Navigating Africa Surgically

I have taken to telling people that I will only know Richard has had his second operation when he is wheeled out of the theatre and the surgeon confirms the operation was successfully completed and actually involved penetrating Richard’s tibia. Then and only then will I confidently say “Yes, Richard had his surgery.”

Richard’s first operation was performed this past summer. The days following I accompanied him to the hospital in Buikwe, a rural area near the shores of Lake Victoria, for post-op care. It was then that I learned firsthand of the procedure’s precise nature.

I stood outside the hospital with Richard under the glaring sun, on the red dirt road waiting for a crumbling taxi van to pull up and send us into a cloud of whirling dust. Richard’s attending physician walked by and greeted us. The gentle conversation and my light mood swiftly collapsed when the doctor told me blank-faced that the surgeons “only cut into the boy’s skin.”

I jolted. “What?”

He repeated himself.

“That can’t be. They went into the bone. All the doctors told me that is the only way to effectively treat chronic osteomyelitis.”

“Yes, but it was superficial. They didn’t have the right instrument to cut bone.”

I shut my eyes. My stomach dropped. My head shook. Nobody bothered to inform me that the required surgery as originally planned was not performed due to lack of proper mechanisms until it was casually mentioned to me several days later. Another, only in Africa moment.

The doctor saw my disappointment; I am unsure if he recognized my disgust.

“We will do it in October. Another surgeon will be coming from Europe then.”

“But will you have the right instrument?”

The doctor’s face lifted in surprise and contemplation. Apparently he hadn’t thought of that.

“I’ll ask my administrator.”

“Okay. I need to know soon because then I will have to take my boy to another hospital and start the procedure of queuing for another surgery all over again if you can’t get it.”

The doctor nodded and crossed the dusty road.

Calls and visits to Buikwe hospital over the next few weeks were more of the same non-answers. Yes, a surgeon is coming in October. Or. Maybe November. I have requested that we order the instrument.

I was contemplating not waiting till the fall for the elusive Czech surgeon and surgical instruments for fear of another mishap. But this hospital, despite its gaffe, was seemingly more trustworthy than the other option: the government hospital, Mulago.

I was told that one needed to “know somebody” to be effectively treated at Mulago. And the surgeons there didn’t have what the surgeons at Buikwe hospital had, Western medical training and practice. I had a choice: gamble and wait on medical practitioners and instruments to be flown into Buikwe from abroad and have a surgery performed at a low cost or start over and try my luck with the notorious government hospital where the total costs could be considerably more and the quality of care significantly less. I decided to wait it out.

“The surgeon will be here the first week of October,” Richard’s doctor had assured me in September.

“Okay, so I will plan on coming a couple of days after he gets here?”

“Yes.”

I came the agreed-upon day. The surgeon had just arrived, but wasn’t actually at the hospital yet. Come back tomorrow.

I returned the following day and entered the dressing room; shimmering blue eyes and glowing fair hair and skin greeted me. I had long since taken to staring at muzungus like Africans. They look so strange and what are they doing here in Uganda?

The Slovak doctors introduced themselves. The surgeon was of the general variety, but had been to Africa and performed orthopedic surgeries on chronic osteomyelitis patients previously. They unwrapped the bandage and looked at the boy’s oozing leg.

“Yes. I can do the surgery. We will do it Monday.”

“Okay, but the last surgeon didn’t have the correct instrument. Do you know if they’ve gotten it?”

“I think so. I am like 90% sure we will do it Monday.”

Richard and I were at the hospital Monday, but the instrument was not.

“I will see if I can order it,” the doctor told me through his Eastern European accent.

I was deflated, but not surprised. I was coming to understand African life as a menagerie of the exotic, sluggish, insincere and incalculable; it could only be reliably defined as careless and unexpected.

The doctor was going to text me with an update. A week later a message from Dr. Mark blinked on my phone’s screen:

“Hi Nataly. I am sorry, but we still don’t have the instrument and any information when we will have it. When I know more, I will let you know. Maybe on Friday. But it will take some time.”

That week I began mobilizing for Plan B. But then I received a call. It was Richard’s attending African doctor.

“Hi Natalie. Can we meet in Lugazi today? “

“Is this about Richard?”

“Yes. I will tell you.”

I met Richard’s doctor at a hotel in town; the instrument had been ordered and would arrive in a few weeks. They would be able to do the surgery.

I jumped up and down in the hotel’s bar. A few days I received another message from the Dr. Mark:

“Hi Nataly. I’m sorry I haven’t answered, but I still don’t have the instrument. Hopefully your boy will get proper treatment in Kampala.”

What is going on?!?

More calls and another visit to Buikwe confirmed that the instrument was on order to arrive mid-December. The surgeon currently at Buikwe would only be there until year end. Come January, I was told, another European doctor would be coming. But what if he couldn’t do the surgery? What if the instrument arrived late?

I was getting anxious, but the unpredictable nature of Africa could make one perpetually nervous, it could aggravate ulcers developed from a bacterial infection contracted during one’s stay. I was forced to learn to live with the chaos.

Why? Why? Why? Is often the chant from Americans on the other end of my phone, wondering why instruments take so long to arrive, wondering why swabs of infected legs can’t reliably be taken during a surgery, wondering why medications are prescribed incorrectly or expired.

Whatever. I say. This is Africa.

So, as of this moment, as of my last conversation with the doctors at Buikwe earlier this week, yes, the needed instrument is to arrive in less than two weeks time, and yes, Richard’s operation is to take place sometime around the December 18, but as I have taken to telling all who ask, I will only believe the surgery has been successfully completed when Richard is in the recovery room and the surgeon is standing over his leg, showing and telling me the procedure has been performed as prescribed. Then and only then will I know my boy has been properly treated after five months of care and nearly two years of suffering with puss and drainage constantly emitting from an open wound on his right shin. Only then will I say, “Yes, Richard has had his surgery.”