On Friday, we had an awesome day of surgery in Lira. We left at 9 a.m. so we could arrive before the clinic opened. When we arrived, the “waiting room” (also serving as pre-op holding, post-op, and sometimes a consultation room) was already full of patients who wanted treated by the muzungus. This was by far one of the most eye-opening days I’ve had here. Pretty much the only rule to be considered medically capable is to wear scrubs. I had on my freshest pair of scrubs and instantly, I held an encylopedia of medical knowledge in my head. (Shout out to Cornerstone and Doc Byrd for my medical schooling!)

The clinic/hospital is headed up by a Ugandan doctor named Dr. Opio. In Uganda, doctors don’t really specialize in anything, so they are often about average in all skills because they have to have a large variety of expertise. Dr. Opio is one of the best in the country, so people travel great distance to come to his facility, and especially so, when they know the missionary doctors are coming into town. In our group of about 25, we had a pediatric surgeon, OB-GYN, general surgeon, several nurses, a few med and pre-med students, high school kids and some randoms like myself. Dr. Bridget (the medical director at RG) stated that our only rules for the day were to learn, help, have fun and not come home with “the HIV”.

Our first duty was to make rounds in the clinic and give second opions on cases that Dr. Opio was having trouble solving. The first man we assessed was having headaches, numbness and tingling, and blurred vision. He needs an MRI, but the only place for that is 8 hours away in Kampala, so unfortunately, he must find transportation and the funds before any treatment can be provided. The second patient was a 78 year old man with esophageal cancer, who was starving to death. Sadly, there was not much treatment for him, so we put a feeding tube in and prayed for the man to have a peaceful transition to Heaven. He didn’t speak English but body language is universal – the light in his eyes and smile were all that was necessary. The third consultation was a girl who we believe had thyroid problems and large painful cysts on her neck. She was only 14. It was so painful to watch all of these patients get diagnosed but yet, we couldn’t always fix them right away or at all. Prayer was all we had; we thank the Lord for that freedom to come to Him with what we cannot handle.

Before I start on the time spent in the Theatre Room (operating room), I want to warn you that the details may be graphic, but I feel they are necessary. (Side note: I have a passion for science and the medical field, so this blog may get lengthy 🙂 ) Let me start by saying that supplies are limited. Regulations are few and far between. HIPAA is nonexistent. We may not all agree with American healthcare and all that comes with that subject, but I will forever be grateful for the treatment, care and service that I have the opportunity to receive.

Let me first set the scene of how things are done in a Ugandan hospital. Anesthesia is not a thing. They use two different drug to try and block the patient from feeling the pain and another to try and keep them asleep. These drugs are simply administered as the patient needs them; meaning, the patients starts to groan, wake up, open their eyes, and move around, and the nurse then knows it’s time to administer another dose. This was extremely difficult to stomach and hard to operate on a moving patient. There is only one operating room, so tools were sterilized with machines in between surgeries, but there was not a lot of time, thus, sterilization was sketchy at best. Ugandans understand the concept of keeping a surgical field sterile, but they don’t always follow procedure when the field is broken. Anyone was allowed to enter and exit the OR at anytime, all you needed was a mask and head cap. Blood and guts spilled all over people and the floor – only a quick mop between surgery patients.

The first patient of the day was a 14 year old boy who had a distended bowel that needed resectioning. Our pediatric surgeon, Dr. Nathan, headed up this surgery with Dr. Opeo with a couple of the medical students and nurses scrubbing in. They drained the boy’s entire bowel, removed some dead parts, and added a drainage tube. It is customary to remove the appendix, if possible while operating, so Dr. Opio, took it out. He then threw the appendix across the room at Dr. Bridget and giggled…the appendix remained on the floor for the rest of the day, through four different surgeries. Totally acceptable. Sadly for this boy, Dr. Nathan saw some dead bowel that he though should be removed, but Dr. Opio overruled that decision. We aren’t very optimistic about the boy’s future with the dead bowel; once again, all we could do was pray.

The second patient tugged at my heartstrings. Her name is Betty and she’s 22 years old. She also did not speak English, but the fear in her eyes was clear. I wasn’t even the patient about to go through the operation but my heart was pounding empathetically. I held her hand, hugged her and just kept praying and praying, while she lay helplessly on the operating table, getting stuck with needles over and over again. The prep felt endless as I cried and cried while she stayed strong. Such a brave young lady. Betty had extremely large cysts on her ovaries that were thought to be benign, but the surgeons went ahead and did a full hysterectomy to be safe. She had developed these issues from being abused during the war. It is also common in Ugandan culture for the medical staff to show the families of the patients the organs they removed. They have difficulty understanding and believing without seeing. Afterward, we got to disect her reproductive organs, right in the middle of the pre-op holding area, naturally – the all-purpose room.

Now for the biggest part of the day: the third patient needed a full hysterectomy (also caused from abuse during the war), and I GOT TO SCRUB IN! There were so many conflicting emotions inside of me, but it was such a valuable experience. Unfortunately, this lady was really struggling, so she had to be sedated before she ever entered the OR. She was a tough case. I can’t even begin to describe how it felt to have my hands inside another human being. The worst part of the whole experience was over very quickly – the sound of flesh being cut open with the scalpal. The next thing you know, Dr. Bridget was grabbing my hands and having me pull back some adipose tissue so she could have a better look to start the cutting and stitching. We finally found the uterus, which had many fibroids, but they could not seem to get the uterus to come out. After much digging, poking and prodding, they discovered that this woman had two uteruses!! I held back the uteruses, so the surgeons could start the processs of removal. I realized the body is very durable and can take a lot of abuse. We really are remarkably made. Time went on and they worked quickly until a little accident happened. (Don’t freak out Mom and Dad, obviously I made it through to tell you this story.) A cut was made and a squirt of blood shot straight into my eye. I couldn’t see, so luckily, the other surgeons were there to take over for me, ha! One of the Ugandan surgical techs, came to the rescue and proceeded to do what he knew best…sterilize with 100% alcohol. The rest was pretty much a blur (pun intended). He tried to usher me out of the room, but the blindness made that a little troublesome. I removed my gloves and waited until the stinging was managable to move out of the room. The second best piece of surgical advice I received was “The solution to pollution is dilution”. Dr. Nathan and a girl named Caroline took me outside and helped me get my contact out of my eye. Naturally, all of the Ugandans started swarming around trying to figure out why the Mzungus were causing such a commotion. Dr. Nathan had me kneel down while he squirted saline into my eye. I’ve never been able to open my eyes under water, but I imagined this is what it felt like. The liquid went on forever and I swore he had a two liter of saline, with half of it all over my clothes. After it was all said and done, I felt like I should get up and thank my faithful audience, ha! It’s been about a week since the incident and I am symptom free, so we think I’m in the clear! Praise the Lord!

When they finished up the surgery for me, I got the privilege of seeing where their sterile waste sight was. A nurse carried the organs out into the front quad, walked around like a dog looking for a spot to  mark his territory, dumped the organs and proceeded to kick dirt over them. All gone!

Patients who have to stay in the hospital after procedures are required to bring all bedding and food for themselves. Nothing is provided by the hospital except a few ibuprofen.

The whole process was an unbelievable experience. I still have trouble wrapping my head around some of the things I did and saw, but I continue to be grateful to have such a God who is the great protector and in control of all things.

Your new favorite surgeon,
Dr. Kelsey