Rotation at CURE Hospital in Uganda provides different perspective on learning

by Pedro Aguilar, MD
(Neurological Surgery 6th-Year Resident)

Pittsburgh, February 1, 2006 -- There is a world outside of a neurosurgery residency. I’ve always been curious as to what that world looked like. That’s why when an attending approached me in the fall of 2004 and offered me an opportunity to spend a neurosurgical rotation in Uganda, I took a deep breath. Okay, enough talking.

The rotation would take place at the CURE Hospital in Mbale. With an interest in pediatric neurosurgery for the past few years, the trip made sense. I would be training under the supervision of Ben Warf, MD. An extraordinary human being in his own right, Dr. Warf has pioneered the endoscopic third ventriculostomy (ETV) as a treatment for all types of childhood hydrocephalus.

With the rotation set for July of 2005 and my wedding scheduled a few months later in October, I was initially very uneasy on traveling alone to Uganda. And while my fiancé’s support of me made the trip possible, I could tell it weighed heavily on her mind.

Was a neurosurgical rotation half-way around the world worth the risk? It didn’t take long before we began picturing worse case scenarios of myself sweating out yet another malaria-induced fever surrounded by a mob of angry American-hating Ugandans. That was my perception of Uganda on the evening of June 30, 2005.

The reality of Uganda, however, was very different. Nothing could have prepared me for those first few days in the country.

My eyes slowly acclimated to the bright, blue sky whose equatorial clouds appeared to be within an arms length grasp. Smells of burnt fields and sounds of all kind of roaming cattle filled the air. Topographically speaking, aside from residing on the planet Earth, Pennsylvania and Uganda had nothing in common.

In a month, I was involved in 35 cases. The great majority were ETVs and ventriculoperitoneal shunts, with a handful of myelomengoceles. For a resident in training, the anatomical exercise of locating the space between the basilar artery and dorsum sella within an infant’s brain, ravaged by infection was, itself, worth the trip. I had never seen pus line septal veins nor had I seen choroid plexus matted down with scar.

In the states, informed consent can be a challenge with any patient. Try consenting a non-English speaking Ugandan.

First, get the language straight. Your interpreter starts speaking phrases in one of the seven languages he or she knows until he or she hits the right one. Failure to connect results from the patient belonging to one of the other 7-10 tribes he didn’t cover. Think of that the next time you pat yourself on the back for remembering the French you picked up in twelfth grade.

Once you’ve got the language dilemma solved, try to explain to a mother why her child’s head won’t stop growing and what you’re planning to do during an endoscopic third ventriculostomy. One of the challenges in our field is translating the science of medicine to our particular patient. I soon saw how for granted I’d taken my ability to communicate with patients in the states.

My fondest memory in Uganda was our drive north to the town of Lira. A satellite clinic had just opened adjacent to one of the refugee camps (Internally Displaced Camps or IDC to be more specific.) My resident’s view on clinic changed dramatically when surrounded by displaced Sudanese/Northern Ugandan families, many being seen by a physician for the first time.

After clinic, our team was invited to tour the camp. This was not the camp I had envisioned. Children laughing, smiling, enamored with the digital camera, always asking for another picture. I walked alongside parents showing me their camp with the pride of new homeowners. No begging, no complaining, no tears, just gratitude.

Was a neurosurgical rotation half way around the world worth it? Absolutely. Worth all of the risk had the risk been doubled. Aside from the surgical experience, I took home a different global perspective. I glimpsed a people whose shear will to survive is as real as their peril. I learned that, for as different as Uganda is, the fundamental relationship between a doctor and his or her patient crosses all borders and oceans.

So if you’re a neurosurgery resident and you find yourself bogged down...if you can’t see the tunnel let alone the light at the end of it...if you are curious with how neurosurgery works around the world, please don’t take my word for it. Go to a globe, spin it a few times and stop it with one finger. That’s how your own journey may very well begin.