Gone is the Thief Of

by Ajul Shah, MD

On May 1st, 2014, a group of volunteers embarked upon a plastic surgery mission trip to Mbale, Uganda with the non-profit foundation “Changing Children’s Lives”.  The foundation, founded by Dr. Mark Weinstein, has embarked upon yearly mission trips to areas in need – most often, for children with cleft lips and/or palates.  The foundation has been to multiple countries, including Vietnam, Thailand, Uganda, and others.  I was fortunate enough to be a part of the trip to Uganda this year (the foundation has been to the same site twice in the past), and I can say without hesitation, the experience will change your perspective.

The group, consisting of surgeons, students, residents, nurses, physician assistants, and administrators from three separate institutions, met at JFK on May 1st to start upon the long journey to Mbale.  After an eight hour flight to Amsterdam, a ten hour flight to Entebbe, and an eight hour bus ride to Mbale, the group arrived tired and sweaty to the Mt. Elgon Hotel.  The traffic leaving Kampala was….tricky. A view on Google Maps showed a distance from Kampala to Mbale that should have taken 2.5 hours to traverse, but we quickly realized that we would have no chance of leaving Kampala itself in that time period. It took nearly 4 hours to navigate the potholes, single lanes, traffic, and lack of street-lights and stop signs to leave the city of Kampala (25 miles). After arriving in Mbale, the group met at the hotel bar for a few glasses of wine, and turned in for the night in preparation of the next full day of screening.
 Figure 1Figure 1 – Entrance to Mbale Regional Hospital
We arrived at the hospital the next morning to set up the operating rooms and screening tables. The hospital environment was striking – although a sizable complex, most wards were no more than open-air buildings with four walls, packed with beds side-by-side. Chickens ran freely throughout the various wings, with patients crammed in to each ward of the complex. The operating theater consisted of three operating rooms stocked with the basic necessities – a table that cannot be moved up or down and operating room lights that often failed to work. We brought the remainder of the supplies with us, including gloves, instruments, anesthesia equipment, and dressings. The operating rooms and the screening areas were set up simultaneously, and then…we waited. And waited.  As I was informed by Dr. Weinstein, the patient screening process was markedly different in Uganda than it was in the Southeast Asian countries – during the first day in Vietnam the year before, the staff screened 150 patients.  He told me that although the foundation had a contact in the local community that spread the word of the upcoming mission trip, the local population demonstrated a general sense of hesitation to visit the international surgeons.  He let me know that rather than screening all patients on the first day, there would be a constant daily stream of patients after word of successful surgeries spread through the community. And he was correct.  Slowly, patients arrived. A patient with a bilateral cleft lip. A unilateral cleft lip. A burn contracture. A Veau II cleft. A Veau III cleft.  By the end of the day, the operating schedule for Monday was full.
 Figure 2Figure 2 – One of the hospital wards
Figure 3Figure 3- Senior Administrator Shefali Shah in foreground beginning the screening process with Dr. Mark Weinstein and Dr. Devinder Singh (attending surgeons) in background evaluating patients
The week was filled with operating and screening. The patients arrived on a daily basis as successful surgeries were completed.  The majority of patients operated upon had cleft pathology – cleft lips, cleft palates, or both.  There were also patients with AV malformations, burn scar contractures, soft tissue tumors, and others.  Some stories were truly emotional. A 28 year-old male patient presented with an incomplete unilateral cleft lip.  He said that during his school years, he was so ridiculed by his peers that he could not stand the thought of returning. He left school at the equivalent of the 7th grade, and later went to look for work in the city. He found that older people were just as malicious – he felt so ostracized in his surroundings that he left the city and moved, in his words, “to the edge of the forest to be away from people”.  We completed a Fisher repair of his cleft lip, and let him look in a mirror – his face relayed his underlying emotions.  My feelings were bittersweet – I felt very grateful for the opportunity to help this man, but also felt saddened at the thought that a simple 45-minute operation as a child could have saved him a lifetime of heartache.
Figure 4
Figure 4 – Ajul Shah with a patient after the completion of the patient’s operation
These types of feelings pervaded the trip.  The backdrop of the Ugandan countryside, lush and green, contrasting to the poverty and underdevelopment at its forefront, was striking. I felt happy to provide assistance to a community that needed it, but felt distraught by the lack of resources available to the general public. Discussions with local staff and surgeons revealed a community torn by strife and corruption whose natural resources, in their opinion, were being misused and mismanaged. The interactions we had with the people of the community were the most affecting.  Each patient, each parent, and each relative brought with them an individual story of achievement and overcoming the odds in an environment where the odds were set against them.  I stood in admiration of a community in solidarity, whose children were stronger than most adults I know (including myself). It puts life in to perspective, and makes you question what is truly important in your own.
If you have any stories from mission trips of your own, please do not hesitate to comment.
Here’s a link to the documentary of the trip:


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