The skilled surgeon and his OR team

The years of planning, screening patients, organizing, arriving, and preparing are all necessary for the critical 60 minutes of bypass time and 30 minutes of cross clamp time necessary to correct the child's intracardiac defect. During this time, all the pieces of the team must come together in complete synchronicity and harmony for Dr. Michael Mill to surgically heal the child on the OR table. Closest to him is Jenn Ditto, OR Scrub nurse, and Ruben Bocanegra, physicians assistant, while Bill Nicotra runs the bypass machine and Dr. Gene Freid keeps the patient unconscious, immobile, and pain free. This team that works so well at UNC hundreds of times a year, is now displaced to a foreign land some 7900 miles away. They are in the final stages of preparing their Ugandan counterparts to continue these procedures independently with their own team once we depart. The handoff has occurred....Drs. John Omagino, Tom Mwambu and Michael Oketcho are the Ugandan Cardiac Surgeons; Obwin John the Scrub RN; Sam Wambuzi the perfusionist; and Dr. Cephas Mijumbi is the anesthesiologist.

The cardiologists

Dr. Craig Sable has been coming to Mulago Hospital since 2002. He has screened thousands of children over those years with his dear friend and colleague, Dr Peter Lwabi, aUgandan Pediatric cardiologist. Together these two had the vision then, for what the program is NOW. Drs. Stephanie Lacey, Lowell Frank, and Laura Olivieri enter the hospital each morning to see a waiting room full of children and their families. Along with Samaritan's Purse volunteers, they register the patients and gather extensive clinical histories and demographics. Complete physical examinations are performed followed by echocardiography. The days are full. In between these patients' visits, they are called to the operating "Theatre" for transesophageal echo's. A long growing list of children in need of curative heart operations now exists. We will complete 11 operations on this mission, but many, many more are needed.

Saturday in Uganda

I can hardly believe it is Saturday..... The Uganda, UNC and DC teams have been working extremely hard since we all came together last Monday. Initially, we located the medical equipment and supplies that were shipped over, began un-packing and organizing equipment, and set up the ICU in order to take care of the patients. We then started education and training for the Mulago Hospital Staff, screening patients for surgery, and are now taking care of patients in the ICU.

Today we have one Cardiac Surgery case, that is now in the "theatre" (operating room). This will be the 7th patient since our arrival. The children are all doing very well. They have wonderful families, and the most beautiful smiles I have ever seen!

Yesterday, we were able to visit the Pediatric ICU that we came over in 2005 to set up. We took medical equipment and supplies to the unit, and were greeted by several smiling and familiar faces that we met during our 2005 mission. The PICU had two very sick babies when we visited. We arrived just in time to round with the PICU team. One of the babies had been diagnosed with meningitis, the other with renal failure.

I have been spending time in the Neonatal ICU as well. We shipped medical equipment and supplies for that specific area. Un-packing and organizing equipment, as well as teaching and training for the Neonatal ICU has been a great success thus far. The Neonatal ICU is a large and busy unit with approximately 80 babies. They have two nurses to care for all of these babies as well as admissions. The mothers are encouraged to stay with their babies and care for them around the clock.

We have much more to do in the days that lie ahead...Continue to keep us in your thoughts and prayers.

--Tiffany Mabe

Focus on the task before you

Having been on the UNC Medical Mission to Mulago Hospital last year, I thought that things would be easier this year. Some things have and others haven't. The Mulago Heart Institute with whom we work has made substantial improvements in the past year especially in their equipment and OR/ICU set up and personnel training. Thanks to a one-time grant from a private foundation, the Heart Institute was able to purchase new equipment for both the OR and ICU which has dramatically improved their ability to use these machines while we are here as well as when we leave. Unfortunately, without the technical support that is usually available for us in the US, they are still faced with challenges to the efficient use of the equipment. While we are here we hope to help Mulago set up some mechanisms for outside support after we leave.

So though we see very tangible evidence of improved facilities and better-trained health professionals, the obstacles that still remain on a daily basis are overwhelming. We brought lots of donated medical supplies from the U.S., and we pushed the cart loaded with these goods up the hill to the Pediatric ICU at Mulago to deliver these much needed goods.The numbers of families waiting to be seen or staying by the bedsides of their sick children, reminded us that we were dealing with a small part of a much larger health crisis in Africa. It is discouraging to me but I can only imagine how those who face this in their daily lives must feel. And yet, the Ugandans that we have met do not seem hopeless or in dispair; quite the opposite. They are patient and grateful for any assistance offered to their families.

A close friend of mine traveled in India a number of years ago to work with Mother Teresa in one of her "death houses," but upon arriving my friend and her companions were overwhelmed at the conditions and needs. Mother Teresa advised them not to look around them, for they would only be successful if they focused on the task in front of them--no matter how small or mundane--because doing small things to affect one person was the first step in healing the whole. I have tried to keep this advice in mind, as our team has worked to heal the hearts of 13 small children who will receive life-saving surgery while we are here as well as the 100's who will be screened and treated for their heart conditions in other non-surgical ways as well.

So as we watch the financial meltdown of developed countries around the world on CNN,
things don't change much here in Uganda. Life goes on and we must all focus on the small things that we can do to improve the world, no matter the obstacles here or at home. I am grateful for lessons that the Ugandans are teaching me about patience and determination to move forward even though the journey may zigzag, plunge and crest.

I hope that these lessons will still be with me as we return to our country that has been shaken by the chaos of financial markets and uncertainty of our financial futures knowing that there are far worse conditions with which a majority of our world's population deals every day.

Helen Snow, UNC Medical Mission Team Member
October 10, 2008

We rejoice in our successes but remember what surrounds us

We have had such a wonderful few days, meeting the Ugandan children and their families before surgery when apprehensions are running high and the tears run freely. We are later met with smiles, words of thanks, and tears of joy when the families reunite after surgery. But as I lay in bed, contemplating tomorrow, my thoughts are broken by the screams that cry out in the night in the open air Mulago Hospital. We are surrounded by others who have not been as fortunate as the children we operated on today. Instead, families are grieving in the most profound way over the loss of those dear to them. We are traveling with Dr Cathy Partyka, an old friend of Drs Sable and I (we were pediatric residents together in Washington DC), who is spending her vacation time in the neonatal ICU on the 5th floor of Mulago Hospital. Her first day was not as joyful as ours...She was greeted first thing in the morning by the deaths of 3 newborns. She has been introduced in a harsh way to the realities of Ugandan Medicine; knowing what and how to save a child's life but being unable to accomplish this in the austere conditions we work in. We hope and pray that tomorrow will be another successful day for our team and a day of healing for those around us who are infirm......Good night...

Before I lay down to sleep......

Take 2...

First look from Uganda...