MMFC In Rwanda 2015: 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.