Despite having felt like I had been in Kyangwali for weeks, we had come up on Friday, the last day of the mission. Arriving at Health Centre IV, Alex and I put together the synthetic torso before giving a teaching session on spinal taps. Health officers and midwives from several different departments were in attendance, and despite some minor difficulties with the mannequin, the teaching was well received.

After the teaching we returned to the maternity ward for our last training session with the ultrasound. We had a smaller turnout this time as so many staff lost clinical time with the other session in the morning. The few that remained however, were developing quickly, and we were able to go over some advanced techniques and watch them teach each other. I really do hope they continue to use the probes after we go, but I do have my concerns. For one, the ultrasound software requires periodic updating or it stops working, which means that someone is going to have to take the tablet somewhere with internet connectivity to update it. Not only that, but as new patches come out, the software demands the latest version of iOS, and as the tablets age they will become incompatible with the latest software. Alex had actually reached out to the makers of the probe about this since it makes the probe more difficult to use in low resource settings. Their reply was not very helpful. ‘Buy a new tablet that can support the latest iOS,’ they said. We explained all this to the midwives, but I still fear we’ll come back next year and find the device abandoned if they can’t get it to work given the scarce internet connection. It is what it is.

The two sessions took us to around noon, and at this point both the ward rounds and the pre-op evaluations had concluded, which left Alex and I idle. I walked around for a bit but then found myself compelled to take action against my boredom, so I wandered towards the surgical building and poked my head in the door.

‘You guys need a hand?’

Pradeep told me to get changed and scrub in.

Even though I did sterile procedures with regularity in the ICU, the last time I assisted a surgery was in medical school, and even then it was only a handful of times. I’ll admit I washed an extra time with the wrong soap, but once I was ready I butt-pushed my way through the double doors and into the theatre.       

It was a single room theatre, with two dividers that allowed for three beds to operate simultaneously. Pradeep and I took the middle, with Susana and Julie to one side resecting a sacral kyangwalinoma and the local surgeons on the other doing similar things. All of the procedures were under local anesthesia or nerve blocks, so there were no heavy sedatives or complicated infusions. I had poor surgical intuition and required intermittent prompting, but successfully dapped and padded when needed. We resected a lipoma from one lady’s arm and a dermoid cyst from a man’s head. The dermoid cyst was more involved, as surgeries of the scalp deal with tough, vascular tissue. This means the resection bled a lot and Pradeep had to really muscle the needle driver to the get the sutures in. I enjoyed being involved.

When I was a medical student, surgery never appealed to me. ‘I like my patients better when they’re awake,’ I would always say. I also enjoyed the intellectual stimulation of medicine too much, although I see now that surgery has its appeal. Mechanical problems that have definitive mechanical solutions can lead to tremendously gratifying cases, and the tactile stimulation of using your hands is something that we lose in occidental medicine. I had an orthopedic surgeon in Ireland tell me why he chose his specialty, he was a big burly lad and former rugby player with a south Dublin accent.

‘It’s either broken or it’s not, and we either fix it or we don’t,’ he said. ‘There’s no business of sodium or counting sodiums, none of that.’

He’s not wrong.

I also think surgery lends itself well to humanitarian work in a way that medicine cannot. I have to talk about complete health systems overhaul to provide meaningful changes, whereas a surgeon can use their skill even if it’s just once. I met an ENT in Ireland who traveled to Africa with a group once a year. They operated on hundreds of technically difficult cleft palates over two weeks, changing children’s lives forever and then traveling back to Europe with their friends and family and made their money. Not a bad setup.

Once the OR wrapped up later in the afternoon, Tayseer wanted us to be ready for a special surprise. I said my goodbyes to the midwives, the medical officers, Godfrey the interpreter, and grabbed the last of our things. Everyone met at the school before we loaded the vans and drove out of the camp centre. We drove for a while, maybe fifteen minutes, and the terrain got notably marshier, punctuated by a flooded soccer pitch where we stopped the van. Stepping out, the pitch was in a clearing that met a wall of tall grass around 2 metres high. Several of our local partners met us there, and a round of handshakes was followed by gestures for us to follow them into the grass. Narrowing into a single file, we walked a mud path that ebbed and flowed, passing the occasional mud walled house. As we walked I heard rumbling in the distance, rhythmic chanting and clapping like a far off dream. The trail led us deeper and lower into the hills as the singing grew louder and sharper. Finally, the trail rounded a bend and I saw maybe fifty people, women, children, and men in tattered clothes forming two rows emphatically choraling tribal songs. I hope this isn’t all for us, I thought to myself.

It was.

Our local partners funneled us between the two rows and I understood what was happening. Just past the group was a concrete well with a waterspout, freshly painted. This was a well opening ceremony. The cheers grew more excited as the Mzungus filled in behind the well, and they pulled at us to join the dance in the middle, which of course I did, until finally the singing came to a halt. One of our local partners from the UN said some words to commemorate the well’s construction. Tayseer was fixed onto his camera, recording the event for his donors. Then, in typical white man fashion, several boxes of sugar snacks and drinks were opened and it became a free-for-all of reaching hands from the kids. I will admit, it was slightly reminiscent of my time in Kenya with the Masai that I have written about before, that terrible sense of white guilt to be here handing out treats to human beings as if they were animals. The opening ceremony I liked, but the shouting children clawing over each other for cookies and the video cameras weren’t for me. I hung back, respectfully trying not to participate and found Alex doing the same thing. The idea of pulling out my phone and putting this on camera made me shudder.

Despite my constant grappling with the consequences of colonialism, there was no denying that this well would do more good for the people of Kyangwali than any amount of work I could offer. It’s possible our ultrasound work could wind up leaving nothing, even though we tried, but this well was not going anywhere. When I walked ten metres down the path to see the old source of mud-coloured still water, I was even more convinced. However, a well was just a well, yes it provided clean water, but it did nothing to correct the underlying disparities that lead to people drinking dirty water in the first place. Again the rabbit hole goes deeper, and the lingering question of what the hell am I doing and whether it matters goes deeper with it.

I am starting to get annoyed with the rabbit hole.

I tried not to overthink the implications of the ceremony, and the mood was high within the team. We then went back to the school to participate in their Friday afternoon recess. There were more snacks handed out, some singing and playing with the kids, and a million reasons to smile. Despite everything, the children smile wider in Africa than anywhere else: that is Dr Bozo certified fact.

We rounded off the evening with dinner again with the local partners at the guesthouse, and as everyone filtered out to go home just our staff remained. We had some bottles of wine left and some beers, and many things to discuss, from love to death to happiness and things in between until the stars twinkled bright enough to cast a shadow. Those five days felt like many more, but that night seemed like it flew by in an instant.

Life is funny that way isn’t it.

On Saturday morning we left the camp and went full tourist mode. A river tour on the Nile led us to Murchison falls in conjunction with hippos, elephants, and other exotic animals. This was followed by a night in a safari house and a desperately needed hot shower. The next morning we went on safari in the morning before tripping back to Kampala, where the team went out for dinner. I had a great time amongst even better company.

In a way, this trip showed me a window into the humanitarian space that I had never seen before. Short term medical missions now seemed in more ways compatible with what I want to achieve in my career, Tayseer’s advice being particularly useful. As I plot my next move, I ask myself if I really have to live in the jungle to feel fulfilled or true to myself and my mission. At the very least, while I have savings, energy, and youth on my side, I want to try and see as many things as I can within this space. For me right now, I think that will mean dropping my anchor in one place, being that Panama, Botswana, Rwanda, or somewhere else, while also bopping off to short term missions a few times a year. If things don’t pan out, maybe this will become a gap year, or gap several years until something pulls me back across the pond. If I have to come back to the West and make money, maybe a fellowship in infectious diseases or critical care is possible. Who knows, maybe along the way I might even meet somebody. The possibilities seem endless.

If you’re still reading, I thank you. Truth is, this was a hard set of entries to finish. At times I nearly gave up, now finishing these journals more than three months after my trip.  Returning to the US I worked a million hours straight during the most intense patient surge we’ve seen since Omicron, which then led right into Christmas, which led into another million hours straight until the day I caught another flight. As I write this I’m on a plane heading due south to Cape Town before a six week attachment at Princess Marina Hospital in Botswana. This one looks to be a different beast than ever before, a big hospital in the capital city, medical school and all. Maybe they could offer me a job… No rest for the wicked am I right?

Wouldn’t have it any other way.

All my love,

Pez