MMFC In Rwanda 2015: Surgery: Day 4

Finally settling in to a consistent sleep schedule, the team arrived at breakfast well rested and ready to go for day four.

Two new residents joined us today, with Drs. Tuyishimire and Nkurunziza returning to their school. Each resident I've met is extremely energetic and excited to learn from the breadth of experience Drs. Jag and Merry hold. The nurses remained with us as well, continuing to gain knowledge from our incredible nursing team here.

The local media joined us today, interested in seeing our work here and the great results from yesterday's surgeries. They interviewed some of the post operation patients as well as Dr. Jag, and filmed the procedures in the operating room.

With three surgeries on the docket for today, we got started early, pre-oping the first patient at 7. The first case went quickly, finishing in about an hour. The second patient, Fortune, presented a challenge with a very large and complicated goiter. As I mentioned yesterday, she holds some mistrust with the medical field, and was clearly very nervous as the PACU team got her ready for surgery. She presented the largest goiter we've performed surgery on thus far, but Drs. Jag and Merry worked efficiently and she came out with beautiful results after about two hours in the OR. The nerves she felt before surgery had vanished and she smiled wide and proud when she looked at her neck in the mirror for the first time. The work of Drs. Jag and Merry continue to amaze people here, as they exemplify the best of ENT surgery.

People continued to show up today trying to be screened before we leave. In particular, a boy named Christian and his mother arrived today. The youngest boy we've seen by far at just four years-old, Christian was a bundle of energy and plenty smart, brightening up everyone's day who met him. He loved high fives and drew numbers and letters on a coloring books Shannon brought him. He even knew a couple words in English and we taught him head shoulders, knees, and toes, with a big smile. We went back into the PACU and after a few minutes went by, who but Christian strolled in confidently to hang out with us. First, he gave the coloring books back to Shannon, explaining that he didn't want to steal from us, but he beamed with joy when he learned they were a gift. Fascinated by our iPad, he scrolled through all the apps and photos, finally settling on a guitar tuner app where he laughed at the sounds he could make pushing the buttons. We put music on and quickly he had all the PACU nurses dancing around with him as well. Little instances like that, little kids like Christian, make all of the hours of hard work in a day well worth it.

On another note, everyone loves to have their photo taken here. I went around taking pre and post operation pictures, and quickly a mass of people gathered around me for their picture as well. They laughed and smiled at their photograph on the big screen of the iPad. Quickly people started taking pictures of me as well, smiling and waving at me as I triaged other potential patients.

Throughout the week, it's been quite evident that goiters are more common in women and generally appear on the right side of the neck. Goiters themselves generally come from an iodine deficiency, exacerbated more and more by additional pregnancies. In turn, this deficiency puts added stress on the thyroid gland, causing it to enlarge as compensation. Additionally, the cassava plant, commonly eaten here, adds stress to the thyroid gland causing it to enlarge as well. As a whole, the country is pushing towards having iodine in all of it's salt, as it is in the United States, to help alleviate some of the deficiency in diets here.

As day four wrapped up, we traveled to Vianney's house for dinner and lively entertainment. Our local contact in Rwanda, Vianney, is a rockstar here. He knows just about everyone, and consistently supplies us with everything we need, arranging for our travel plans and accommodations, translating the local language and utilizing his medical skills to screen and examine patients. Born in Rwanda, he moved to America and worked in Detroit at a hospital for many years before returning to Rwanda to bring his experience back home. Giving up his vacation time to help us, he is one of the most generous and hardworking people I've met, and the trip would not be possible without him. His family provided us with a delicious dinner and drinks, allowing us to relax and destress after a few hard days of work. Before dinner, Vianney brought in local dancers to show us the traditional Rwandan dance; one of the most memorable displays I've ever witnessed. By the end of the show, they had our entire group up dancing with each other, providing some much needed laughter and fun for everyone in the group.

In the end, day four was another very successful day. After three more operations, we reach 14 total for the week, with a full schedule for the final two days of surgery. The patients from yesterday look great and we discharged all but one, holding her back for merely precautionary measures. Each of them smiled with joy at the results of their operations and they shook our hands saying, 'merikozi,' Rwandi for thank you. Their gleeful expressions and the happiness we see in each of their family members at the beautiful results of the operations fill us with tremendous pride and satisfaction in the work we're doing, and it drives us to push through the last few days of surgery here. The week has gone by quick, but we look to take advantage of every opportunity to help people over the next two days.