Final Thoughts on Rwanda

Saturday arrived and the majority of the team packed up and moved out while a few of us stuck back to see the gorillas in Rwanda's National Park; an amazing experience in it of itself.

Looking back, when I signed on for this trip I didn't know what to expect. As the new member to a team that had been coming to Rwanda for years, I didn't know how I, or the rest of the new members, would fit in. This group took us in and welcomed us with open arms.  By the end of day one, we were a team; by the end of the week, we were a family. Working sometimes upwards of 14-hour work days, we relied on one another to step up and assist each other when needed. We picked each other up with laughter and camaraderie, and we pushed each other to do the best work possible for our patients. Jana accurately summed the trip up reflecting how everyone checked their ego at the door. Not one person was above a job on this trip. Each member pushed through jet lag, long days, hot weather, and competing demands to do their job, and we did that job well. 

In the end, we completed 22 surgeries on incredibly deserving individuals. Better yet, each one of those patients walked out of the hospital with a smile and without complications. The doctors pushed themselves, but never to the point where they put a single patient in danger, an important distinction to realize on trips like these when we all want to work around the clock to help as many people as possible. 

By the same accord, the people we helped were so deserving and appreciative of our aid. They are fathers, mothers, sons, and daughters, each with a unique and fascinating story and each now with a new opportunity to dictate their story moving forward. Little Christian no longer has to go through his early days of school with a growing cyst on the bottom of his jawline. Nyiraregwa can continue being the life of the party without a goiter slowly pushing on her vocal chords and putting upward pressure on her enlightening smile. Fortune can learn to trust modern medicine again, and her beaming smile after surgery stands as a testament to medicine's progress in Rwanda. Jovia can enlighten her husband's day and give him the surprise of a lifetime. All of these people have a new breadth of fresh air in life; a new hope for the future. 

Accordingly, in just a short time we made a tremendous impact in a number of people's lives. For each patient we saved, another 5-10 of their family members came to us blessing us and expressing their love and gratitude for our work. While not always fatal in nature, goiters can have terrible ramifications if left untreated. Many of these patients, some single parents, have upwards of 8-10 children. Our work helped ensure that these children would never grow up without their mother or father as a result of thyroid complications. Before we treated them, they likely never believed they had a chance at being helped. These patients have been turned away from numerous hospitals and left on a waiting list for thyroid surgery that extends hundreds of individuals long. Healthcare in Rwanda is on the rise, but with an intense lack of ENT surgeons in the country and an over abundance of thyroid issues, a great disparity persists, requiring our continued help.

With that, another vital component of our involvement throughout the week came through the education and mentorship of local medical personnel. Working with residents, doctors, nurses and anesthesia techs at the Kibagabaga Hospital, each member of our team taught their unique skill sets to their counterparts and helped mentor the future of Rwanda's medicine. Our presence, and the broad-based media coverage associated with it, will hopefully continue to shed light on the growing need to address thyroid surgery in the country. 

While we may have only touched the surface with this surgery in Rwanda, just a week of work touched the lives of hundreds of people, and our legacy will continue on for years to come as the team continues with follow on missions.

Before I wrap up this final blog, I want to thank all of you for your continued support in reading this blog. Additionally, a special thank you to Ethicon, as without their generous donations this trip would not have been possible. Lastly, I want to personally acknowledge each member of this incredible family, without whom none of this amazing work could have happened.

The Surgery Team:

Dr. Jagdish Dhingra:

As a new member on the team, I had never met Jag before but had heard nothing but incredible things about his work and drive. Described as a superstar by Jana, he lived up to the name and produced impeccable results with each of his patients.  Light-hearted (and surprisingly quite a good dancer), Jag never lost his composure even when dealing with the high pressure to perform on as many people as possible. Instead, he remained focused and kind to every patient and team member he worked with. As the team leader, Jag kept this whole operation together and without him, the lives of so many people would not have been changed for the better.

Dr. Merry Sebelik:

Bringing a wealth of experience from medical mission trips across the world, Merry fit right in with the group and became an indispensable member of the operating room. Working side-by-side with Jag, she immediately developed a chemistry that brought them efficient and beautiful results in the OR. In addition, her kindness and incredible work ethic always left her open to helping others. Immediately after a case when we'd ask for her help or opinion on a patient, and when I'm sure she was tired from hours of intense focus in the OR, she never hesitated, but instead got up with excitement and asked how she could help. A delight to be around, the success of this trip would not have been possible without Merry's strong work.

The Anesthesia Team:

Dr. Paul Satwicz:

Paul fit right in with the group with the help of his corny dad jokes and light-hearted but motivating poems to end the day. He brought great joy to the group and all of his patients, singing to little Christian to put him at ease before surgery and later finding a way to get the entire operating room to erupt in song. His light-hearted nature made it easy for the surgeons to work with but it never interrupted his constant professionalism at critical moments of a case. Additionally, his calm demeanor provided a great teaching platform for the anesthesia techs under his guidance.

Dr. Stewart Chritton:

Very similar to Paul, Stewart's calm and collected personality made it extremely easy to work with and he took a vested interest in mentoring the anesthesia techs assigned to him. Having worked in Rwanda for over a year through the HRH program, Stewart brought a unique perspective and knowledge vital to the team. Additionally, his warm and friendly personality built a strong partnership between him and Paul and made it a pleasure for all of us to learn from and interact with him.

The OR Nurses:

Tatyana Lashchuk:

Tatyana is one of the most dedicated nurses I've met. Her chemistry in the OR with Jag and Merry was unparalleled as she often knew what instrument to give them before they even asked for it, making each surgery go efficiently and smoothly. One day, feeling the effects of the heat, Tatyana was ordered to sit out a case while getting plugged with an IV. At one point during the case, one of the machines in the OR was making distracting noises and no one seemed to know how to fix it. Who then, but Tatyana, rushed out of bed, IV in hand, to solve the issue. She then guzzled down a bottle of water and asked to scrub in the next case. That's the kind of girl Tatyana is; tough as nails and impossible to keep down. Her witty humor kept everyone on their toes and she was an absolute delight to be around. After her first trip, Jag said he wouldn't do another trip without her, and she's been a vital member of the team ever since.

Nancy Satwicz:

An essential piece of the operating room, Nancy kept everything together with her flexibility and warm personality. If a nurse needed a break, Nancy stepped up to scrub in and seamlessly transitioned the work between cases. Her close work with the surgeons throughout the case and her quick work cleaning the OR after surgery allowed for great efficiency in the OR and ensured that we got to every case possible. In addition, her warm and caring nature looked over everyone on the trip, and she ensured our team worked at its maximum potential. She took care of our team when someone needed help and she handled patients with unrivaled love, serving as the backbone of our OR. 

The PACU:

Jana Barkman:

A veteran now on these trips, Jana brought experience, energy and great passion for work in the PACU. Full of life, she worked tirelessly to ensure that her patients had everything they needed before and after surgery. A constant professional, Jana's deep care for her patients was evident in every person she dealt with. Her flexibility and leadership help keep the team together as well, as she scrubbed in on cases, provided IVs, and intubated patients in addition to her normal PACU duties. She could get the room laughing with her warm personality or captivate it with the care she took with patients and she will remain a valued member of the team for years to come.

Shannon O'Keefe:

Just like Jana, Shannon was a veteran on this team and their chemistry in the PACU together was evident from day one. A beaming and joyful presence in the PACU, Shannon brought laughter and energy to all of the staff and patients she encountered. Full of treats and toys for both patients and our team, Shannon was an essential part of the camaraderie we developed within our team and with our patients. Just like Jana, she performed numerous jobs outside of her normal PACU responsibilities, and her flexibility and drive allowed this team to function so well together. Another leader on this team, Shannon kept this team together with her big heart and impeccable skills as a nurse.

I should note that when I came in, I wasn't exactly sure what my role would be on the trip. Among other things, I assimilated myself primarily in the PACU as Shannon and Jana took me under their wing. Two of the most amazing nurses, and people for that matter, that I've had the pleasure to meet, they mentored me throughout the week and showed what right looked like in terms of patient care in a hospital.

Administration:

Vianney Ruhumuliza:

Vianney ran the show on this trip. Incredibly selflessly, he moved the trip away from his hometown in Gitwe to the capital in Kigali, knowing that we could impact a far broader base of people there even at the cost of some of his dear friends and neighbors. With a celebrity-like presence in Rwanda, Vianney seemed to know just about everyone, and if we needed something done we went to him. He set up our luxurious accommodations, established our travel plans, got every supply we needed, translated, triaged and cared for patients, and organized our arrangement with the local hospital. No matter how difficult the task, he would simply smile and say 'don't worry I'll take care of it,' Giving up his vacation to help us, Vianney was the MVP of our trip, working tirelessly to make sure everything went smoothly, and he always did so with a smile.

Overall, the team blew me away with all of their work and selflessness throughout the trip. Each person gave up vacation time to travel across the world, working extremely hard in tough conditions to make a difference in other people's lives. I'm humbled to be part of such an incredibly gifted and caring team. When asked about my favorite or most memorable part of the trip, I respond without question that it was the people. From the doctors and nurses on our team, to the staff at our hotel, to the patients and their families, I was in constant awe of how truly amazing these people are.

In the end, Rwanda was an incredible experience; one that I hope everyone can seek out in the future. The country is beautiful and its people are even better. Their ability to forgive and unite in the most horrid of circumstances amazes me and should serve as a benchmark and teaching point for years to come. By the end of week, I came out of the week with clear eyes and a full heart for the good that exists in people and for the impact that our actions can have around the world.

For our team, this family that we developed over the week, it was an honor to serve with you. I will never forget this week, the bond I shared with all of you, or the incredible people of Rwanda that we helped. Our work here is far from done, but we can walk away with our heads held high at all of the people we managed to save, looking upwards at the many more to come in the future. 

The week produced some incredible results:

And we made some incredible friends along the way:

But even with great results, there is a lot of work still to come:

All the more reason to come back next year.

Surgery: Day 6

We arrived at breakfast in disbelief that our time in Kibagabaga, Rwanda was coming to a close. In just a short time, our group had grown into an integral team, caring for and relying on one another to get through each work day successfully.

Surgery on day 6 started off with David. One of the earliest patients to show up for screening on our first day in Rwanda, David returned each day and waited patiently for his opportunity to receive our help. Moreover, with moderate English speaking abilities, David stepped up without my asking and played a major role in screening patients, translating between Kinyarwanda and English. Through this partnership we developed a strong bond during the week and I was elated when I saw him on the schedule for the final day of surgery. A driver of wheat from Tanzania to Rwanda, David was one of the kindest and most professional patients we dealt with. After about an hour and a half in the operating room, he emerged with rest results. Hours later, after he woke up from the anesthesia and felt strong enough to return to his family, I stopped over to visit him one last time. With tears in his eyes, he grabbed my hand and muttered a humble 'thank you.' Little moments like those almost brought me to my knees at the work we were doing here. In just a short time, we were able to change the lives of so many deserving people and their families, and it was humbling to see how much it meant to them. 

On that note, it's a somewhat odd dynamic that I hold with these patients. Of all the people on our team, I deserve the least amount of credit for their successful surgery. Ironically, however, since I've interacted with these patients in depth from their first screening to their recovery after surgery, I've developed a very strong bond with many of them. These people are so grateful for the work we've done here, and the doctors and nurses working tirelessly in the operating room don't always get to see the expressions of gratitude and amazement from patients at the work they've done. If anything, it speaks volumes of the selflessness and humility in our doctors and nurses in the OR, who spend every minute dedicated to saving as many patients as possible and don't have the luxury of time to build such personal relationships. With the unique ability to see these patients at each step along the way here, I've learned stories about them that many people on our team never knew. Through this blog, I have not only tried to convey their stories and gratitude to our friends and family back home, but to also shed light on their complete story to the members of our team.

Finishing out our time here, the 2nd and 3rd surgeries of the day went smoothly and the patients emerged with beautiful results. The second patient of the day, Esperance, oddly enough, was forced into a marriage at the age of 16 and tried to run away afterwards before being brought back to her husband by her parents. Since then, however, she has lived a very happy life, building a family with her husband in northern Rwanda. She and her family were ecstatic when they saw the incredible results of her surgery. 

The third surgery of the day, and the last surgery of our trip in Rwanda, was performed on a quiet, lovely woman named Grace. One of the first patients to arrive at the hospital on our first day, she, like David, kept coming every day and waited patiently with the hopes of being seen. The look on her face said it all when we awoke after surgery, elated at the amazing work that Drs. Jag and Merry had accomplished.

In total, the three surgeries on day six brought our total to 22 for the trip. The OR and PACU teams worked extremely hard and developed a strong system to ensure that our group treated as many patients as possible. Without these incredible people, 22 patients would not have had their lives changed for the better this week and I am in awe of their dedication and medical abilities.

While the last few surgeries went on, Vianney and I continued to screen more and more patients. Another 20 people showed up on our last day of surgery, all unable to receive our help until next year. Vianney received one of the hardest jobs of the trip, screening these people and subsequently telling many of them that they would not be able to receive our help this year. Extremely personable and kind in nature, Vianney developed a strong relationship with these people and had to look them in their tear-filled eyes as he told them they wouldn't be eligible for surgery for at least another year. Each one had a compelling story, each had a reason squeeze them in for one more surgery, but we simply didn't have time to take care of all of them. For each person we helped, another ten were left untreated, all very deserving of our aid, but it would take months of hard work with our team to get to all of the patients we wanted to. The great demand of patients we faced each day only solidifies our need to continue coming back to Rwanda. We are so grateful for the opportunity we had to make a significant difference for 22 lives, and many more when looking at the second and third order effects, but we are only scratching the surface with thyroid surgeries in Rwanda. Until a substantial push for ENT surgeons becomes prevalent in the country, this group makes up a substantial portion of goiter surgery in Rwanda and as such, the team remains dedicated to coming back for many years to come.

As we finished up our final day of surgery, we all stood around to give our final thoughts for the week, still amazed that it was over so quickly. We looked for ways to improve for next year's trip and we thanked each for our work throughout the week. In each person's words, I witnessed firsthand how much we care about each other, our patients, and the cause we stand for here.

Our final night in the country consisted of a goodbye dinner and a night out for some of us to spread our wings and relax after a long week of hard work. Within a day, the bulk of the team will be out of Rwanda, along with our equipment. Our impact, however, will live on with each of these patients and we stand waiting for the next opportunity to come back to this great country. 

David patiently awaits his surgery to start the day.

The OR team works hard to treat him.

Nurse Nancy scrubbing in!

Who said I couldn't help with surgery?!

David joined his wife again to rest after surgery.

He came out with beautiful results.

Grace gives a smile before going into surgery. 

The doctors did a wonderful job with her procedure.

With a big smile, Jana scrubbed in to help out.

The anesthesia team says goodbye to their anesthesia technician students. Aline and Marie were a pleasure to work with and they represent a bright future for medicine in Rwanda.

Jovia returned to get the bandage off her neck. Her husband returns from his trip on Monday and she looks forward to surprising him with the results of her surgery.

Dr. Jag thanked all of us for our hard work throughout the week. The trip would not have been possible without his leadership and dedication.

The team unwinds from a busy week with a relaxing last dinner together.

Surgery: Day 5

Day five opened up with our favorite little guy, Christian. He confidently walked into the pre-op room and high-fived everybody before going in for surgery. He emerged from the OR looking very handsome after another fantastic surgery performed by Drs. Jag and Merry. Although pretty loopy and cranky as he first awoke, Christian quickly returned to his usual form with a beaming smile and high-fives for everyone. He kept saying 'thank you' in English to every person he saw in the PACU. He beamed with joy and shot us two thumbs up for approval when Shannon gave him a ballon and a pair of sunglasses to keep. We prepared to carry him out but he quickly told the translator he was strong and could do it himself. He then confidently walked out and waved to everyone before leaving. He passed another patient on the way out, telling her to 'be strong' in Kinyarwanda, busting our hearts at his courage for such a young boy. The future of Rwanda is bright with little kids like Christian. His mother told our translator that she loved us, especially Shannon, and blessed us all for being here. Taking care of Christian was one of the great highlights of our trip thus far.

After the news story aired on the national news last night, a large new influx of patients and phone calls rushed into the hospital looking for help from our team. Unfortunately, with today and tomorrow filled with scheduled surgeries (and many more on the waiting list), we had to tell all of these people that surgery from our team was not possible this year. In total, we've turned away upwards of fifty people from surgery so far, and Vianney said there are hundreds more on the waiting list for the hospital in Kigali. It's heartbreaking to see people react to the news that they won't be receiving surgery this year, with some crying in despair, when all of these people are so humble and deserving of our help. Thankfully, the core of this team will be back next year and we hope even more teams can be sponsored in the future to help these well-deserving people. Health care in Rwanda is okay and quickly growing, but it still has a long way to go. The doctors and nurses we've met here are energetic, knowledgeable, and very eager to learn. The healthcare system, however, needs many more people like them to help as most hospitals are understaffed and unable to care for the massive influx of patients they face on a daily basis. Specifically, with only one publicly practicing ENT surgeon in the country, there is an enormous demand for doctors to come perform thyroid surgery here. Such a gap in medical experience puts increased importance on trips like this and subsequently increased sponsorship of groups like MMFC. The doctors and nurses that come on these trips not only change the lives of the 20-25 patients they perform surgery on, but the knowledge they share with residents and local doctors here remain fundamental to the growth of healthcare in some of these local hospitals and their residents.

 

While triaging this great influx of patients, Vianney and I listened to countless fascinating stories from the potential patients. One person, Epijawiya, a mother of ten with a fairly large goiter, showed up at the hospital because her daughter was going into labor, completely unbeknownst to her that our team was here. Although not a candidate for surgery this year, this unlikely coincidence put her on the list of patients for next year's team. We also saw a few more people with burns along their goiters. As I've mentioned before, this is part of a traditional Rwandan medical practice. In the process, they would take a knife and put the flat part in a fire until it was red hot, then apply it to the affected area. This particular woman, another great potential surgical candidate for next year, had small burn marks all over her goiter. 

Similarly, another woman, Jovia, had a very large keloid (inflammatory scarring from many cuts) on her neck. A beautiful woman of just 35 years, Jovia lost her father during an operation here and as a result her mother prevented her from seeing a doctor for a growth on her neck, unlikely a goiter. Subsequently, she underwent the traditional medical practice of cutting, using small razor blades to bleed out the affected part of the body, and thus developed a rather large keloid. After working up enough courage to come in to see us, we triaged her, and Dr. Jag quickly fit her in for a short, easy case to end the day. Jovia's husband, away at work, did not know she came in for surgery today, and she was ecstatic to surprise him. She smiled from ear to ear after the procedure and even exclaimed to the nurse translating for us that she wanted me to marry her sister. Her entire family surrounded me when I brought her out, blessing us all for being here and exclaiming that they loved us. One of the happiest and friendliest patients we've had, Jovia was an absolute pleasure to take care of and reminded the team how quickly we can make an impact on a person's life through our work.

Just as we were finishing the triage, a young woman walked in with her one year-old child, who contained an extremely large tumor on his neck. Turned away from every hospital in the area due to her socio-economic status (the subsidized national health care here won't take care of special cases like goiters), she came to us for help. Merry assessed the tumor as either a cystic hygroma or a hemangioma, and unfortunately without the resources of a typical hospital in the U.S. there was nothing we could do to help. Requiring numerous scans, doctors of differing specialties, and likely return surgeries, the little boy couldn't be operated on by our group without putting him in danger. Cases like this one make me realize how fortunate we are to have the medical resources that we do in America, as it was heart wrenching, but necessary, to turn him away without the supplies and additional doctors necessary to treat him.

The other surgeries went flawless again today. The team conducted five more surgeries as a whole, bringing our total to 19 surgeries for the week thus far. Interestingly, the second patient had a number of burn marks on her arm and we all assumed it was part of the burning process associated with traditional medicine here, but she corrected us explaining that she had burned herself as a young woman for decorative purposes. Her surgery and the third surgery of the day presented a challenge with very large goiters, each lasting for over two hours, but the patients look amazing afterwards. Watching these surgeries is like watching a master artist at work. Drs. Merry and Jag are so incredibly skilled, and while they've only been together for five days, you would've thought they'd been a team for five years. The work they're able to complete is life changing and their operations are awe-inspiring.

By the same token, everyone on this team continues to amaze me. Each member wears about a hundred different hats each day, from anesthesiologists acting as surgical techs and even mopping floors to PACU nurses scrubbing in to assist on a surgery. More than anything, these people are tough. Working long, 14 hour days in the heat without air conditioning, they continue to rise up to every challenge given. When people need a break, someone seamlessly steps up to ensure our quality of work stays at the highest levels. It's an honor to work among such strong, professional, happy, and genuinely great people. I'm sad to know that tomorrow is our last day, but I'm proud of the work we've done. This has been one of the most memorable and important experiences I've been on and I look forward to one final successful day of operations.

Shannon and her best buddy, Christian.

Giving Christian some anesthesia while he plays guitar on the iPad.

The medical team hard at work.

Dr. Paul carries him out after a successful surgery.

Shannon gave Christian a balloon and sunglasses.

He gave us two big thumbs up...

...and gave her a big hug :)

He insisted on walking out on his own and waved goodbye as he left.

Jovia came in to see us with a keloid on her neck.

She was very nervous before surgery but emerged with a big smile.

Outside with all of Jovia's sisters as they giggled taking a picture with me.

Goiter on our second patient of the day.

She emerged with beautiful results.

Decorative burn marks on her arm from when she was a child.

Nurse Nancy intubating a patient.

Tatyana, stubborn as a mule, and one of the toughest and most dedicated nurses I've met.

Shannon scrubbing in!

Vianney triaging one of the many people who came in after the news story ran last night.

Numerous people stood outside our office waiting to be seen.

The little boy with the tumor on his neck.

We did our best to put a smile on his face.

With time, hopefully he can get the special treatment he needs.

We saw many people desperate for our help:

The burn marks on her neck are the result of some of the traditional Rwandan medical practices performed in the past.

Dr. Paul reads a poem to entertain the group as the day finishes up.

Lovers lane on the walk back.