So after the hard work, the team explored the country and learned more about the beautiful culture and it’s people!

We happened to spend time with the Mountain Gorillas! This was a truly magical and most awesome experience! They are extremely well cared for by the governments of Rwanda and Uganda. It was quite the hike but worth every effort!

And equally as powerful and significant, team members visited the Genocide Memorial as well as nearby churches where 1000s of Rwandans were massacred in the darkest days of Rwanda’s history in 1994! Between April and June of 1994, an estimated ONE MILLION Tutsi people were barbarically murdered!

At this time, 70% of the Rwandan population is UNDER the age of 25! There is no known life expectancy secondary to lack of statistical subjects!

If you have spent any time reading this blog and found our support for the Rwandan people appealing…I urge you to learn more about this tragedy!

Please visit AEGIS and help prevent ethnic cleansing and genocides worldwide!

Lastly, we plan to “support” Rwanda in a different way tomorrow…it’s economy! Then it’s back home!

Thank you SO much for all the likes, comments, and support! We are blessed to have this opportunity! If you have ever considered visiting a wonderful, beautiful country with incredibly kind, gentle people…book Rwanda!

Back to hand surgery…

Sadly, today was the last day with our new Rwandan surgical colleagues and new friends!!

The day started with the unveiling of our new locally made Rwandan fabric team scrub hats!!! They were a big hit…and the team will continue to wear them with pride and memories in years to come back home!

Just as the days before, we were prepping for our last big cases!

These included:

Burn scar releases and resurfacing for a 2 year old boy who had been badly burned with hot porridge. As a result of his contracture, he hasn’t used his hand or walked in a year! After surgery, he should be able to toe touch and begin walking again! All our surgeries are meaningful and rewarding, but it’s ones like this that change someone’s life that really make our jobs truly special!

Another was a very unique and interesting presentation of a short arm with what seemed like “twisted” arm and a painful shoulder! It seems this dysplasia happened secondary to infection years ago!

The team performed another major brachial plexus reconstruction with a combination of nerve grafting and transfers! It was a crowded field with lots of work to get done!

And just as planned, Dr Charles Furaha and his team performed their first brachial plexus reconstruction on their own this morning! This involved a teres muscle transfer for a young obstetrical brachial plexus injury…taught to the team in the days prior!

All in all, it was a very successful and rewarding and enjoyable experience teaching and working with Dr Furaha and his team at Rwanda Military Hospital this week!

We will be sure to post the exact numbers but it was a busy and successful week for our team and Rwanda!

Before leaving the hospital one last time, we left a large amount of surgical supplies and equipment for the hospital, it’s providers and future endeavors! Our therapists did the same for the therapy unit!

After we finished the final OR at 9PM, we headed to celebratory dinner with the Rwandans! Dr Osterman spoke about the honor of coming to Rwanda at the request of Dr Furaha! He also gifted them with multiple textbooks about nerve surgery, hand surgery and hand rehabilitation!

Dr Furaha then thanked us for making the trip. He remarked on the last few days by saying “we now know that brachial plexus surgery is possible in Rwanda!” And he promised “that he will develop a brachial plexus program at Rwanda Military Hospital!”

Elissa Topol read aloud a commemorative poem that she had written about the trip!

Overall, it’s been a truly wonderful experience! We are so fortunate to have the opportunity to travel abroad and teach what we know! We thank all our families and colleagues and mentors who made this possible!

We hope to be back in the future!!

As for now, rumor has it that “Phillie Phanatic” has a date this weekend with the silverback gorillas! Stay tuned…there might be updates?

And as per usual, here are some of our favorite moments:

We would also like to thank General Butera, an orthopaedic trauma surgeon, for allowing us to visit Rwanda Military Hospital!

The team got a few hours of sleep and was ready to go in the morning!

On the schedule today were some more complex cases that kept the team busy!

Some of the highlights:

We did another brachial plexus case with four nerve transfers focusing on shoulder and elbow function! And just like that…mission accomplished…see one, do one (now teach one) as Dr Charles Furaha took over harvesting some intercostal nerves for nerve transfer!

We reconstructed a young mans wrist who unfortunately lacerated his wrist…and all the tendon and nerves…but never repaired because of unavailability of services!

We worked on improving motion on two fingers that had previously been previously repaired. As a restaurant owner, she was having trouble using her hand.

And for those hand surgeons following the blog…if you need a suture button elsewhere, try cutting the topper off a syringe plunger and pop some holes with towel clamp! Voila!

We worked on a young child with congenital differences of his fingers.

At the end of the day, there is no job too small or menial for this team! Dr Lee Osterman, President of the Philadelphia Hand to Shoulder Center, was caught washing instruments and helping to expedite the room “turn overs!”

After leaving the OR at 830PM, we had the opportunity to have a great meal at Retreat at Heaven! We even had a pretty famous bartender…

Tomorrow (sadly) will be our last day of operating in Rwanda…for this year! Fortunately, we have a bunch of more complex cases to do tomorrow, ranging from more brachial plexus reconstructions to pediatric burns! Stay tuned!

Again, thank you for the endless amounts of support and comments! We miss all of you!

For now, enjoy some of our favorite moments…

Well, that was an operating day!! The team just finished out last case at 1123PM!

The day started with rounding on our patients from yesterday who were all happy, appreciative and comfortable!

Then it was back to the operating room to prepare for surgeries!

Some of the bigger cases included:

The team performed two adult brachial plexus reconstructions with multiple nerve transfers for each patient! These procedures “borrow” donor nerves with expendable and/or redundant function to instead supply more desirable and functional muscles that have lost their innervation from injury! Top priorities are elbow bending and straightening and raising the shoulder!

A large arterial-venous malformation of the hand was removed with careful planning and dissection to avoid significant bleeding complications. This patient has had agonizing pain in her engorged fingers for years!

Another late brachial plexus patient had contracture releases and tendon transfers to augment residual function.

The therapy team was busy seeing some patients and teaching local therapists! They began their day by starting therapy on our local shop owner and new friend, after an examination by Dr Osterman…over breakfast at the hotel! (Permission given by patient)

We will get our therapists to post a separate update!

And, as has been the usual now, we evaluated two more patients!

It’s bedtime now…because we have a another full day of big surgeries tomorrow!

As usual, here are some of our favorites:

Philadelphia Hand Surgery Fellow, Dr Clayton Nelson, teaching the Rwandan medical students about the specifics and anatomy of the next surgery!

Back at the Rwanda Military Hospital, we operated on our first patients today. By the end of the day, we operated on 7 patients!

Our superstar nursing team, Kathy, Renee and Lindsey, did an amazing job working with the Rwandan nursing team and kept our rooms running efficiently and well equipped!

The team performed two teres major transfers for some of our youngest patients with obstetrical brachial plexus injuries! Dr Dan Zlotolow was in the spotlight teaching a crowd of onlookers and surgeons!

Among the highlights:

A young boy had a scar revision and skin grafting for a deformed hand with keloids and contractures.

Two adults with late brachial plexus injuries received various tendon transfers to augment their remaining function of their arm!

Additionally, we began non-operative casting treatment for a young girl with factitious lymphedema! A very difficult and challenging problem to treat in any country!

And it seems “the word” is definitely out on the streets about the team’s presence in Kigali! ANOTHER acute brachial plexus patient made his way though the hospital and showed up at the “operating theater” with our name and his name on a post it note! Needless to say, we have squeezed another big surgery into the schedule!

Even out in town, our team is never not working and offering help! It seems local jeweler and shop owner at Abraham Konga has had some pain and stiffness in his finger, which our hand therapists evaluated and began some basic therapy…on the shop counter! (Permission given by Owner)

Well, we have a BIG day tomorrow with 5 complex surgeries scheduled!

Thanks for staying tuned. Take a look at some of our favorite moments from today:

This little cutie will wake up from her surgery with a new stuffed animal…outfitted with a matching right arm cast, just like her! ☺️

We made our way back to the Rwanda Military Hospital this morning.

We dropped off our OR supplies at the “operating theater” where our amazing nurses took inventory and prepared for the upcoming cases!

Then we made it to the lecture room. There were dozens of surgeons, residents, and medical students from orthopaedics, plastic surgery, and general surgery! It was standing room only and “the largest turnout for teaching” ever.

There were hours of lectures ranging from peripheral nerve basics to brachial plexus anatomy/injuries to carpal/cubital tunnel syndromes to distal radius fractures and more!

The attendees were seen feverishly taking notes and asking many questions!

After the lectures, we got word that three additional patients showed up for evaluation! Two of them will be squeezed into the OR schedule including horrific burn scar contractures of a 3 year old boy’s hand and leg! (Permission given by mother for photos)

Of note, we must thank team member, Janet Dewan MS PHD CRNA from Northeastern University, who has screened all patients for operative concerns and will be assisting in their safe anesthesia. This is her FIFTH trip to Kigali, Rwanda and she has served a vital resource of information and coordination for the hand team at the hospital! Of note, it is her longtime friendship with Dr Osterman’s wife, Elissa Topol MSN FNP RN, that sparked this entire mission!

Well, it’s bedtime now! We have our first full day of operating tomorrow with eight surgeries planned!

Thanks for following!

First, thank you for ALL the support, likes, comments and views from all around the world!!

If you have any questions, feel free to comment and ask!

Now, here are some more photos that so many have asked for (permission had been granted for each photo by patient or parent)…

 

Even in Rwanda, there are Longhorns fans!  #HookEmHorns

Reviewing available supplies and allocating them for surgeries

Receiving an acute brachial plexus injury patient by ambulance

Appreciating the atrophic changes and disuse of an entire right arm after a severe brachial plexus injury from 10 years ago!

Educating the Rwandans not only about hand and peripheral nerve surgery…but also about “Phillie Phanatic,” the Phillies, and the city of Philadelphia!

Hanging in there after a long day of screening patients…and now planning the OR schedule with anesthesia colleagues.

Posting the week’s schedule of surgeries (see yellow sticky notes on the wall)

We started off with a big breakfast and a team selfie…

We made our way to the Rwanda Military Hospital where we met up with local plastic surgeon, Dr Charles Furaha.

Our team spent the entire day screening 30 patients, some of which travelled from hours away for an evaluation.

We saw an incredible variety of upper extremity problems! No brachial plexus surgery is performed in the entire country of Rwanda – a country whose primary mode of transportation is motorcycling!! There were multiple devastating pan-plexus patients living with flail arms for years since their injuries. There were sub acute brachial plexus injuries from the last few months. And even an unexpected brachial plexus patient injured 5 days ago brought by ambulance today after “word got out” about our presence here!

Dr Dan Zlotolow led the team in evaluating five of the cutest, youngest Rwandans at varying stages of recovery from birth-related obstetrical brachial plexus palsy!

Other than brachial plexus, we were asked to evaluate complex tendon and nerve injuries, malunions of various fractures, vascular malformations, and even some congenital hand problems!

(Dr Lee Osterman explaining the flexor tendon anatomy to a patient, using one of his famous bedside sketches)

We even saw a patient who had flexor tendons and ulnar nerve repaired last week and told, “Maybe they can do something more, like therapy?”  The answer is YES!  We have two of the best hand therapists with us for patients just like this, and show the local therapists!

At the end of the day, we have scheduled 18 surgeries, including three adult brachial plexus reconstructions and two late obstetrical brachial plexus reconstructions. Another half dozen of chronic brachial plexus patients will receive various tendon transfers to improve their function. There is no doubt that we will have a big impact on these patients and help teach the local medical community!

Tomorrow, we have a full schedule of didactic lecture for the surgeons, residents, students, therapists and nursing staff!

After many hours, miles and connections….we are in Kigali, Rwanda…all members present and accounted for…(unfortunately we can’t say the same for some luggage of supplies!). We will roll with the punches and hope they come tomorrow!

For now, we need a bite to eat and get some rest before screening day for dozens of patients tomorrow!

Ugandan National Basketball team having drinks at the hotel. Even across the world, they welcome the Philadelphians! They all also “trust the process” and cheer for fellow African Joel Embiid! Go 76ers! #sixers #joelembiid #trusttheprocess

#PHSC #PhillyHand #ASSH #RwandaMission #HandSurgery

Good night!!