This morning started off with a beautiful breakfast, fish, breads, cheeses and fresh cucumber juice and french press coffee. There were many choices in the buffet, omelets, pastry delicasies, jams and compotes, fresh fruit, meats and yoghurt as well as the many choices of cereals and special blends of grains.
Some of the group dressed and went to church, which turned out to be very Americanish, pastor from Oklahoma. The rest of us went to the hospital and set up the ORs. It didn't take long, we are more organized every trip! I have a great team. Thank you Pat Wagner for all the behind the scenes sorting and typing you did. And Paula, what a trooper, driving up from Georgia on weekends to do staffing and help us organize and pack boxes! We got it done and our pre trip work really paid off. We do have some troubleshooting to do and some issues to resolve. It seems the black max operates at about 60psi, and "we need more power, Robbie",....." but Captain I can't, she won't hold,  she's gonna blow ~! "  I'm sure Robbie will screw drive it and tape it up and it'll be fine. And the microscope is the same kind we use to put in myringotomy tubes in Duke Raleigh,  old ENT model. Usable, but we might be limited somewhat, we'll see.

After the hospital, we went for a walk to get lunch at an African Italian pizza place. We sat down, waited. Ordered. Waited. Waited. Got drinks. Waited. .........Watched as at the other table, Japanese patrons were drinking and making bathroom runs holding their stomachs and trotting to the loo. We wondered if eating there was such a good idea. ....so after some classic oldies juke box dancing and a good time and fun conversation, the pizzas arrived. And we waited for our checks. and waited. Almost 3 hours later we were ready to leave.
Walked to the market to get my sneakers for work, (yes i forgot shoes). It was an interesting experience and I'm glad we went. Got a few small snacks and other things and headed back, walking past maternitie hospital and public hospital. I think that would be an eye opening tour. Renee did surgery there tonight and I think she will remember that experience for a long time. Not everybody does it the same way we do. That is all I can say.
Renee, Paula and I went out via hotel taxi for dinner at Heaven restaurant. It was beautiful rooftop dining overlooking the lovely city lights on the hill. The weather was cool and misty. The Sangria was spiced with herbs and cinnamon with bits of fruit, and the pork chops were done on an open fire, with very fresh and delicious spinach and sweet potato. Paula enjoyed her Mojito and hamburger with fries.
We have our plan for tomorrow, be up at 6 for breakfast and out to the van by 0700 for a quick meeting before heading off to the operating theaters. So, goodnight, off to bed, early day tomorrow.

Rwanda 2011

We arrived safely at a reasonable hour and without incident ! Some amusing flight stories, but no major holdups, and all of our supplies arrived on time from DHL, thank you Marcus ~! Check in at the Serena was smooooooth and easy, and after Dr Haglund's discussion with the hotel staff, we will be permitted to stay as per our reservations, instead of just the 3 days they decided we should stay ! This am several of us slept thru the most amazing breakfast buffet you would ever want. But we got our 8-10 hours of beauty rest and woke up at noon Africa time, 0700 NC time. It was great to "sleep in" as with our previous trips we usually have to be up and out by 0600 and on the bus by 0700 to get to the hospital no matter what time we got in. We packed ourselves into the van, (good thing we are a close and well bonded team) and we arrived at King Faisal mid morning. After an introductory meeting in the board room, we toured the hospital. It was the most sparkly clean hospital and grounds I have ever seen. So well maintained, but still in need of some updating. I posted some pics on fb for now, until I remember how to post pics to my blog, please feel free to friend me if you would like to see the pics. @Pamela Borden, Raleigh, NC. The hospital staff brought all of our supplies up to the OR for us, and all we had to do was organize them and account for them. Easy breezy. We assessed the equipment and we'll have some troubleshooting to do tomorrow, (Sunday) but it's nothing that Robbie McGyver can't handle. All he needs is one screwdriver and a roll of tape and he can transform anything into a well functioning piece of high tech surgical equipment. And let me just say, it's a good thing Robbie knew that you cannot run compressed 02 as a source of power to run a black max. Whoa, close call. KaPow! Haven't seen it yet, but I hear the microscope is akin to our 1930's version of the ENT scope we use for tubes at Duke Raleigh. Okay, so this isn't brain surgery,......wait, yeah, this IS brain surgery. SO, I'll just think about that tomorra...ahem. Let's change the subject now, and talk about the amazing dinner we had back at the hotel, all courses were delicious and it was so good to be able to sit down at the table with the whole team, and toast to yet another wonderful experience together. Looking forward to making memories and new friendships with each and every one of you, Duke Neuro and Rwandan team alike. Thank  you Dr. Haglund, for helping me live my motto, Life is NOT a spectator sport. Okay ~ Duke Neurosurgery East Africa Training Team, let's roll~! stay tuned for more.....

Officially, we are flying a holding pattern~

Last night each of us on the Duke Neurosurgery East Africa Training Team received a phone call from Dr H informing us that the State Dept issued a Travel Advisory for Americans traveling to Uganda and that our trip will be postponed until the terrorist activity has calmed down and is no longer an active threat. We know that none of us is ever guaranteed a safe road, but certainly waiting until this blows over is a safer road. And besides, Al Qaeda is in Kampala and Omar Kadafi and other leaders have taken over our hotel reservations. I can imagine the breakfast conversation if we were there, I would order and then I would yell, "MAKE MINE KOSHER!" Anyway, I realized my own case of nerves when I started thinking of a burka as PPE. ( for non medical that means Personal Protection Equipment)
Our reschedule date is October 21. All of our supplies are on their way via DHL, including the Borden Neonatal shipment to Dr Joshephat. I hope everything arrives intact and makes the journey from Entebbe Airport to Mulago Hospital without incident, where it will be stored in the warehouse until our team arrives in the fall.                                   Safe journey, supplies, see you soon.

Duke Neurosurgery East Africa Training Team, stay by the phone.

I just a call from Dr H, the US Embassy has issued a Travel Alert for Americans traveling to Uganda. We are postponing until further notice.
Stay tuned.

doing as much homework as possible

I am in grad school and the term just started July 6th, so in order to remain current in my studies while I am in Uganda, I am doing as much work as possible before I leave. I won't be able to pack the weight in text books otherwise. I have been working today since 0900 and it's 5 20 pm now. I hope to take one exam on Wednesday, and be near completion on my case study. I have done much of the research for the case study and printed it all to take with me. I stay up sometimes until 1:30 or 2 am and then after a nap, I am ready to get up for work again at 0530! I know this is short term though, and once we get back I can resume my regular schedule of going to sleep around 11 and sleeping until at least 7 on the weekends. Of course, my dog, Sam, a white shepherd, tries to get me up at 0530 no matter what day it is.
I haven't gotten any travel alerts from the embassy. We are still on track for Thursday travel~
I have made the necessary requests and arranged for information sharing for family and friends to be available and responsible for my beautiful daughter, who is at adventure camp this summer.
Yesterday, I received my driver's license in the mail. (whew!) I renewed it July 7th but the new thing at the NCDL office is to mail it in 5-10 days. I was worried that I wouldn't have ID to board the plane!

Bombings in Kampala, Uganda

Last Wednesday, July  7,  I was so happy to be clearing out the storage unit and driving the last of my boxes to DHL for shipping to Uganda. With the help of many friends, I was able to raise the money to pay to send 2100 pounds of neonatal supplies, baby blankets, hats and tees to Africa. My summer term at Frontier School of Midwifery and Family Nursing just started after one week of break and now I could concentrate on my studies.
I had 3 or 4 days to let it sink in that after months of stress and worry, and lots of effort, the shipment was finally at DHL. I had even opened a store to sell donated baby clothes to raise money!
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And then, from the US Embassy in Kampala, Uganda
Warden Message 03 - July 11, 2010

The bombings on July 11 at the World cup viewing events at the Ethiopian Village Restaurant and the Rugby Club, which resulted in 64 dead and scores injured highlighted the vulnerabilities associated with visiting large public gatherings in Uganda.

At this time, the Department encourages U.S. citizens in Uganda to strongly consider the risk of attending large public gatherings because these events can provide vulnerable targets for extremist or terrorist groups. 

U.S citizens in Uganda not directly affected by today’s events are strongly encouraged to contact friends and family outside of Uganda to notify them of their well-being.

U.S. citizens are advised to register and update their contact information with the U.S. Embassy in Uganda.  The U.S. Embassy is located at Plot 1577 Ggaba Road.  The phone number is (256) (0) (414) 306 001 or (256) (0) (414) 259 791, fax (256) (0) (414) 258 451, email: KampalaUSCitizen@state.gov, and U.S. Embassy Kampala website: http://kampala.usembassy.gov.  In the case of an emergency outside business hours, or during any suspension of public services, U.S. citizens may reach the embassy duty officer at the same numbers.

For the latest security information, U.S. citizens traveling abroad should regularly monitor the U.S. Department of State's Bureau of Consular Affairs’ internet website at http://www.travel.state.gov/, where the current Worldwide Caution, Travel Alerts, Travel Warnings, and Country Specific Information can be found.  Up-to-date information on security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.  These numbers are available from 8 a.m. to 8 p.m. Eastern Time, Monday through Friday (except U.S. Federal holidays).
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Well, we did lose three members of the team due to family pressure to back out, but otherwise we are intact and ready to go! Of course if things get too active and the US Embassy issues a travel advisory or Duke pulls their students out of the country we will reconsider. For now, we are moving forward and will be picking up our surgical instruments at our packing party next Wednesday.
We are also having to change our hotel reservations. There's an African Business Congress in Kampala, and it seems that our accomodations have been lost to them, so Dr H is scrambling to find us safe, secure lodging within reasonable distance to the hospital with as many of the amenities as possible, including meals. 
In the interest of safety, our safari is canceled. The drive north from Kampala to the Paraa Lodge is about 6 hours into desolate country, leaving our mostly white foreign faces too exposed and obvious to risk it. 

getting ready

5 days til we leave for Africa ! I am traveling with Dr Haglund's Duke Neurosurgery East Africa Training Team to Kampala, Uganda, Africa. It feels like we have been preparing for this trip for years, but really we started collecting things and organizing as we got back from last year's trip.
This is how it all started~
I have been an NRP instructor since about 1991. I visited Uganda on a mission with Duke Neurosurgery last year and was permitted to observe in the Labour Ward at Kampala's Mulago Hospital. I witnessed a failure to recognize and intervene appropriately when babies did not attempt to breathe at delivery. I demonstrated basic dry and stim and a few stimulation techniques and worked briefly with the British OB on a proposal she wrote to make NRP mandatory for all midwives. 2 weeks after I left Uganda, very basic NRP was taught and they certified 102 midwives. I used this experience as my intervention for my presentation in my community assessment class in midwifery school. During this past year, some of my student midwifery classmates conducted a baby blanket drive and collected ~ 4,000 baby blankets so that the Ugandan midwives had a blanket to dry and stimulate the newborns. Also donated were an otoscope, 2 cases of bulb bx and several ambu bags and much more in labour ward and neonatal supplies. I need money for shipping via DHL when our mission returns July 21, 2010. We ship in 2 days. I am making a plea for donations. I need to raise about 3,800 more to pay for the shipping. Would you be interested in viewing my powerpoint presentation or allowing me to come show you the conditions at this facility? Please help me provide one more piece of support for them. This is our last year and this facility and I have all the supplies ready to ship. Please consider meeting with me. Thank you.
Pamela Borden, RNC, RLC, IBCLC, CNIV

Student Nurse Midwife
Frontier School of Midwifery and Family Nursing
Pamela.Borden@DUKE.edu