Uganda Spine Surgery Mission

Trip Report 2019

August 9-25, 2019

Mbarara, Uganda
 Team Roster

Name Role Dates

Dr. Mark Kayanja Orthopedic Surgeon 8/9/19 – 8/17/19
Teteisha Pearson Nurse Anesthetist 8/9/19 – 8/17/19
Ashlee Gentile Neuromonitoring Technician 8/9/19 – 8/17/19
Sherron Wilson Registered Nurse 8/9/19 – 8/24/19
Jason Ash Surgical Technologist 8/9/19 – 8/24/19
Dr. Nathaniel Schaffer Orthopedic Surgery Resident 8/9/19 – 8/24/19
Taylor Nack College Student 8/9/19 – 8/24/19
Dr. Isador Lieberman Orthopedic Surgeon 8/16/19 – 8/24/19
Sherri LaCivita Surgical Technologist 8/16/19 – 8/24/19
Dr. Michael Hisey Orthopedic Surgeon 8/16/19 – 8/24/19
Dr. Sue Benton Anesthesiologist 8/16/19 – 8/24/19
Brian Failla Equipment Technician 8/16/19 – 8/24/19
Dr. Stephen Gorlick Family Physician 8/16/19 – 8/24/19
Kari Zagar Neuromonitoring Technician 8/16/19 – 8/24/19
 Mission Statistics
Volunteers: 14

Days Seeing Patients: 14

Patients Seen: 180

Surgical Cases: 25
 Surgery List
Serial Date Name Age & Diagnosis Procedure
Number Sex
1. 8/13/19 Sanyo Allen 45, female T12-L1 T11-L3
flexion/distraction decompression and
fusion
2. 8/13/19 Akwine Monica 55, female L2-3, L3-4 lumbar L2-3, L3-4
stenosis decompression
3. 8/13/19 Porina Elijah 74, male L1-2 T12-L4 PSF
flexiondistraction
4. 8/14/19 Asiimwe Obedience 6, male Infected spinal cyst, I&D upper thoracic
suspected abscess
neurofibroma
5. 8/14/19 Natakuna 38, female L2-3 T12-L5
Generous fracture/dislocation instrumentation and
fusion, I&D of open
ankle fracture
6. 8/14/19 Kyochairwer Peruth 63, female Tumor of the right Biopsy of tumor of
scapula right scapula
7. 8/14/19 Senyange Sharif 23, male Pott’s Disease L2 corpectomy, L1-L3
fusion
8. 8/15/19 Mutahangarwa Female L4-5 disc herniation L4-5 decompression
Regina and anterolisthesis and fusion
9. 8/15/19 Kabikwa Josline 59, female L3-4, L4-5 lumbar L3-4 and L4-5
stenosis decompression
10. 8/15/19 Rebecca Balaba 51, female Cervical spondylotic C5-6, C6-7 ACDF
myelopathy
11. 8/16/19 Nsimire Lima 16, female Pseudarthrosis Revision PSF T10-L4

12. 8/16/19 Ngabirano Ezekiel 14, male Pseudarthrosis Instrument revision

13. 8/19/19 Tumiheirwe 45, male TB of the spine T8-T11 fusion
Saverino
14. 8/19/19 Rev. Ben Jackson 48, male L4-5 lumbar stenosis L4-5 decompression
with spondylosis

15. 8/19/19 Sheila 42, female TB of the spine T10-12 I&D, T8-L2 PSF
Tugendamuguru
16. 8/20/19 Faith Achom 21, female Upper mediastinal I&D and biopsy
thoracic mass
17. 8/20/19 Kyarimpa Kedress 42, female TB of the spine with Lateral T10-12 I&D,
collapsed T10-12 T8-L2 PSF
18. 8/21/19 Tibekinga Sederesi 72, female L4-5 stenosis Bilateral L4-5
laminotomy and
decompression
19. 8/21/19 Natukunda 38, Excessive drainage I&D of T11-L3 incision
Generous female from surgical site
20. 8/21/19 Katusiime Daleth 11, Sub-occipital Basilar invagination
female craniectomy and C1
laminectomy
21. 8/21/19 Namirembe 35. Possible hematoma L2-3 laminectomy and
Salama female open durotomy
22. 8/22/19 James Muganze 50, male TB of the spine Anterior L5
corpectomy and
reconstruction,
posterior L5-S1
instrumentation,
decompression, and
fusion
23. 8/23/19 Kyohairwe Jane 49, Neuroforaminal Laminoforaminotamy
female stenosis
24. 8/23/19 Niwagaba Harriet 12, Congenital scoliosis Rotation correction,
female instrumentation, and
fusion T8-L1
25. 8/23/19 Owembabazi 6, female Right-sided thoracic T3-T12
Daphine scoliosis instrumentation and
fusion
 Trip Report
Arrival in Uganda!
August 9 and 10, 2019

Day 1 and 2 (travel days)

After a long two days, Team 1 has finally arrived at the Lake View Hotel in Mbarara, (mostly) in one
piece. On this team is Dr. Mark Kayanja, Dr. Nathaniel Schaffer, Jason Ash, scrub technician, Ashlee
Gentile, neurophysiologist, Sherron Wilson, RN, Teteisha Pearson, CRNA, and myself, Taylor Nack, an
undergraduate student. The flights were uneventful for most—minus one lost suitcase (sorry Nathaniel)
and some issues getting some extra supplies checked onto a flight. We all arrived in Entebbe around
11:30pm, got our many crates and suitcases together, and headed out to find the bus.

However, the bus was MIA. Luckily, Jason came to our rescue and made a few calls, locating the bus.
Due to some road issues, he was running late. The bus arrived around 12:30am and we got it all loaded
up with our crates and suitcases. Fortunately for us, there were not too many crates and there was only
6 of us, which meant we got to sprawl out and sleep across the rows of seats. We started the 6-hour
trek to the hotel around 1:00am.

We got to the hotel around 7am, checked in, and got to go back to our rooms to unpack before the days’
activities began!
Team No Sleep
August 11, 2019

Day 2 (arrival day)

We arrived at the hotel this morning at 7am and hit the ground running (or maybe it was more like
jogging, due to the iffy sleep quality these past few days). We started with a big breakfast to last us all
day at the hospital if needed, followed by quick showers and changes. We were back in Dr. Kayanja’s car
headed to the hospital by 8:45am.

The team on the way to the hospital!

Jason gave the two Spine Mission rookies, Ashlee and me (Taylor), a quick tour of the hospital grounds.
Although I have been on mission trips to Uganda on three other occasions, I have never been inside of a
hospital here. I was initially struck by the sheer number of patients here—in beds, on floors, outside,
inside. There were so many patients, all of whom looked like they so badly needed the expert care
thatour physician team could provide. And I know that tomorrow as clinic begins, the number of
patients in need will only continue to grow. Also, especially being just an undergraduate student, I was
struck by a yearning to be able to do more. Both of these things initially made me a little sad. But I think
going forward I will just need to remind myself that while our time here is limited and we can only see so
many patients, that we are greatly impacting the lives of those that we are able to help.
 Rounding on some patients and checking out the surgical ward.

Dr. Kayanja, Dr. Nathaniel Schaffer, Dr. Kisitu, and some others went to check out some existing patients
in the surgical ward. After making their rounds through both the men and women’s sides, they decided
on about seven or so cases that they planned to operate on this week. They also decided which they
thought were the highest priority and should be done first, one of which was a 45-year-old female who
had experienced a 40-foot fall onto her back.

Dr. Schaffer examining a patient X-ray while all of the physicians discussed a diagnosis and treatment plan for this patient.

Meanwhile, the rest of the team began filling up the storage closet with some of the supplies we
brought in our checked luggage. The veterans were surprised to find all of the supplies they had brought
last year were gone already—but luckily it appears we’ll have more than enough supplies to fill it all the
way back up this year. The rest of the supplies that were shipped to Uganda from the U.S. will be
arriving tonight and will be unloaded and organized in the morning while clinic begins.

After finishing up at the hospital, we headed back to the hotel to rest. Long showers, time on the good
lobby WiFi, and massages for some in preparation for the long day expected tomorrow were just what
the doctor ordered. Then dinner and an early bed time to get ready for the next day. We are expecting a
busy day tomorrow—already with an estimated 60 cases to be seen in the clinic.
 Dinner at the Lakeview Resort & Hotel

What number patient is this again?

August 12, 2019

Day 3 (first clinical day)

Today started with a wake-up call of 6am and downstairs by 6:45 for breakfast (for most people). We all
ate our fill, plus a little more, to keep us full for the busy day ahead of us. After slipping some boiled
eggs and bananas into our backpacks to hand out to some of the kids we would see at the hospital later,
we headed out to the hospital at 7:30am.

Upon arrival, the group split in half. Ashlee, Josh, Teisha, and Sherron headed for the surgery floor to
unload the final truck-full of supplies that had come in that morning. They also made goodie bags with
donated t-shirts and candy to give to the kids that had surgery these next two weeks. And they gave the
operating rooms a very thorough wipe-down and got everything organized and ready to go for
tomorrow’s surgeries.

Central Command Center being set up by Sherron, Teteisha and Jason

Dr. Kayanja, Dr. Schaffer, and myself (Taylor), headed for the room that was set up for clinic. Before we
had even arrived, there were rows and rows of patients lined up for clinic, each holding a slip of paper
with a number on it to mark their place in line and each carrying a large folder containing most of their
medical history or existing scans. Our goal for the day was to see 60 patients—and we weren’t stopping
until we saw that many!

Schaeffer and Kayanja reviewing imaging studies

We got started around 8:30am seeing patients. One patient would come in, he or she would sit across
from Dr. Kayanja, who would start looking over existing documents, and Dr. Schaffer would start looking
over any imaging the patient brought in with them. Then Drs. Kayanja and Schaffer would start
examining the patient, while I furiously typed down just about everything I heard. The sentences were
not very coherent and some of the “science-y” words were so misspelled that even autocorrect couldn’t
fix it! This continued until about 7pm—no breaks for these hardworking doctors! By the end of the day
we had seen 61 patients, one more than our goal. We also saw many patients twice, because we sent
them for imaging and then had the patients come back in to read their results. So, our real total was
definitely more than 61 clinic visits. There were over 100 patients lined up that day, so we decided that
in order to see them all we would hold clinic outside the surgical floor during our breaks. By the end of
the day, we ended up booking 13 cases for surgery this week and 3 for surgery next week when the
second team comes. There were also many patients for which we were waiting to see their most recent
imaging from before deciding to schedule them for operations, which would have to be next week—so
Team 2 is busy already and they haven’t even gotten here year!

One of my favorite things from today was seeing how much the other doctors and students here want to
learn, and how much our team wants to teach them! I think that’s what makes a successful mission—
building the capacity of the people who are here all the time, so that the people and patients continue
to benefit long after we leave.

We wrapped up the day with another yummy (late!) dinner at the hotel before turning in and getting
some sleep before our long day tomorrow, with four surgical cases and the ad hoc “Hallway Clinic” in
between.
 The clinic begins,

It’s Go Time!
August 13, 2019

Day 4 (first surgical day)

We started the day today with another 6:00am wakeup call, at breakfast by 6:30am. I would say we
definitely loaded up for our first day of surgery; French toast, bread, marble cake, potatoes, eggs, we ate
it all. We loaded onto the bus at 7:30am with the goal of starting surgery at 8:00am. Well, as a veteran
visitor to Uganda, I know that such a thing as “Ugandan time” exists. This means that we don’t always
get to follow the schedule we intended. But hey, that’s okay. We’ll get done what needs to get done in
the end. The patient prepping process was running behind, so Dr. Kayanja, Dr. Schaffer, and I used this
time to see some more patients in the clinic that we had not been able to get to yesterday. Since we saw
61 out of the 100 yesterday, that means we have 39 left to squeeze in wherever we can. Between our
time in the clinic in the morning and our time seeing clinic patients in between surgery, we managed to
get about 20 of these patients seen. Less than 20 left (as of now)!

By about 9:30am it was time to get surgery started. We had a big crowd of local nurses and doctors
watching every aspect of the surgery—from the surgery itself to the neuromonitoring to the anesthesia.
At one point, we counted 18 people in the room!

Our busy room during our first surgery. Everyone wanted in on the action!
We did three surgeries today: one decompression and fusion to treat a fracture, one decompression to
treat lumbar stenosis, and one PSF (posterior spinal fusion) to treat another fracture.

Drs. Kayanja and Schaffer working on a fusion and decompression for our first patient of the day.

One thing I really loved about today, aside from seeing surgeries and cases I had never gotten to see
before, was seeing the adaptability of the physicians and other team members and how well they dealt
with the changes that arose today. First, Drs. Kayanja and Schaffer responded so well to the surgeries
being postponed, seeing it as a perfect opportunity to see even more patients. Also, due to some delays,
we ended up having to move a fourth case that we had planned for today to tomorrow. This change was
taken in stride and we are all excited to work hard tomorrow to do the FIVE procedures we have
planned. Also, during our last procedure, we lost power, no surprise for the veterans. Everyone kept on
working, with the aid of multiple head lamps and flashlights. All of the changes and unexpected things
that popped up today were handled so well, which is the reason these trips run so well. It wouldn’t be
the Uganda Spine Surgery Mission without some unexpected changes and redirections!

When the lights go out in the OR, we make it work!

We finished up the final surgery around 10:00pm—meaning that we were at the hospital for over 14
hours today! Tired and hungry (not sure which of these we were more of), we headed back to the hotel
for a late dinner and some discussion about clinic cases and surgical cases for tomorrow. We are looking
forward to our even longer day tomorrow! The impact on the patients’ lives is worth all the tiredness
and hunger.

Divide and Conquer!

August 14, 2019

Day 5 (the operating room marathon)

Morning came way too soon for us this morning. As for my roommate Sherron and I, who slept straight
through the alarm, the getting ready process was especially rushed! We were all downstairs by 7:00am
for a quick but hearty breakfast before we left. Some brought some leftover breakfast along for a
midday pick-me-up (which are much needed!).

On the schedule for the day, we had five surgeries planned. That meant if we wanted to get through
everything and get out at a reasonable time, we were going to need to divide and conquer. Dr. Schaffer
started by rounding on yesterday’s surgical cases while Dr. Kayanja and I set up in the lobby of the
surgical floor for clinic. At the same time, the rest of the team was prepping the OR and the patient for
the first case, which was a 6-year-old scheduled for an I&D (irrigation and debridement, cleaning of an
infected wound) of an upper thoracic abcess. Dr. Schaffer tackled this one with ease. Next Dr. Schaffer
got started on a biopsy of a tumor of the right scapula. At the same time, Dr. Kayanja got going on an
instrumentation and fusion in the next room over.

Dr. Schaffer working on the I&D of a suspected neurofibroma.

 Dr. Schaffer working on the biopsy of the right scapular tumor.

Dr. Kayanja and Jason Ash starting the work on a T12-L5 instrumentation and fusion.

The T12-L5 instrumentation and fusion proved to be full of surprises. When the neuromonitoring
technician, Ashlee, started prepping the patient and places her needles and wires, she had to unwrap
some bandages on the patients’ right foot. She had had a previous ankle fracture which had been
operated on. When the bandage was unwrapped, she exposed an open ankle fracture wound and a
large, necrotic calcaneus wound. This threw a little bit of a wrench in our plans, and we had to stop to
thoroughly clean and debride the wound before proceeding. After this case, we had patient with
probably Pott’s disease (Tuberculosis that has eroded the spine), scheduled for a corpectomy and
fusion. This case was also long and grueling!

Dr. Kayanja working on our difficult T12-L5 instrumentation case.

While we had five cases planned, our final patient came to the floor for surgery and it was discovered
that she had not taken her blood pressure medication in two days! We decided it would be safer for her
to wait until tomorrow to operate, after she had had time to take her medication and allow her BP to
come down. It also had gotten very late. While we were off to a speedy start, due to delays and some
challenges, we did not finish our fourth case until 10:00pm.

But we were still able to finish four great cases and Dr. Kayanja got our total number of patients seen in
the clinic up to 98 patients, plus many patients that we saw twice to examine scans we had ordered for
them! We headed back to the hotel and most people skipped dinner and went straight to bed—looking
forward to a little extra sleep and a big breakfast in the morning.

Slow and Steady Wins the Race?

August 15, 2019

Day 6 (stamina prevails)

We are all starting to feel the long days and late nights catching up to us. Each day people wake up a tiny
bit later, get ready a tiny bit quicker, eat a tiny bit faster. All to be out the door at 7:30am. Today was no
exception. After eating breakfast (I learned to load up on the eggs and potatoes before we leave so that
I am good and full), we jumped in the bus and headed to the hospital.

We’ve gotten in a solid rhythm in the mornings—Kayanja and I to clinic, Dr. Schaffer to round, and Jason,
Ashlee, Sherron, and Teisha to setting up. Already when we walked in, there was a line of patients
outside of the operating wing, waiting to be seen by Dr. Kayanja in clinic. Dr. Kayanja and I quickly
assumed our positions at the ad hoc Hallway Clinic (aka the front desk area). We got our tally up to 104
patients seen for in clinic this week. At the same time, Nathaniel went to round on our patients from the
first and second days of surgery. We were seeing positive results, so we were glad to hear that.
Our first hiccup of the day happened when the hospital staff brought us the wrong patient for the first
case. That resulted in a delay of starting our cases for the day. Our first surgery ended up being an L3-4
and L4-5 decompression and fusion, which ended up being a doozy. The surgeons had difficulty with
retraction and visibility and extra imaging equipment had to be brought in to assist with parts of the
case. It was a long and difficult case, clocking it at around 8 hours long.

Drs. Kayanja and Schaffer taking a step back from the operating table during our
complicated first case in order to examine the patients’ films.

Drs. Kayanja, Schaffer, and Kisitu looking at the x-ray that was
snapped during the surgery and discussing their next steps.

When we finally wrapped up this case, it was almost 6:00pm. That meant we definitely weren’t going to
get through the five planned cases today and would need to bump some to tomorrow. But we were still
going to work as hard as we could to get as many done as possible! We did two more cases: a
decompression and an ACDF (anterior cervical discectomy and fusion). These did not exactly go
smoothly either—making for a very late night. During the ACDF surgery, due to a loss of signals picked
up by the neuro spinal cord monitoring, instrumentation went in, then had to come out, and then went
back in. That one finished around 11:00pm. Then it was off to finish the two-level decompression that
Dr. Schaffer and Dr. Natasha had started next door. Meaning we were for sure in for a late night.

We wrapped up at the hospital shortly after 12:00am. It was straight to bed for everyone so we would
be as fresh as possible for our last three surgeries tomorrow. Even though it was a difficult day, the team
did their best to keep spirits up and keep each other energized. Everyone stepped in where they were
needed and went above and beyond to help each other out. Afterall, we are all here for the patients! It
was a perfect example of teamwork in action!

Wishful Thinking
August 16, 2019

Day 7 (week one home stretch)

Everyone needed an extra cup of coffee or tea (or both) this morning to get over our surgery-hangover
from the night before. Unfortunately, little did we know, we probably should’ve had another one. Today
was destined to be another battle of attrition.

We started the day as normal—Dr. Kayanja and Dr. Schaffer rounding on our previous patients, me
typing furiously to stay up to date on notes and such, the rest of the team setting up for the day. Then
we saw a few more patients in clinic, bringing our final total for the week to 108 (not counting those
patients that we saw for repeat visits after they went and got new scans.

As we opened for our first case this morning, Dr. Schaffer said, “I feel like today is going to be a good
day.” And it did. Everyone was in great spirits and had high energy, even given the challenging day we
had yesterday. Our last shipment of surgical supplies had finally arrived, so we had pre-made packs that
would make the prepping and operating process so much easier and quicker. That meant that less
running around all day for Sherron, who was our superhero this week. So, when Nathaniel said that, I
am sure we were all willing it to be true.

Unfortunately, despite our best efforts, this wasn’t really the case today, either. During our first surgery,
which was a revision of a previous surgery, we had an issue during the opening process. Then, we could
not find any tools the right size to remove the existing screws. Everyone began frantically looking
through all the makeshift tool sets and sterile instruments, all Allen wrenches and screw drivers were
examined. By the time we found the right size tool to remove the screws, it looked like a Home Depot
aisle in the OR!

After that surgery, which lasted a while, we had time for one more case. That one wrapped up about
10:00pm, we got packed up and then headed back to the hotel. That evening was our last with Team 1
here. In the morning, Teisha, Ashlee, and Dr. Kayanja are leaving and we were sad to see them go, but
excited to welcome Team 2 soon!
 Dr. Kisitu breaking out the hardware tools, looking for what we needed.

I have been so grateful for how helpful and supportive everyone is on the team. Even in the midst of
crazy cases like the ones yesterday and today, everyone made the effort to explain things to me and
teach me something new. In addition they’re extremely patient when I ask them to repeat themselves,
explain things to me, and spell all the words I have never heard before. As just an undergraduate
student, coming in I was very worried about how much I would be able to contribute and if my lack of
knowledge would hinder everyone’s ability to do their jobs. But thanks to all of my teammates, I have
learned so many new things and had so many new experiences that I will cherish! I was glad that I still
have over a week left to learn and do even more new things.

R&R
August 17-18, 2019

Day 8 and 9 (the cavalry arrives)

This weekend was MUCH needed. After lots of late nights and a heavy case load last week, we were all
slowing down. Three members of Team 1 left us on Saturday morning—Dr. Kayanja, Teisha, and
Ashlee—and the rest of us that were staying for week two as well had a day to ourselves. But fear not,
we didn’t neglect our patients! Dr. Schaffer started his day by rounding on our cases from this week,
discharging those that had been operated on early in the week and were ready to go home. Then it was
my job to get caught up on note-taking and updating our patient records. Dr. Schaffer then set to work
on a lecture that he is giving to some med students and post-grads later this week. The rest of us had a
more relaxing day—venturing into the city with some locals or lounging at the hotel. Regardless, we all
had ample time to sleep and get recharged for another busy week once Team 2 arrived.

Team 2 arrived at 05:00 Sunday morning, bringing Dr. Isador Lieberman, Dr. Michael Hisey, both
orthopedic surgeons, Dr. Sue Benton, anaesthesiologist, Dr. Stephen Gorlick, family physician, Sherri
LaCivita, scrub technician, Brian Failla, equipment technician, and Kari Zagar, neuromonitoring
technician. The veterans, with a combined Uganda experience of over 55 missions, brought our
Team/Week 2 total to 11 people.
 Team 2 ready to get to work at the hospital!

After that group got a little time to settle in, (that is code for Lieberman going for his obligatory run) it
was time to get to work. We headed over to the hospital for a few hours to get ourselves oriented and
organized for the week. During clinic last week, we had many more surgical cases than we had time for
that week, so we had designated them for this week. Drs. Lieberman, Schaffer, Hisey, Gorlick, Benton
and I went over the cases we had operated on last week, to get everyone caught up. Then we started
talking through the list of additional surgical cases that we had not gotten to last week. The list is pretty
long—we joked last week that by the time Team 2 got here we would have their schedule filled already!
We decided on a few cases that we wanted to operate on for sure and got them put on the schedule.
For the other cases, we would need to take another look at their scans before we put them on the
schedule, which would be done later in the evening at the hotel. Then our little group went to round on
post-operative patients and see a few in-patients that were to be operated on this week. The rest of the
team organized our lounge area and storage closet with more equipment that was brought with this
team and got all of the equipment ready that we would need for our scheduled cases tomorrow.

Drs. Lieberman, Hisey, and Schaffer looking at the scans for one of our surgical candidates outside of
the emergency room, where we had just stopped to see some patients.
After staying at the hospital a few hours, we headed back to the hotel to rest before heading out for
dinner. We decided to treat ourselves to dinner away from the hotel, since we might be spending long
days at the hospital again this week. We ate at the Igongo Hotel a little way down the road from us, and
it was phenomenal! We ate our share of their amazing barbeque meats and had some fun playing Heads
Up at the table while we waited for our food—though Dr. Lieberman sneakily skipped his turn. It was
awesome seeing how well this team has bonded over the years and I was eager with excitement to see
it all in action this week in clinic and surgery!

One of my favorite things from this weekend was starting “Lessons of the Day,” something the team has
done in the past but that we did not do last week (largely because we did not eat dinner very many
times!). Dr. Lieberman said his lesson for the day was on the importance of always pushing yourself to
learn more and how that helps you to grow as both a physician and as a person. I loved that lesson and
became even more excited to learn as much as possible during the week and into my career as a
physician.

It’s Go Time… Again!

August 19, 2019

Day 10 (expect the unexpected TIA)

This morning started with a 5:15am wake-up call for those that wanted to do some Pilates led by Dr.
Lieberman. Or some extra sleep for the others. We all met up for a good breakfast at 6:30 before
heading out for the hospital at 7:00am. When we got there, we fell back into a familiar rhythm:
Nathaniel to round, Drs. Lieberman and Gorlick and I to set up at clinic, and Dr. Hisey and the rest of the
team to run around and get the operating rooms set up for today’s cases. Today we had three cases
planned: a fusion for a patient with spinal tuberculosis, a decompression for a man with lumbar stenosis
and spondylosis, and hardware removal for a young girl with severely broken and protruding rods from a
previous fusion operation.

In the clinic (aka “the penalty box” as affectionately referred to by Lieberman) today, we saw 55 patients
in about six hours. Drs. Lieberman and Gorlick assessed, diagnosed, and planned cases for the rest of the
week. I loved watching how careful Dr. Lieberman was to ensure that the patients fully understood their
diagnoses and that he answered any and all questions they had, despite the language barrier that
existed between him and the patients.

Dr. Lieberman and Jason Ash looking over a patient x-ray.

 Dr. Lieberman going over a patients’ x-ray with him, making sure that the patient understood
what he saw in their scans and the diagnosis he had come to.

It was awesome having such a full team here today—everything went so smoothly (for the most part)!
Operations could happen while clinic was happening, room turnover was quick and efficient, and we
were able to move swiftly between each case. After completing clinic Drs Lieberman and Gorlick
proceeded to the operating room to tag team with Drs Hisey and Schaffer. This meant for a much
fasterpaced, slightly shorter day than we had gotten used to last week! We finished up at the hospital
around 6:30pm, and we were all ready to go back to the hotel for an earlier dinner. However, we are
afraid we might have jinxed ourselves. After the surgery, the third patient woke up fine but then became
very agitated, so he had to be sedated. Then he was not breathing well, so he had to be intubated
before going to the ICU overnight. After all was said and done, Lieberman and Benton felt the patient
had an idiosyncratic psychosis due to the anesthetic medications. In short TIA (this is Africa). After
taking care to ensure that the patient was stable and would be watched closely, we wrapped up around
8:30pm. Although not as early as expected, our top priority is of course the patients’ wellbeing and
safety, so we didn’t mind staying around a bit longer.

Our busy post-op OR getting turned over and cleaned for another surgery.

Dinner was a yummy buffet at the hotel (surprisingly ready when we arrived, as Uganda is notorious for
slow food preparation), followed by everyone sharing their “lesson of the day.” One of my favorites
from that evening was when Dr. Hisey talked about how easy it is to focus on the repeat patients that
we have seen in the past—ones still with some pain or with broken hardware that needs to be repaired.
He said that it is so easy to focus on the cases that did not go perfectly, that we forget to think of those
patients that do not return because their pain has been alleviated and are doing well. Dr. Lieberman
cited a cartoon drawing that says, “A patient cured is a customer lost” and Dr. Gorlick cited an old
professor in medical school that said as physicians, “you should work to put yourself out of business.” I
loved this lesson and all of these quotes because it reminded the team that for all of the repeat patients
we see, there are hundreds more that we do not see again—because we don’t need to! What we did for
them in the past really worked.

The Man with the Anesthesia has Gone

August 20, 2019

Day 11 (“teaching the village to fish”)

The week prior, Dr. Kayanja told us about a book written by a Ugandan physician entitled, “The Man
with the Key has Gone.” In it, he describes some of the barriers to healthcare delivery in the country.
One such barrier is the fact that it is so difficult to locate people and things, leading to delay and
inefficiency. We experienced this today. The title of our book today, though, would have been “The Man
with the Anesthesia has Gone.”

We had planned a shorter day today, with only two cases that were meant to run simultaneously, as
there was a Ground Round for physicians and residents that our doctors were set to present at in the
afternoon. In one room we would have a fusion/instrumentation case and in the other we would have a
decompression and biopsy of a large, left thoracic tumor. Dr. Sue Benton was to be the anesthesiologist
for the instrumentation case while one of the Ugandan anesthesiologists worked on the biopsy patient
in the adjacent room. We arrived at the hospital at 8:00am, predicting an early start shortly afterwards.

Dr. Schaffer performing an exam on a patient scheduled for surgery tomorrow.

While the team prepared for our two cases, Dr. Schaffer and I ran around the ward, rounding on
previous surgical patients. Afterwards, we quickly walked (more like jogged, for me, to keep up with
Nathaniel’s very long legs) back to the surgical floor, hoping that we had not missed the start of the
cases. Well, we definitely did not miss them. Not even close. Dr. Benton’s case was able to start on time.
However, the other case was missing an anesthesiologist. So we waited. And waited. And waited and
waited and waited. Finally, around 12:30pm (over 4 hours later!), we were able to locate him. To his
credit he was resuscitating a complex multi system trauma patient in the ICU and he simply could not
leave and we did not know where to find him.

Despite the delays, we finished up that case just in time to head to Grand Rounds for students and
physicians alike. Drs. Lieberman, Schaffer, and Hisey gave a presentation on cervical spine trauma. They
gave some practical advice on diagnosing cervical spine injuries, taught what the next steps should be
given a particular cervical spine injury, and presented some interesting cervical spine cases. The lecture
wrapped up about 2 hours later, much to the crowd’s dismay. They had so many good questions and
were so interested in learning so that they could provide the best care to their future patients.

The large crowd (plus more that came in after the photo was taken) that came to hear Drs. Lieberman, Hisey, and Schaffer.

Our fearless lecturers!

After that, it was back the clinic to view a few more x-rays that we had ordered for patients yesterday.
Our total for the week so far is up to about 70 people (and it is only day 2 of seeing patients!).

We wrapped up the day with a yummy dinner at the hotel, where we were joined by Dr. Kisitu and
Natasha, “Lessons of the Day,” and a pre midnight bedtime.

Yummy dinner with the whole team, plus a few extras!

9 whole fish were ordered and (surprisingly) were all ready at the same time, much faster than expected.

Succeed we MUST
August 21, 2019

Day 12 (“Failure to adapt is the easiest way to fail.”)

This morning was running for some, sleeping for others, and breakfast for all. No over-sleepers like
yesterday (*cough* Dr. Gorlick *cough*)! We loaded the bus shortly after 7:00am and headed to the
hospital. Dr. Lieberman went immediately over to the medical school to give another short lecture to
the med students. He talked about all different kinds of spinal conditions—from scoliosis to stenosis to
spondylolisthesis and lots of things in between. The students were very engaged in the lecture and loved
having him.

Meanwhile, back at the hospital, we started our work. We had 4 cases planned today, 2 in each
operating room, that would run simultaneously. Yesterday, we emphasized the importance of the
anesthesiologist being here on time this morning so that we would be able to do so. We did not want
another long delay like we had the prior day. Thankfully, he was here! One case was able to start around
8:30am, an L4-5 decompression done by Dr. Hisey and Dr. Kisitu. The other case, an I&D of one of our
post-operative patients whose incision site was draining a little more than we would have liked it to, was
able to start around 9:00am, when Dr. Schaffer and I returned from rounding on our patients.
Dr. Hisey’s case got off to a slow start because the suction was not working properly. After some
tinkering, our neuromonitoring technician-turned-engineer, Kari, saved the day and “MacGyvered” her
way to a solution. After that, the case was able to continue on smoothly.

Kari being resourceful and fixing our suction machine so that we could continue on with the operation that was in progress.
“Success”

We finished up our four cases around 5pm and decided to try out the restaurant at a new hotel we had
driven past earlier in the week called the Hotel Triangle Mbarara. Though the food took a long time
(over 3 and a half hours once we finally finished), it was amazing. Dr. Lieberman’s face in the following
pictures shows the satisfaction we all felt after that meal. It is definitely going on the list of places to eat
dinner in the future!

Before: the anticipation of a flavorful meal.

 During: Dissected the spine with perfect precision, “Success”.

After: Triumphant, yet feeling a bit over indulgent, “Success at a cost”.

While we were waiting for dinner, we all went around the table and told what our “Lesson of the Day.”
We also got “Quote of the Day” out of that discussion. While in the past our quotes have been very
humorous, this one was very inspiring and thoughtful! When talking about how quickly plans change
when you are here due to unforeseen problems or lack of resources, Dr. Benton said, “Failure to adapt is
the easiest way to fail.” We all thought this was beautifully said and was applicable both to our work
here and at home. Sometimes, despite your best efforts, things just do not go how you wanted them to
or how you expected them to. If you do not adapt, altering your plans to meet the changing demands of
the case, you risk making mistakes or missing out on a better way to do things. This is definitely an
essential thing to hang on to in Africa—as surprises seem to hang around every corner.

4, 3, 2, 1
August 22, 2019

Day 13 (“Take two weeks of vacation to go somewhere and work twice as hard as you do at home…”)

Wake-up, work-out, eat-up. That’s how our morning went again today! The only deviation was the
delayed arrival of the coffee, much to everyone’s dismay.

We practiced our adaptability today, like all the other days. When we arrived at the hospital at 7:30am,
we had four cases planned. By about 8:00am, we were down to only two remaining. One patient
decided not to have her operation late the previous night, so we were not aware until the morning. The
other patient we had scheduled for the last case of the day but we were waiting on receiving MRI scans
the morning before deciding on what we would do. Unfortunately, the patient had a large tumor in
addition to some other issues that were going to make the operation extremely dangerous. He had
some kyphosis (a hunched forward bend) of his spine that the doctors believed his body developed to
compensate for the obstruction of his airways. Therefore, correcting this would potentially take away his
breathing abilities. Drs. Lieberman, Hisey, and Schaffer were worried that attempting a surgery would do
the patient more harm than it would good. So, despite brainstorming many possibilities, they ultimately
decided against doing the operation. This was a hard case—we all so desperately wanted to think of a
way to help this patient as the tumor was slowly rendering him a quadriplegic, but we had to think
realistically about the possibilities and risks involved. Then by about noon, we were down to only one
patient. Our fourth surgery scheduled was a three-year-old girl with congenital scoliosis. She had a
hemivertebra at L3 and was going to undergo a L1-L5 instrumentation and fusion. The plan was for the
child to get a CT scan that morning so that the physicians could have better imaging before going into
the surgery, especially due to the fact that the intra-operative fluoroscope C-arm was not functioning.
However, despite giving the child some medication to calm her down, she refused to sit still enough for
the CT scan. Ultimately, Drs. Lieberman and Hisey decided it was again far too risky to do the surgery
without a thorough understanding of the anatomy before starting the case. She would get the surgery
next summer instead when she is a little bit older.

Despite our three cancellations, we still had a very full day. We also had a packed OR filled with a very
captive audience. Our remaining case—a TB patient—ended up taking much longer than expected due
to difficulty during exposure in the first case. He was getting an anterior L5 corpectomy and a posterior
instrumentation and fusion. The fact that this surgery involved both an anterior and a posterior (front
and back) approach added some additional difficulty to the case. The patient also had a lot of scar tissue
engulfing the major blood vessels, in the abdominal area, making it a difficult dissection. While the first
half of the surgery was underway, Drs. Schaffer and Hisey rounded on some post-operative patients,
followed up on some scans and medications we had ordered, and saw a few more patients in clinic. For
the week, we saw about 80 patients. When it was finally time to flip the patient over, it was already past
3:00pm. At this time, Dr. Hisey scrubbed in and took over on the latter half of the surgery.

The captive audience for the long surgery ahead.

 Dr. Hisey teaching some of the residents and medical students about the surgery taking place.

The patient did incredibly during the operation. He woke up from anesthesia very nicely and then was
transferred back to the ward. We finished up around 7:00pm and decided that we would head back to
the Hotel Triangle where we had dinner last night—the food was just too good! After the rave reviews of
the whole fish devoured by Lieberman the previous night, seven out of the eleven of us ordered it for
this night.

Dinner selfie! By Sherri the “Selfie Queen”

We wrapped up with more “Lessons of the Day.” An overwhelming theme has been how thankful we are
to have a full team that works so well together. Everyone is likeminded in their goals and priorities. Dr.
Benton said it perfectly (she was 2/2 the last two days for Quotes of the Day). She said how lucky (and
maybe a little crazy) it is that we can put together a group of people “that want to take two weeks of
vacation to go somewhere and work twice as hard as we do at home.” She’s right—everyone is so hard-
working, and we are all so lucky to be a part of this awesome team and awesome mission.
Sweet Caroline
August 23, 2019

Day 14 (a commitment fulfilled)

Today was our last (super) early morning and we are very excited about that. Our breakfast of eggs,
potatoes, onion rings, beans, sausage, toast, fruit, tea, and coffee came at 6:30am again this morning,
followed closely behind by a 7:00am departure for the hospital. Dr. Hisey, Dr. Schaffer, and I rounded on
our patients, getting to discharge three more today. That meant we were down to only 6 patients out of
the 21 we had operated on during these two weeks still remaining. I also got to see my favorite little girl
that follows me around during rounds (which might be because of the candy I keep in my pocket, but I
am going to tell myself it’s because we are friends).

After we finished rounding, we got back up to the Operating Theater just in time for Dr. Schaffer to join
Dr. Lieberman in the first case—an instrumentation, rotation and correction, and fusion on a 12-year-old
girl to help with her congenital scoliosis. I got to watch large parts of this surgery and it was very
interesting. The amount of force that the procedure requires and how strong the bones in the spine are
to withstand this force was very surprising for me. Simultaneously, Dr. Hisey did a laminoforaminotamy
in the room next store. While the operating teams were working Sherron, Jason, and I started packing
up our supplies and storage closet to get ready for departure on Saturday. After that case, we finished
up the day with yet another scoliosis case. A T3-L1 instrumentation and fusion on a 6-year-old girl with
right sided thoracic scoliosis. This surgery went very well and everyone wrapped up in great spirits. Such
great spirits, in fact, that Drs. Lieberman and Hisey and the rest of the team in the operating room
wrapped up by reciting the prayer and belting out the song “Sweet Caroline”—“Whaw, Whaw,
Whaaaaws” and all!

Dr. Lieberman, Dr. Hisey, and Sherri working a scoli case together.

After we finished up at the hospital, we had a fun last night planned. We went to the goat farm of one of
Dr. Lieberman’s previous patients, Aron, that he had operated on during the mission a few years back.
Aron has come to see Dr. Lieberman each year for a follow-up appointment and to invite the team over
for dinner. Due to the business of the trip, it is always so hard to fit this in. But Dr. Lieberman feeling
very ashamed and guilty that every year he says he will visit Aron and never did, decided that this was
the year he would fulfill the commitment—we were going! This ended up being our best meal in
Uganda! The family had prepared goat, chicken, pork, potatoes, vegetables, and matoke for us.

The delicious spread that Aron and his family prepared for us.
But besides how amazing the food was, spending time in their home was what made this night so
special. During the meal, the family offered so many thanks to Dr. Lieberman and the team for what
they had been able to do for Aron and his pain. It was so incredible to see the impact on the patients’
life that the team’s work has made. So often the team has to work and then leave. Then, if nothing goes
wrong for the patient, we do not see or hear from them again, as their pain has been resolved. It is rare
that the team gets a first-hand look at the results of their work here. So it was great to see and hear
about all the good that the team can do in patients’ and families’ lives. I think what also stuck out to all
of us the most that night was the importance of family and friends and community. We bonded around
a home-cooked meal, sharing lessons of the day, and listening to our own Jason Ash who brought his
guitar and played and sang some rock classics and love ballads. Aron and his family welcomed us so
graciously into their homes and treated us like family. They made us feel so welcome. While Aron’s
family said they felt honored to have us in their home, we were the ones that felt most honored and
humbled.

The team (minus Sue and Jason who missed the picture) with Aron and his extended family.

This is really why we commit to these missions—to change people’s lives for the better. And we hope
that we can continue to impact people’s lives in the same way that the lives of Aron and his family have
been impacted.

The Departure
August 24 and 25, 2019
Day 16 and 17 (“Work so that we no longer have to come back to Mbarara”)

This day was bittersweet. We are all exhausted, especially those of us that have been here for two
weeks. But at the same time, being here is incredible and we do not want to leave. The care that the
physicians provide here (made possible by all the other supporting members of the team) makes such a
huge impact on the patients’ lives. But there is still so much need that remains, so many more patients
that could benefit from operations. The extent of those suffering from spinal ailments is overwhelming.
Twenty-five surgeries don’t even make a dent in the amount of need that exists here. So many of us are
torn—we miss our home and families, but we also wish we could stay to keep helping the people here.

The morning started a little later with a whole team Pilates session on the lawn, at 08:00, then breakfast
to follow. We had all checked out of the hotel and loaded the bus with Hassan’s help (our weeklong
driver). We got to the hospital for a final combined ward round with the orthopaedic house officers and
Dr. Kisitu. The team then split with Shaffer and Lieberman retreating to the lecture room with the
orthopaedic house officers to give one final lecture. The remaining team members proceeded to the
operating room to pack up the equipment and distribute the unused supplies to the operating room
staff and the pharmacy.

With the lecture done and supplies and equipment accounted for, the team boarded the bus in
anticipation of the traditional Khyber Pass Restaurant departure meal in Kampala, yet in dread of the
butt numbing five hour ride to Kampala. Needless to say we all rapidly forgot the latter once the curry
was served.

One of the ways that I feel this mission and team does a great job of combatting this issue of the need
that remains even after we leave is through capacity building. By lecturing students and physicians on
surgical practices, teaching doctors and residents during the procedures themselves, and discussing with
the partners here about the issues they are facing and how to approach them, the Uganda Spine Surgery
Mission is giving the local people the ability to grow and succeed after we leave. Just as Dr. Gorlick said
that as a physician, you should work to put yourself out of business, maybe the philosophy of the
Uganda Spine Surgery Mission should be to “Work so that we no longer have to come back to Mbarara”.
Not because we are not passionate about the work that we do here, but because their own program has
become so strong that they no longer need us. Then we can pick somewhere else to set up shop and
duplicate the effort.

Epilogues
Dr. Isador Lieberman, Orthopedic Surgeon:

This year’s mission was about commitment and change. I observed with great pride as the team
worked, and I witnessed, their uncompromising commitment. I noticed this year through our travels
around Mbarara and within the Hospital the extent of change, both in infrastructure and attitude. My
first visit to Mbarara was in 2006 when a young Dr Mark Kayanja coerced me into a trip that I would
have never considered part of my personality. Mark’s commitment transferred into my commitment
and now into the commitment of over 90 volunteers during the 14 years. The city of Mbarara, the
Mbarara regional Referral Hospital, the Mbarara University of Science & Technology (MUST), and in fact
Uganda, have all evolved reflecting a change for the better. It is evident that the economy is booming
by virtue of all the construction and local population growth. Not to discount the commitment or
change in any way there is still so much to be done. As I am fond of stating “everything responds to
slow gentle pressure”. I am so very grateful to my family, friends and colleagues who allow myself and
the team to continue our commitment to affect the change.

Dr. Stephen Gorlick, Family Physician:

This year’s Mission was as rewarding, productive and smooth as any I have participated in.

In some ways, "less is more”: While our total number of surgeries may have been slightly reduced over
previous years, our broadened involvement and impact has been more than any other. We had
wonderful interactions with students (medical or otherwise), local surgeons, and health care staff, as our
relationships continue to build.

Dr. Nathaniel Schaffer, Orthopedic Surgery Resident:

On the mission we get to enjoy the reasons we work in healthcare in their purest form. We work in the
absence of distraction or extraneous tasks, devoting ourselves fully to the betterment of truly grateful
patients for whom there would be no help without us. We of course encounter challenges and
difficulties that we do not face at home, but for a short time, we are able to insulate ourselves from
everything but doing the most possible good for the most people. It helps me remember why improving
other people's lives is the greatest calling a person can have.

Taylor Nack, Undergraduate Student:

Though this was my first time traveling to Uganda with this mission, I have been to Uganda on three
other mission trips. Through those trips, I developed a love for the Ugandan people and for serving
them. As an undergraduate student pursuing medicine, being invited to go on this trip seemed like the
opportunity of a lifetime—I would have the chance to combine my love for Uganda with my interest in
medicine and medical missions. The trip was more amazing than I ever could have dreamed of. Chiefly,
the trip gave me a glimpse into the future that I could have as a physician and how I could incorporate
my passions into my future career. I am so grateful to everyone that made this trip possible and I hope
that as I continue in my training, I will be able to return and continue the amazing work that is being
done in Uganda.

Teteisha Pearson, CRNA:

After my first mission trip in 2018 with Uganda Spine Medical Mission, I knew I wanted to come back. I
was delighted when Dr. Lieberman asked Dr. St Clair if I wanted to attend again. I was absolutely ecstatic
to go. I immediately started asking the hospital and pharmacy staff for medical supplies (both
medication and medical supplies). I was walking around the facility asking and collecting whatever I
thought would be useful. I was seeking supplies not only for my practice, but for the municipal of
Mbarara. Many of my coworkers assisted me by collecting whatever they assumed would be useful for
me. I ended up with an astonishing amount of items. The majority of them were unable to make it on
the flight with me, thanks to Delta!!!. At the airport, I had to immediately store the rest of the items in
my car because of the luggage height was greater than airline requirement. During this hassle, I had
almost missed by flight. I heard my name being paged over the airport speaker and I was praying to the
Lord that “please don’t let me miss my flight”. I finally reached my gate and the door was closed. The
airline gate agent looked at me and asked, “are you Ms. Pearson” and I said “yes”. She then replied,
“you almost missed you flight” and she opened the door at gate. I was relieved and my heart filled with
joy as I walked through the door and boarded my flight.

After meeting some of the team members in Amsterdam, we then landed at Entebbe. I was delighted
that I returned to do what I love to do. When we arrived at the hotel, there was no down time. It was
work time. We headed straight to the hospital and started unloading supplies and preparing for surgery.
The rest of the team were doing patient consults. We started our cases early the following morning and
worked the entire day. This process continued each day. After a while I was getting tired, but I really love
and enjoy what I do. I have had the desire to do medical mission for many years and this desire
continues to grow inside of me. This desire fuels me, so leaving late didn’t really bother me since I was
making someone’s life better. That superseded any of my complaints. I was able to follow-up on some
of my patients post operatively, not as many as I would have liked, because the majority of my time was
spent in the operating room. I was consumed with many emotions because of how wonderful and
successful both surgery and anesthesia was. I would never forget, the time I had assisted the Ugandan
staff with a cardiopulmonary arrest. I was glad to have assisted them and to know the patient survived
and recovered well. When I was leaving the hospital on my last day, I was sad because I could not stay
longer. I would always be grateful for the experience that I had, both at the facility and the people
whom I encountered. If anyone ask me if i would participate in any medical mission again, my answer
will be overwhelmingly “I love what I do” and “absolutely I would do it again”. Thank you everyone for
allowing me to come and join this medical mission. Thanks so very much.
(Agatha) Sherron Wilson RN, BSN:

It’s become a tradition, following our evening meal, to ask each member to share with the group a
lesson they had learnt that day. One lesson, given by Ms. Sue Benton (our Anesthesiologist) stood out,
and I quote, “Failure to adapt is the failure to succeed”. My reflection validated her statement.

During the first week of the mission we encountered many challenges. In addition to not having an
instrument representative, the shipment of sterile packs necessary to set up the cases, were delayed in
Kampala pending an official’s order to release. We were obliged to look at practical solutions and find
work-around, in order to deliver the care we came to provide.

It quickly became evident that we had to resort to making our own surgical packs, being careful to
maximize the meager resources that were available. We substituted plain gauze for Raytec (an x-ray
detectable gauze), and used Cidex (Glutaraldehyde Solution), for high level disinfection of heat sensitive
equipment such as suction tubing and electro-cautery pencils, and sterilized towels and half sheets for
drapes. Sister Rose, the Charge Nurse of the theatre, was sympathetic to our predicament and
miraculously provided us with some sterile laparotomy drapes and other necessary items.

Notwithstanding the challenges, the team collaborated together and we were able to complete 12
(twelve) surgical procedures. It is indeed true, that when we are attentive and steadfast in
accomplishing our central goal, that we can thrust ourselves beyond what we thought was tenuously
possible, to achieve that goal.

Of my many trips with the Uganda Spine Mission, I can say assuredly that I have gained added respect
and appreciation for all the members of the team (veterans and rookies) who selflessly donate their
time and expertise to care for others. Personally, the added responsibilities that I shouldered, afforded
me fresh fortitude and dedication to the Team and all the Patients of the Uganda Spine Mission that we
serve.

The definition of TEAM:-

T Together

E Each

A Accomplishes

M More

Jason Ash, Surgical Technologist:

This was my second year to attend the spine mission to Mbarara. Just shy of 2 months before the trip,
my family and I lost our house and our cars to a house fire. Total loss. My passport and my yellow fever
card were 2 of the ONLY things to come out of the fire. I knew I still must go to Uganda....

The trip was just like last year to me; the opportunity to see in a totally different light, how we are all
blessed in our lives, total house fire or not...
The time in Africa is so rewarding to the soul. We as healthcare workers, get the opportunity to see
other facets of patient care, like clinic, going on rounds, post-operative care, etc. I also make it a point to
bring clothes and food for all the people that I can staying in the hospital, and their families.

The comradeship between all of the volunteers is amazing. Volunteer workers, who are now part of your
family.... We share a special bond working together for the people of Africa. Lessons are learned there
that cannot be learned here in America... because there is no time to stop, to reflect, to step outside of
your normal daily obligations; and give WHOLLY in the service of others. You really can see a special side
of helping others, when there is nothing else to do but just that...

Going on these mission trips has become my “CTRL+ALT+DEL”, or “yearly reset” button. It gives me a
chance to see how truly fortunate we are in Dallas, Texas; in both our professional and our private lives.
It also shows me that we, as Americans, have so much to be thankful for, that we treat with little to no
respect.

God, may you watch over this mission trip, its volunteers, its patients, and the future of the mission. I am
honored to be a part of it all.

Kari Zagar, Neuromonitoring Technician:

Although I have been on this mission for several years now, each experience is unique and touches me in
new ways. This year, we were honored by a local patient, who invited us into his home for a feast as a
thank you for our work. The Uganda Spine Mission Team had operated on him several years ago, and
each year in his follow up appointment, he has begged Dr. Lieberman to bring the team over for a feast.
So Friday night we joined in with his family and neighbors for a feast, and the experience was incredible
and resonated with me on multiple levels. We were surrounded by family, amazing food, hospitality,
and appreciation. Back home in the US, because my role is specific to the operating room, I don’t get to
spend a lot of time with patients before and after their surgeries, so to visit with a patient years after
surgery was a new experience. And it was incredibly special, to be with him and his family and to
celebrate the healing power of surgery. As we sat and listened to the stories of his chronic pain, I felt a
sense of common humanity. That we all may experience suffering in our lives, and that chronic pain is
debilitating to people, and also to their spirit, their family, and their community. As we sat and listened
to them speak, I truly felt the power of this mission, and the ability it has to turn around many lives.
Sometimes missionary work can be hard because it feels like we are barely making a dent, but to this
one patient and his entire family, the mission changed their lives on a practical level, and also on a
deeper level, by giving them a renewed sense of hope and well-being.

Dr. Mark Kayanja, Orthopedic Surgeon:

It had been a while since my last mission trip. The needs were still great, large numbers of patients and
the difficult decisions of triaging who we could help. It was a sobering experience once again,
understanding how others have greater needs than ours. I will keep going.