He was a young man with a seemingly bright future ahead of him, a university student with a loving family. He was only twenty years old when he came to Mulago Hospital. He was skin and bones by the time he had arrived, his eyes sunken and blank as if he knew the end was in sight. Under his thin bedcovers lay the source of his malady: an open midline incision. The suture lay exposed, along with his spleen and small bowel. His tattered skin crisscrossed over his open abdomen, the edges of his incision well worn. He had multiple enterocutaneous fistulas.
A surgery gone wrong, they had said. An infection. He’ll be fine. We’ve seen worse. Soon he’ll go to the theater. He will be saved. Sadly, they were wrong.
Not all surgeons are great, although most aspire to be. In a place like Mulago, many if not all of the surgeons display some of the qualities of a great surgeon. While the surgeon who initially treated Moses may not have possessed great skill, they were likely calm in the face of the uncertainty that is felt when performing an emergent exploratory laparotomy. Surgical skill can be gained through hours of practice and diligence, but the drive to continuously improve that skill is much harder to learn.
While the surgeons here at Mulago work with much less than we do at home, they know the virtue of patience. After having been in the hospital for about three weeks, Moses was slowly regaining his strength. The surgical team had found a sponsor to pay for a central line and total parenteral nutrition (TPN). Everything was set for him to begin TPN, except the intensive care unit (ICU) was at capacity. Meanwhile, central lines were not allowed on the normal wards. Hence the team was patiently waiting, checking every day and persevering through the bureaucracy. Knowing that the surgical team would be unable to provide ideal treatment for the patient, they continued to provide the next best possible care: keeping the patient hydrated and the wound clean, the only the things they could control at the time.
Moses’ story is not one of a great surgical triumph. In fact, it is more a story of failure than anything, but it showcases multiple qualities that a great surgeon should possess. The final quality that Moses’ case brought to life is the ability to innovate. When faced with almost no surgical instruments, scant resources, and unreliable electricity, surgeons in Mulago need to be ready to improvise and innovate at a moment’s notice. This ability to change procedures and repurpose ordinary objects is one of the most important qualities a surgeon can have. One must constantly pioneer new ideas and make improvements. This quality in particular seems to be the cornerstone of surgery: the ability to continuously work towards improvement. While the surgery performed in Mulago may not be cutting-edge, I would wager that the surgeons possess the qualities that make a surgeon great.