Neurosurgery Camp!

Last week Christine and I rotated in the neurology unit at Mulago. I have long harbored a secret desire to be a neurologist, so I found this rotation particularly interesting, though admittedly it was not at all representative of a neuro practice in the US. The patients present with symptoms that are far more advanced than those you would see in the states –Mr. X has left sided paralysis, he has been like this for three weeks, he is HIV positive, when his speech began to slur we decided to bring him in….etc—
Also, in mulago, anyone who is admitted to the hospital while unconscious is turfed to the neuro ward so we saw a fair number of recovering alcoholics and hypoglycemic patients along with many of the expected neurological complications like stroke, meningitis, dementia, brain cancer and bell’s paulsy. In addition, we saw some of the more rare neurological disorders (rare in the US) such as guillan barre syndrome (ascending but often reversible paralysis) and AIDS-associated-toxoplasmosis. Toxoplasmosis is the parasite associated with cat feces, and virtually all of the population has been exposed to it (you’re infected right now!) but under normal circumstances, our incredible immune systems keep it under control. In AIDS patients, however, the immune system is sometimes too weak to fight off this infection and the parasite can invade the brain creating large “ring enhancing” lesions (indicating inflammation around the edges of the lesion, as you would expect in toxo, TB meningitis or some types of lymphoma) that result in a variety of potentially lethal complications. In the US, HIV positive patients are given prophylactic medication to avoid toxoplasmosis infection, but here in Uganda patients do not have the same access to medication and so toxo is unfortunately quite common.
Mid week Christine and I learned that there was a “neurosurgery camp” being hosted in one of the surgical wards by a US medical team from Duke and we decided to seek them out to see if they would let us join in on the fun. I mean, come on! Neurosurgery camp? It sounds like the best camp ever!!! (Who needs s’mores and a swimming pool when you can observe brain surgery?) There was one doctor in particular, Dr. Robert Wilkins, a retired neurosurgeon on the faculty at Duke who made a particular point to teach us about the different surgeries and make us feel at ease. He was awesome. While the surgeries were being performed he would take us from room to room and walk us through the x-rays and CT scans of each patient so that we could better understand the procedures.
We found out near the end of the first day that Dr. Wilkins is actually a world renowned surgeon! He founded the journal “Neurosurgery” (amazing) and co-authored/edited two editions of the book “neurosurgery” a major text in the field. Half the fun of Neuro Camp was hearing about how he managed to start a journal and how the practice of neurosurgery has changed since the beginning of his career. I felt very lucky to be learning from someone who is both so knowledgeable and so patient. All in all a very good week.