Neurosurgery Camp, Part 2: A Few of the Lucky Ones

May 29, 2015
Sister Agnes runs the show at the Mulago Hospital Operating Theatre

By Diana Harvey, Associate Director of Communications and Marketing

This post is the second of a three-part series about the bi-annual neurosurgery camp at Mulago Hospital in Kampala, Uganda.

Monday, Patient #1

It was the first day of Duke’s bi-annual “neurosurgery camp” at Mulago Hospital in Kampala, Uganda, where I’d joined Duke neurosurgeon and professor of global health Michael Haglund and a team of more than a dozen physicians, nurses and students to learn more about their work at Mulago, one of Duke Global Health Institute’s priority partners.

The patient lay on a gurney, her husband standing at the end near her head, his hands resting gently on her bare shoulders. She had a large tumor on her spine, causing paralysis in her legs and increasing levels of pain as the tumor has grown. The time had come for her to undergo the complex, delicate surgery to remove the tumor in order to relieve her pain and prevent progression of paralysis.

Haglund queried the patient about her about her symptoms and noted the level of function in her arms and legs. He invited the patient and her husband to pray with him. As the three said their amens, Haglund promised to do his best. He encouraged the patient to be strong, and her husband told him, “She is strong.”

This first surgery lasted longer than expected—nearly seven hours—and was marked by scarce supplies and a microscope that needed an emergency repair just prior to the start of the operation. Physicians and residents crowded around the operating table to watch Haglund work, while Haglund described what he was doing and posed questions to the residents, whose job it was to observe and learn.

Tuesday, Patient #1

Eugene was experiencing numbness in his left arm and right leg, caused by a blockage between the brain and spinal cord and preventing the passage of central nervous system fluid. In addition, there was pressure on the spinal cord caused by a bone fragment in his neck. 

Haglund planned a two-part procedure: the first, called a chiari, would repair the blockage causing the fluid back-up; the second, called a laminectomy, would remove fragments of the neck bone to alleviate pressure on the spinal cord nerve which was contributing to his symptoms.

Haglund told Eugene that the surgery would take approximately take three hours, after which he would experience a sore neck, but gradual improvement in his symptoms. “You won’t become magically better immediately after surgery,” said Haglund. “But I do this surgery all the time in the U.S. with very good results.”

Sister Agnes

After Eugene’s uneventful surgery, Haglund paused in the lobby of the operating room area for his trademark bottle of Coke Zero, which Sister Agnes delivered to him on a small platter. 

Sister Agnes has been the ever-present, all-knowing force in this set of operating rooms at Mulago for the last decade. Standing five feet tall and dressed in colorful scrubs and pink Crocs, she firmly enforces rules and protocols, while also attending to the staff’s well-being. One minute she’s scolding someone for mistakenly entering the area in their street shoes, and the next she’s encouraging beleaguered nurses and doctors to take a break and have something to eat or drink.

Tuesday, Patient #2

While nibbling on some cookies and crackers, Haglund noticed his next patient sitting on a gurney across the room. He jumped up to confer with her and her sister, describing her condition in plain terms, and just what the surgery would do to alleviate her symptoms. Margaret, 36, has a slow-growing benign brain tumor that is the size of a baseball. The tumor has affected her vision; she is blind in her right eye and is beginning to lose sight in her left eye. 

“Margaret and her sister don’t realize how complicated the surgery is and how lengthy the recovery could be,” Haglund told me. He began rattling off a host of dire possibilities ranging from inadvertently causing a stroke during surgery by cutting an artery, to damaging the thalamus to the point where the patient does not awaken after surgery. 

Margaret, seemingly oblivious to what lay before her, chatted softly with her sister across the room, occasionally breaking into a broad smile, as they waited for her to be summoned to the operating room.

I’m happy to say that, like the others, Margaret’s surgery was successful.

Read the other posts in the series: