit easier.

Recovery is going amazingly well, the Ugandan nursing team is AMAZING and have come so far over the years. So much fun to watch them work so independantly!

Tomorrow is a "day of Rest", no cases scheduled but some fun day trips have been planned, and the SP dinner in the evening. Hard to believe we've been here 5 days!

More tomorrow!

Night 2 in Mulago Hospital (officially night 3... I think.. time gets a bit confusing...) and its 2:30 in the morning, the Ugandan / American / English team have successfully performed a total os 3 open heart surgeries!! The Ugandan nurses have received all of 3 post patients with amazing independence and professionalism. Harriet, who is now post op day 2, is looking wonderful and resting comfortably. Johnson is our 25 year old and Abdul is our 6 both post op ASD patch closure were done yesterday (Dec 2nd) and are doing remarkably well.
Amy Sims has been our fearless leader all night. Katie and I have been working with the Ugandan nurses (who haven't seemed to need much help!) We discussed med math and to our surprise the Ugandan nurses remember a lot for our teaching in February. The entire Ugandan team is fully engaged with each patient and constantly providing input and asking questions. I believe we are all learning a great deal from this experience, Ugandan and US team alike.

-Amy P & the Night Shift Crew (Amy Sims & Katie)

Harriet- Our first patient, a 17yr old ASD. Courtney & Melissa outside of the ICU day one.

Day Two

Arrived Safely...

We have arrived in Uganda and completed our first surgery successfully! After sorting equipment and locating lost luggage and supplies, the team completed the first ASD of this trip. As I am writing this 12 hours later, our patient is stable, on Room Air, talking, and taking clears! I would call this a success!

Last night, I spent a few hours with Krista and the Ugandans discussing different defects, medications, and random cardiac related things the Ugandan nurses see on their wards. It is obvious to me that all of the Ugandan medical professionals are really learning, are inquisitive, and really desire to learn. They will in time be an autonomous group who will improve the quality of life for so many Ugandans.

Amy S.

Meds are in...boxes are packed...away we go again!

3 days and we'll be headed back to Kamapala for yet another trip.

Stay tuned....

Eight to Ten Cow Big

One of the most interesting parts of this trip is learning new things about different people and cultures. In the down time during the day (which I have quite of bit of) we have a chance to interact with the staff. Some of the things I have learned:
1. Why many of the young school age girls have their heads shaved clean.
2. How to say "cough" in Lugandan (Colola)
3. Breast feeding works just as well as morphine for pain in most post op kids less than 2 years of age
4. For marriageable women - the fatter the better.... which brings us to the title of this post. I decided to blog about this tonight because in future posts, we will likely refer to eachother as some type of cow. I thought I would give a little background to the inside joke....The other day, we started a conversation on gifts for young Ugandan women when they get married. Apparently, the tradition is, when a young lady marries a man, the man's family must given the women's family a certain number of cows, based on her size. The fatter the bride, the more cows her family would get (a good thing). Joseph, one of the day shift nurses here, then went on to tell us how many cows each of us would earn. Krista (who must weigh no more than 100 lbs) was told she would only get one cow.. he then continued to tell another nurse (we can remain nameless) that she would definitely get atleast 8 to 10 cows....whereas we might have taken this as an insult (someone calling us fat), apparently, this is a good thing. I weighed in at 5 cow big (although with the daily breakfast buffet, I'm working on atleast 8 cows by the time I leave).....

AS far as the status of our trip - today was our last case, done solely by the Ugandan team. He came back from the OR about 3 hours ago, and is doing great, already asking for something to drink. I can bet by the time I walk by the ICU next to check on him, they will have him up to a chair..... Tommorow we wrap things up, and wednesday we will leave for our safari.... this week has flown by.

Until next time....

Sonali

The Flush and Run

I have to be honest, I really am looking forward to being able to use the restroom and then be able to leisurely go about my business and then exit the area. There are 3 stalls in this bathroom, featured is stall 3 (close to the open window and major entry way to all mosquito's). Flushing the toilets here causes the water to come down to the bowl with the force of a Category 5 Hurricane and hence, splashing the user. No flags. If you're adept, you can pull the chord and then plaster yourself against the door as you fumble crazily to get out without sustaining splashes. If you're not, or if you're a 'First Time User' you're sunk. I needn't mention more : )

But I digress, the kids are all doing wonderfully and I have to say this trip has been like no other...time off!! We have no cases scheduled for today or tomorrow and the last case on Monday will be done solely by the Ugandan team with our assist. This is truly our goal, to help them become "self-maintained" and able to do more repairs when Teams are not there.

A few folks are leaving today and tomorrow and that's SAD! We have acquired 2 Brits along our way who have fit in just amazingly well with our Team. Sally and Julie from Great Ormond Street in London have been our Anesthetist and Scrub nurse, respectfully, and we will certainly miss them! Jen and Stephanie are leaving tomorrow with 2 Ugandans in tow. Safe Journey all of you!

I will post more patient pictures from home, the connection here is equal to molasses.
Today a large group of folks went up to Jinja to do the ATV Safari!! It is a great trip (albeit the filthiest I have ever been!) I hope we get some good blogs, and pics.

ok, my last night shift tonight, Ja-Ja is on call, we will have a good night!

-Sister Lynda

On call...

So I've decided to keep up the tradition and blog while on call. I'm starting my post early tonight - hoping that soon after dinner gets here I can make my final round in the ICU, do a little teaching, and get back to the call room. The weather is a little cooler tonight, so I'm hoping to get a good night of sleep... if the OR's from today keep doing as good as they have.

So we're more than halfway through our OR schedule for this trip. Two more cases tommorrow, and one on Monday. The team has been working very hard, with great outcomes...This afternoon's case was perhaps one of the coolest things I have ever seen. A 19 year old with a few months of headache, and recent hemoptysis. She came to have an echo on tuesday - revealing the biggest "goomba" I have ever seen sitting in her atrium. She was scheduled for surgery, and just came back a couple hours ago - awake, polite, and talking. This goes back to what Ahmad commented on yesterday - these children are truly amazing. Yesterday evenings case was walking laps up and down the hall, and the morning one is delined, and in a T-shirt - all less than 24 hours after surgery... and right behind or beside them are 5 CNMC nurses and docs taking digital pics of them- mostly because it's so foriegn to us. But I guess it what makes it all worth it....

Well, good night all. Until next time...

Sonali

On call with the mosquitos

As I was woken up from my 2 hours of "sleep" on the top bunk by a screaming woman, I could only think that the worst had happened; someone must have died! I jumped out of bed, almost forgot I am on the top bunk, and almost fell flat on my face. Luckily I still have pretty good reflexes and realized quickly that it just seems too far down and actually came down the ladder. I stumble into the ICU where I express my concern to the Ugandan nurses. Shy smiles on their faces calms me down, as they tell me "it's just the maternity ward and someone is just giving birth". I guess it's all natural birth here, since I have never heard anyone scream like that giving birth.
The next thing I notice is truly amazing (especially for those who work in our CICU back home). Our 13 year old with Sub aortic stenosis and PDA who came out of the OR about 7 hours ago, is sitting up and getting chest PT!!! Couldn't believe it; 7 hours out of the OR!!!!

These patients are amazing; no whimpering, no drama, no whining. They just want to get better and they want to get better fast.

I wish all you (medical professionals and non-medical) could see the courage of these children and the pure joy, happiness and excitement of their families.

I am tired, but ready to do more echos (many more) echos tomorrow until my arms hurt.
Back to the ICU (kudos to Amy and Katie for taking such great care of these kids and teaching all the "sisters").
-Ahmad

Day 2 Uganda

Another beautiful here in Uganda! Becky, Tiffany and I woke up this morning and had a wonderful breakfast by the poolside, the plantains are delicious! Becky and I then decided to venture to the gym next door at the Garden City Mall. We ran on treadmills overlooking the pool and golf course on the balcony. It was amazing! Did I mention they were playing Miley Cyrus "Party in the USA" on the TV.

Despite the one post-op patient already in the ICU and doing well, the Ugandan nurses prepared for the 2 new post-op today. During there "down time" we took the opportunity to do some teaching. The nurses and staff at Mulago Hospital were very appreciative and receptive of all we offer. Now we are all off to bed to rest up for another long day!

- Amy

Real World Uganda

Just got back from a most amazing dinner... great indian food, lots of Nile beer...now just hanging out at the presidential villa (will have to show pics to describe this place - it's far from any sort of roughing it we could have imagined). Long day today - two cases, lots of echos... but the kids are doing well. On a positive note - our first case from yesterday is de-lined, de-tubed, has been out of bed walking around, and most likely will go to "HKU" tommorrow where Rachel will continue his stellar care, and we will get our two new post-ops....Gearing up for another long day so I will pass on the blogging....

Sonali

1 Down...9 to go...

Hi all!
After unpacking all of our supplies and working out some kinks, we successfully completed our first case, and he is recovering nicely in the ICU. We jumped in feet first Monday after our long journey, and are well on our way to a very busy week. In the late afternoon yesterday we reviewed all the cases for the week, made a few adjustments, agreed to one early admission, and we all now have a pretty good idea what our week will look like. You can't move forward without taking on (and conquering) some challenges, so we will admit a baby tomorrow morning to the ICU for some "fine-tuning" prior to her case on Thursday. She might be our challenge.

Everyone is adjusting quite well here and I am proud of everyones very hard work. Who else but a bunch of crazy healt care workers from different parts of the World can come together, and within a few hours of meeting each other, without too many issues, do Heart surgery!?

And in keeping with last year's philosophy of "Adapt and Overcome", and "Where's my Ascom?", we all just simply, got things done and organized for our week, what a great team!

And on a less serious note, apparently some late night swimming happened, (not a lifeguard to be found), I was NOT involved, but it sure was amusing watching people unwind!

I missed all of the crazy bird sounds, especially the one that sounds identical to a car alarm : )
Africa, is truly an amazing place.

Hope all is well for everyone back home.

Sister Lynda

We made it!

Hello all,
We are pleased to let you know that we all arrived safely. Unfortunatly some of our boxes or suite cases have yet to arrive but somehow we have made it through these tough times! Last night we realxed on the patio @ the Golf Course Hotel. For a moment, we were worried they'd run out of Nile beer, and on the first night! Fortunatley for all involed, there were a few more bottles found.

This morning started with poolside breakfast of fresh fruit and coffe. And it's hot. Don't think it's all sun and games- the hard work has started. We arrived at Mulago Hospital ready to work. AFter being welcomed back by old friends and meeting new ones, we set to the task of unpacking boxes and familiarizing ourselves with the ICU, step-down unit and the regular ward. Mulago Hospital serves both pediatric and adult populations so each unit is shared, except for the 4-bed pediatric cardiac ICU. Our first patient, a 9 year old boy from Kenya is already in the OR for his PDA repair.

So long for now- it's lunchtime- can't wait to see what Krista ordered for us!
-Rachel, Lynda, Sonali, Becky, Jen, Tiffany, Katie & Amy

Ugandan Embassy in DC

Today we visited the Ugandan Embassy and met briefly with His Excellency
Perezi K. Kamunanwire, Ambassador.

Mulago 2010

Alas! Our trip is only 3 days away. We are preparing all of our equipment and supplies readying for the 2010 Mission. Stay tuned and check back often we will keep you posted on our progress.

Silence since Monday

Just a quick note so people know we're alive since we've not been near a phone or computer since Monday!

We had a great trip to Mhingo lodge, it was quite a brief R&R, but well needed. We are all exhausted beyond words, but all in the same, we're so happy with the results of our week of surgery. Three kids are left in the ward at Mulago, one to go home tomorrow and the other two should go home after the weekend. Every year this trip gets more rewarding.

So we're scrambling around right now sorting and repacking our luggage getting ready to head over to the Samaritin's Purse Offices to get the kids we're bringing back to the US. There are 17 kids plus Mom's plus the translators. It will be quite a trip home!!

Off we go, arrival in the US in a few (24-30) hrs!

-Sister Lynda
(thanks Laura!)

A few more pictures & more to come

The masterminds of the mission

Caroline one year later!

PT in Uganda

Patiently waiting for an Echo

Hard at work

Cpap in Uganda

Our first patient...

A few pictures

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Bitter Sweet Ending

So today was the final OR day in the "theater". All of us are excited and exhausted in the same breath. We were all saying that it is "last call for the theater" and "standing room only" in a hot, mosquito buzzing OR (a real realization of the state of medicine here in Africa and why we are here). All of the team members have hit the wall with fatigue and look forward to a celebration to finishing the last 2 cases. Dr.Sable proudly announces that we will be doing a pericardial tap on a child that will be going to Germany for a complex repair to bring the total to 12. Shortly after the start of the first case, the realization that another long day was before us with the discovery of unexpected defects in our first case. The past days have morphed into us all asking "what day of the week is it?" All of the patients have done well and are transitioning into the ward where they will have to transition from “muzanga” care to the familiar ward of nurses. Surprisingly the last OR case turned out to be the most complex post op care for the Uganda nurses and a reflection of our goal. Dr.Darren challenged the Uganda nurses with patience and a smile as dopamine and a pacemaker were utilized for the post op course. Although we are all experiencing fatigue, the Uganda nurses are being challenged both physically and mentally with all that we are teaching them. We are all are looking forward to getting a little free time off and our planned excursions. Regretfully several members of the team will be returning to their loved ones in the states both human and furry…(Dwayne) and we wish them a safe flight along with the benefits of KLM airlines. Special shouts to every team member that is a piece to this complex puzzle of care. Loud shouts to Dr.Starr and her skilled hands along with Dr.Sable aka “JaJa” and his vision for this program for without we would not have a mission. Special thanks to all of those that contributed man hours, supplies, and money for all of us to be here today. The final OR day and recovery for 12 Uganda kids not to mention the healing process for 17 kids that will be flying back with various team members throughout the world. We all hope that immigration doesn't question the large drain from her heart. All of the team members have been a blast and hopefully we will have a chance to work together again. The trip does not end here, but some well deserved rest and many celebrations along with fascinating stories about gorillas, 4 wheelers, the Nile…..not the drink, and safaris....... Mostly Amy and a bit Krista

Close call

So, Craig Dobson, Steph, and I thought we were the luckiest people yesterday because we got to take off in the late afternoon yesterday on Labor Day. We actually saw sunshine. We got down to the Craft Market by the National Theatre. The woodwork was amazing. Steph bought a "masterpiece" (we think he meant "one-of-a kind") for a total steal.

We even got to take a nap before heading to Le Chateau for dinner. The food was great. The ambiance was better, except for the obnoxious European man sitting across from us who would signal to the servers by clapping his hands or beckon them with one finger.

Doreka, our Good Samaritan representative, had called a cab for us, and told us that a man named Dennis was coming in a bit to pick us up. We waited for a while and a car finally pulls up in front of the restaurant. Each of us thought it odd that the windows were all tinted black. We asked if he was Dennis and he said yes. So we all got in.

We drove for a bit but something felt odd. Maybe it seemed we were going in circles. Anyways, Doreka calls to tell us that Dennis was waiting at the restaurant for us. Steph told her ta ht we were already in the car with Dennis. And soon it dawned on us that the driver was not sent by Doreka, but somehow he knew where we were to pick us up and he knew that we were working at Mulago Hospital. He finally dropped us off at home intact to our relief.

Steph and I think he intended to kidnap us. Craig D thinks he may have overheard that we needed a ride and came before Dennis to earn some extra cash. Either way, it was scary to think how vulnerable we are.

But alls well that ends well. We were in our PJs for some time before the poor OR team came home from the hospital at 11:30 PM.

Uyen

You don't know tough

Obviously this experience has shown and taught me a whole lot. One of the most notable is the strength and resiliency of people who do not have much. While the care we give is certainly somewhat different than we are used to in the U.S., one marked difference is the kids. They are tough, sweet, and incredibly eager to listen to instructions...the same goes for the families.

The most notable story is the 1 1/2 year old with a terrible cleft lip and palate who was extubated day 1 following a VSD repair and soon thereafter eating toast, porridge and milk - all with a massive cleft lip/palate. No special nipples, no gentle feeding - take the toast, and eat it. Darwin's law...the strong survive.

I clearly am not so strong. I am exhausted - days start at 7:30, and we are not home until nearly midnight....day after day. Resources limited, culture different, and we are all beat...not so tough, sweet, or eager as the patients we are treating...but we already knew that.

Klugs