Time runs out too quickly at the end. There are too many last minute loose ends to tie up and it is difficult when you are tired. Too many toys to pass out to all the kids; too many families and staff to say goodbye to; too many instruments to pack; too many post-operative instructions; too many email addresses to exchange with promises to keep in touch. There is also too little time to sincerely express thanks to those who facilitated our work during the trip: from the physicians, residents, and nurses, to the woman who waited and brought us food during the long OR days, to the kids who were our patients. In most cases they will never see you again, will never know who you were or exactly where you came from, or that it was our privilege, not theirs, to be allowed to care for them.
While the rest of the team had another day to tour around Dakar, my daughter and I had a 2 a.m. flight to Accra, Ghana. At midnight, we found ourselves in a sweltering Air Nigeria office in the airport with no reservations – somehow they had been lost. While I had rarely seen a mosquito during the trip, I watched three land simultaneously on my arm while I swatted away the others flying around my head. Luckily, the flight was delayed two hours and I was eventually able to get in touch with someone in the United States who could retrieve the reservations. We just made the flight and four hours later, we touched down in Accra, a fairly large and busy West African city.
We could barely keep our eyes open for the six-hour drive to Kumasi, the capitol of the Ashanti region in the center of Ghana. I had last been here in 2008. We had three previous workshops there that were successful. With interest now renewed, I was going to re-evaluate the hospital and pediatric urology potential. Being able to operate there not only allows me to gauge the adequacy of the local health care infrastructure, but helps me understand whether an educational experience will fall on fertile ground.
Intake clinic on Sunday (Day 8 of the trip) was very productive. We saw 13 patients, all with very complex urologic conditions (two of the kids have bladder exstrophy and five have ambiguous genitalia). The problem was I had less than two days of surgical availability before I had to get back to Accra to catch my flight; there were four days worth of surgery. Dr. Ken Aboah, the chief of urology and a longtime friend, had the solution that I would just need to stay a few days longer. Believe me, I thought about it. Instead, we worked late Monday running two rooms almost simultaneously, and finished mid-afternoon Tuesday (Day 10). The residents and staff were all engaged in the surgical cases, and we had fun. Some kids would unfortunately have to wait until next year. We need to recommit to Kumasi.
A total of 11 days after we left for Africa, we were back home. After months of preparation, there was nothing left to do. The work that needs to be done there is exhausting to think about right now. But doing this work, in this place, with these people, gets under your skin and into your being. It becomes part of who you are. I am already thinking ahead to the next trip in the fall (back to Zambia), but first must get some sleep.
Fran Schneck, MD