Wonderful!

–nearly passing all descriptions of the superb ending of our “Flightseeing” Super Safari!

It came after the only disappointment of the entire Circumnavigation-11 missions’ series, with all of us covered with permits to enter and stay in CAR were not able to enter because there was an interval in the six months’ renewal permit for the Cessna Caravan 208 we had chartered and its regular renewal, so we could not fly into Zemio to assist the Assa refugees as we had hoped after a week’s wait with the UPDF (Ugandan Peoples’ Defense Force) who are an international all-African force commissioned to capture LRA Joseph Kony–Africa’s current on-the-run “Bad Guy” who had so savagely mutilated the population of our concern.

We flew out of the Nzara military Air Field on the West Equatoria border and landed in Entebbe, where we said goodbye to Scott Downing, returning to Chad, transferred all the surgical and drug supplies and personal support materials through Ron Pontier, the AIM Air pilot there who will distribute the aid to Ambroise the clinical officer we had hoped to train in Zemio and Obo and to Wendy Atkins the long term missionary leader there and to Jean Marco, above all, my long time friend from “Out of Assa” –the title of the book he now has inscribed to him along with the cash support to have his daughters pursue the nursing and medicine we had hoped to help train them in as well.

We now have made a complete plan for next year that includes a Westward Circumnavigation-12 which will start in the second week in January and go to Werkok/Bor/PiBor (we are working on the renovation of the hospital there in the interval) and also Akobo.
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Filed under: Sudan by William on February 28, 2011
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The back end mission to Central African Republic was aborted by TR Sudan due to last minute problems getting clearance for Team Rubicon’s Cessna 208 into Zemio. An unusual (and so far unexplained) glitch in the AIM air system caused the team to sit idle for 6 days at a Ugandan Army base called Nzara. Unfortunately this means that 80 preselected surgical cases failed to receive their treatment. TR is trying to determine cause so that future missions don’t experience the same hitch.

Overall, however, the Project Sudan mission was a huge success, per Dr. Ajak’s email message below. A full and detailed after action report will be written and posted in the near term.

The team is currently back at the Mayfield Guesthouse in Kenya and will retrograde back to the US in the AM. An appropriate and well deserved ‘TR winds down’ photo may find its way onto the blog shortly.

William McNulty
Co-Founder, Team Rubicon

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Filed under: Central African Republic, News, Sudan by William on February 28, 2011
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Dear Drs. Glenn, John and Team Rubicon,

I would like to transmit our thankfulness for Job well done in Werkok and Pibor for the last 2 weeks. Werkok community, patients and the trainees from Panyagor, Duk Payual and Werkok who demonstrated their interest in learning new skills in several areas under the instruction of Dr. Glenn and Sudanese teaching Sudanese program of Continue Medical Education networking. Has showed that our medical staffs have reached another higher level in their surgical skills and clinical judgment. our five work site shall be equipped soon with the supplies we received from you, the following counties (Panyagor, Duk Payual, Werkok, Pibor, Bor civil hospital) will come to pick up their medical supplies donated by Team Rubicon and Dr. Glenn.

Lastly, Pibor community is really blessed for the arrival of our team leaded by Dr. Glenn. We are really overwhelmed about the need in Pibor, these people are the most marginalize of the marginalize of Southern Sudan because there is no access to health care services, zero infrastructure, no running water, and imagine a lot of disease over here in Pibor such as : PTB, Malaria, intestinal parasites, STD, tape worm, brucellosis, typhoid fever, hernias, hepatitis A,B, PID, UTI, PUD, acute diarrheal infections, water born disease, malnutrition, They are lacking of medicines, even qualify medical staffs are lacking. MsF it’s mandate is an emergency medicine, zero surgical procedures been done here at all, woman with obstetric labor can loss her life, ectopic pregnancy or acute appendicitis can loss their lives. We asked MsF staff to give us a room in their facility to operate some of the Murle patients that had been screened for surgery. MsF country director in Juba Mr. Rob Mulder refused, possibly due to their scope of practice contract. However, we went back and created another alternative for our surgeries. During our 4 days here in Pibor We treated 2,500 patients and 5 surgeries done and We referred more than 20 surgical cases to Werkok hospital for further operation. We are the first team started operating in Pibor ever. These people are still living in primitive live, we need to rescue them. Their biggest request is to repair “Lakurnyang Missionary Hospital in Pibor” and bring qualify medical personnel to help them. it’s one of their dream to become reality soon in the nearest future.

We are very grateful to Dr. Glenn and Team Rubicon for helping our people for the last 2 weeks on “Mission to Heal” and for Peace Initiative program between Dinka Bor, Nuer and Murle this is a unique program that will enhance the lives of our people through medical work and skills changes, networking between doctors from different tribes of Jonglei State.

Blessings,

Dr. Ajak Abraham Kuchkon
Chief Medical Officer
Werkok Hospital (MCH)

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Filed under: News, Personal Reflections, Sudan, Thank You by William on February 28, 2011
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For me, personally, the trip to Haiti with TR was a fascinating look at medicine in a third world country. The Cholera Treatment Centers (CTCs) and Oral Rehydration Points (ORPs) run by the IMC (International Medical Corps) are definitely saving lives. Severe dehydration corrected by massive fluid resuscitation (10-20 liters of lactated ringers) was common. The IMC doctors I encountered (Haider and Odile) worked very hard co-ordinating with many other NGOs, the government, the hospital, private pharmacies, etc. to obtain the necessary supplies and medications. They were continually putting out fires. They had hired very good Haitian doctors and staff to do the day-to-day patient care in the CTCs. The goal was to train the Haitian people to take over, so that IMC could pull out in the future. The Haitian docs were very dedicated to helping their people. I can’t imagine their daily frustrations – practicing medicine without the tools we take for granted. The hospital in Les Cayes does not have an EKG machine. Only basic labs are available, and no x-rays/sonos in the cholera tents. What TR brought to the CTCs was attention to IV techniques and safety – ie using sharps containers, how to tape correctly, being prepared with all necessary tools prior to starting the IV, making sure fluids did not run out. The Haitian staff was proud of their work, and care was needed to convey we only wanted to help improve their skills – not denigrate them.

Successes for TR: Using the skills of the 2 paramedics (Sandi O’Neill and Bryan Shaw) to develop CTC ambulance protocols for the drivers and nurses, creating a supply list, chain of command. I helped develop the ambulance log sheet which was also used to collect data on where cholera outbreaks were occurring – epidemiologic data. We also had an ambulance IV protocol to be posted in each vehicle.
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Filed under: Haiti, News, Personal Reflections by William on February 28, 2011
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“Thank you so much for the treatment you did to our people here. All those who have been operated are fine. Not any complications. The rest of the patients who are supposed to travel to Werkok are ready.”

This is exciting!  Reverend Orozu reports that our operative patients are doing well, and other surgical candidates are readying to travel to Werkok for their operations and care.  Murle traveling to Werkok to receive operations by Dinka doctors…doctors trained by a cooperative effort between Sudanese and Americans, now most importantly Sudanese teaching Sudanese!

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Filed under: After Action Report, Sudan by Brittany on February 28, 2011
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Series: 11-FEB-D-8

February 26, Saturday, 2011

Two things became apparent as we scrambled at 3:30 PM on Friday to load the plane after tipping Isaac Mwira for his hospitality in furnishing us another Argentine tinned corned beef and biscuits luncheon: we would NOT be going to Obo by either the UPDF or AIM Air in any case since it seems that Ambroise who is set up as our trainee was going to be there by road, but he had heard about our incarceration here and had NOT gone to Obo but was still in Zemio. For that reason we have but one option if we are going at all—we are going with AIM Air to Zemio if we can get out at all, and the last word was that the ministry had met and the president had verbally approved our departure. We scrambled to lead and pack the plane. But Jon wanted to hear the confirmation number of the approval, and be sure it was not just for this flight but a confirmation for all time that established the precedent that AIM Air would continue to furnish flights to its mission personnel into Zemio as the last twenty years had documented and would not have to go to the prohibitive time and expense of entering through the capital since an extra $6,000 would mean that Wendy Atkins could never fly out of there. So it was said to be assured, and the president was sending the matter to the secretary to type it and he would sign it. But it is late on Friday of an unusual work week. No confirmation number, paper or signature appeared by the 5:15 PM time when we would have to be airborne in order to reach Zemio by dark—so, we reluctantly packed up the plane and one more time got the Naivasha Hotel shuttle to transport us back for a third night—now marking a full week of an idle team at great expense with a chartered plane grounded at the door of our CAR mission.
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Filed under: News, Personal Reflections, Sudan by William on February 26, 2011
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Series: 11-FEB-D-7

February 25, 2011

It is the fifth full day of standing and waiting in a bureaucratic delay of the kind that is tragic and also typical. For every big organization, the procedure is more important than the substance, since each component of the organization is covering its backside, and does not want to create any proactive waves, so any crisis that may be allegedly addressed is long since passed, and there is NO HOPE in major organizations finally getting around to taking ownership of the problem that has flared and consumed all of the intended target aid recipients. Today, we are talking again to the Obo Commander who says he would be happy to help, but has no authority to allow us on the near empty MI-8 chopper that the Ukrainian pilot welcomed us to stack our stuff and come aboard with the three ton airlift capacity, and he had two passengers, named David and Warren, UDPF soldiers with their backpacks and AK-47’s only. Everyone from all along the line, US Embassy Defense Attaché, the officers here including the Flight Operations controller Isaac Mira, and all the people from Ron Miller, Ron Pointier and all along the course of the UPDF except the Obo Commander here has given permission for the UDPF helicopter to carry us to Obo. Ironically, the UDPF is here to care for the LRA refugee victims we are attempting to reach, but he says he could help us and then face a court martial. We are all of us, from UN to US Army to UDPF to AIM Air to the Mission and the local church and pastors are all here for the refugees and their assistance, and we are here for that explicit purpose and cannot get there.
(more…)

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Filed under: Personal Reflections, Sudan by William on February 26, 2011
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Series: 11-FEB-D-6

February 24, 2011

It may be prejudicial to have this alleged “paramilitary Christian organization” seen in the encampment of the Ugandan UDPF military in full uniform and surrounded by our armed guards and the trappings of the salutes and orders and the air field from which we hope soon to be greeting the archaic AN-2 which has allegedly taken off from Arua and is lumbering along the slow pace it has on its biplane wings to reach us, and then to be possibly airlifted to Obo courtesy of the UDPF.

We made an hour long market tour of the thriving business center of Yambio. We took a stroll down the dusty streets during the day like any other mad dog or Englishman at noon. I had loaded up the images and ready to see what was here and was to be further awaited and somewhat disappointed. The market is full of things for sale, even in small quantities, such as onions or a few greens, it is certainly more an “upmarket” from the barren grazed to the ground hard baked earth of Jonglei. The surrounding forest had made it cooler and the overcast of the clouds has made the temperature tolerable. We saw an open air meat market with the hunks of meat drying quickly in the air which has a humidity of less than 10%. It is a tour of the kind that shows all the things for sale or on the market here which has even got kiosks and then cement rental shopping spaces for the goods on display. Many were the kinds of luxuries that arrive from other places such as Scotch or jewels, or the batteries or bicycles, even new ones, with plastic wrap around them as import from Chan—a lot like Wal Mart!
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Filed under: Personal Reflections, Sudan by William on February 26, 2011
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I once had a naive notion that most of the villages of Southern Sudan were going to be very similar. This was not based on any sort of preparatory study of the area, mind you, but upon the general layout of the few villages and towns I had been to thus far. In the three weeks that we had spent in Sudan we had visited a small village and a small town that were roughly 25 kilometers apart. The people had looked similar enough almost everywhere with little exception. They were usually tall, thin, and had very few tribal markings.

I really had no grasp on the differences that could develop over the distance of a few hundred miles. The reason for this is because although the two areas weren’t very far apart, an invisible line separated the region into two distinct tribal areas. The area we were in was populated by Dinka, and the area we were headed was populated by the Murle. The Murle were of similar stature as the Dinka, but they had extremely elaborate body decorations. They scarred their skin with charcoal which left raised patterns. These patterns often surrounded the entire upper body and were accompanied by beaded head-dresses and gauntlets on the women. They were remarkable to behold and reminded me how much can change over so little an area.

The topography changed as well. Shortly after arriving at Pibor we started referring to it as “Scorpion Camp” with the same secrecy as one might speak in hushed tones about ‘Fight Club’.

1) The First Rule of Scorpion Camp is you do not talk about Scorpion Camp

2) The Second Rule of Scorpion Camp is YOU DO NOT TALK ABOUT SCORPION CAMP!

You get my drift…

The barren, cracked clay that is the earth in Pibor allowed perfect passageway for those little buggers to crawl out of at night and wander throughout the compound where we slept. They appeared just after sundown and came in groups of three to five at a time. At first it was exciting, then it became tedious, until finally it was downright terrifying. The scorpions had free reign and often roamed between our feet while we sat around and disinfected our drinking water. The true test of manhood became who would wear flip-flops at night.

It was in this scene that I began assisting in operations for the Murle tribe that lived in Pibor. A woman had a large hernia on her belly that needed to be fixed, and I asked to be involved in the surgery. I had been in the Operating Room dozens of times, and I have assisted in cleaning wounds, anesthetizing patients, placing airways, and manipulating broken bones. Never before had I taken lead on a wound closure as I was preparing to do that day. The hernia reduction went well, and I prepared to suture the wound closed with the help of my Sudanese Clinical Officer, Dr. Ajak Abraham.

Since I had done a good job with the hernia closure, I was allowed to begin working on the removal of two small ganglion cysts that were lodged inside of a young mans forearm. With direct oversight from Dr. Ajak I proceeded carefully into the surgery. I used local anesthesia to numb the area, and after checking distal function of the limb I opened the arm.

I’ll save my readers from the specifics, but the operation went off without a hitch. I closed the wound with suture and checked to make sure the young man had full movement and feeling in his arm. To my surprise, he quietly examined the bandage, flexed his hand a few times, shook mine, and left. As he walked out of our mock operating room he smiled a bit and buttoned up his long-sleeve dress shirt with his newly healed appendage. The others had joked earlier in the day that his shirt was pink, but I had defended the well dressed Sudanese man. “Its cool”, I said, “Its salmon”.

This was truly operating without the extravagances of an American hospital. The candidates weren’t perfect, the gear wasn’t optimal, and the environment was unforgiving. In summation, it was unbelievable. I’d do it again in a heartbeat.

Josh Webster
Former Army Ranger and Air Force Pararescueman “PJ”

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Filed under: Personal Reflections, Photos, Sudan, Volunteers by Brittany on February 25, 2011
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TR waiting under a tent at a Ugandan military air field on the border of Sudan and the Central African Republic.

The team woke up early today in Yambio. A military transport picked them up and took them back to the Zara Air Field, which is occupied by the Ugandan Military. The team is still waiting on clearance to fly into the Central African Republic.

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Filed under: Central African Republic, Photos by Brittany on February 24, 2011
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