final reflection

I’m back in Halifax and looking at our quiet, snowy garden.   The month in Rwanda has been excellent and each time I go back there has been noticeable improvement.

Still, there are terrible challenges such as broken equipment, lack of drugs, overworked and poorly reimbursed staff, very ill patients, few role models, chaos, and poor team communication.  The Rwandan hospitals are not easy places to work.  The reward for visitors is the enthusiasm to learn and improve by the local staff, residents, technicians and medical students.  Everyone is so grateful for our help and friendship.

Being in Rwanda reminds me of how very fortunate we are.  Each day you see people in Rwanda who are warm and cheerful even when coping with great adversity.  I just hope I can remember this in the months to come.

Special highlights:

·      Sharing laughs, tears, scary cases, serious cycling, great food, and inspiring teaching with Lauren and Terri

·      Bona as a great leader in the OR – often running 6 rooms and putting out fires with great skill.

·      Paulin teaching the residents at academic day – they were so proud to be taught by a graduate from their program

·      Christian telling everyone in the room to be quiet during a chaotic and noisy pediatric induction

·      Academic day – great fun, very interactive, seeing light bulbs go off

·      Bringing low fidelity simulation to Rwanda and finding a potential space for the Rwandan Simulation Centre!

·      Bona introducing the Surgical Safety Checklist at CHUK

·      Great meals at Khana Khazana

·      Mountain biking along Lake Kivu for two days – absolutely gorgeous country and very far from the noise and chaos of Kigali

·      The waterfall hike in Nyungwe…

·      Serena Hotel – swim, whirlpool, shower, sauna, tea, salad Nicoise, coffee ice cream and wifi

·      Smiles, hugs and handshakes with my many, many friends in Rwanda

Who knew you could make neurophysiology fun and interactive???

Great impromptu teaching by Lauren

Bona - a pillar of strength

This is me looking happy and relaxed

Our low-fidelity simulation program

Teaching paediatric intubation (Benjamin and Gaston)

Washed coffee beans in Kinunu.  We stayed overnight at the coffee washing station.

Biker chicks

Coffee washing station.  They lay the beans to dry for two weeks and need to turn them regularly.

Tea plantation near Nyungwe

Rwandan resident group

welcome to Karim

These are two of my new friends – Benjamin and Gaston – first year anesthesia residents.

Terri and Lauren are back in Canada and Karim arrived yesterday.  His flight was messed up by the snow in Europe and his luggage didn't come with him.  Fortunately, it has been found and he's off to the airport to retrieve it.  Karim gets great bonus points for initiative.  He grabbed a cab at the airport and asked for the Merez petrol station in Nyamirambo (the closest thing we have to an address).  He found a guy with a cell phone and called me from there.

We had academic day today and, as always, the residents are very keen to learn.  I spent some time discussing their various research projects.  Each one must complete a project during residency.

I get quite sad when my time in Rwanda starts coming to an end.  It never feels long enough.  It has been a pleasure to teach such a great group of guys.

Moral Corruption

Christian and Claude at Khana Khazana

Gaston with his guitar

Well, it's our last day in Kigali today and it's quite hard to believe that we're leaving since are time here has gone so fast. Our flight has already been delayed so maybe that's a sign that we should be staying longer! Patty is here for one more week without us and is awaiting the arrival of Karim who will replace us (big shoes to fill though!).
This week was filled to the brim with teaching activities, days in the operating room, work on our projects and lots of goodbyes.  We made time for a memorable dinner with Christian and his lovely wife Grace who hosted us for a traditional African meal of maize pate, sombe, fish, chicken and plantains, one of our best meals yet!

Our simulation teaching of Anesthesia Non-Technical Skills

Thursday we did our last paediatric case, a 2 month old with pyloric stenosis.  Everything went really well and you can see the enormous benefit monitors like the Lifebox are making especially with the lack of paediatric sized equipment.  It was also great to see yet again what an influential leader Bona is in the operating room, making these difficult cases run so smoothly.

The Lifebox paediatric pulse oximeter

Friday afternoon Lauren and I went to the genocide memorial at Nyamata. We were hosted by our friend Steven who Patty met four years ago at the same memorial. It will take us a long time before we can fully process what we have seen and heard but we are very grateful to Steven for sharing his experiences with us.
Friday evening we had one last dinner out at Heaven restaurant with Bona and his wonderful wife Adelene as well as fellow surgery residents and even an epidemiologist, it was a dinner of great minds!!! (and great wine!).  We had a memorable taxi ride home with our first female cab driver and it wasn't long before Patty was dancing with the rest of us, we even taught her to "fist pump", she will forever be changed.
This is mine and Lauren's last blog, but not Patty's we'll see how her week goes without us and we're off to battle the snowstorms that are keeping us from our families back home.
Terri

Buhuro, Buhuro

Slow by slow. That was how we made it through this grueling yet incredibly beautiful mountain biking trip along the shores of Lake Kivu.  When we asked Tom how many more hills there were, he said well take 1000 hills, and subtract the number we've done, and that's how many we have left :).  

We started our biking trip at Tom's house (our guide) and met our porter Tuciere. We were thankful that our Tuciere was a former member of the Rwandan national cycling team, carrying extra bags was definitely not a problem for him.  After trying out our bikes and helmets, and of course a group photo, we were off on our 80 km bike ride.  

We saw a side of Rwanda you could never see unless traveling by bike or foot into the rural areas. We saw coffee washing stations and fishing villages and everyone stopped to say good morning (even well into the afternoon) as we went.  There was even a small town where instead of "good morning" all the children yell what's up! at the same time, they have definitely been taught by a muzungu!

We spent the night at Kinunu coffee washing station and were treated to a swim and a great meal.  We were very proud of our long day of cycling yet aware that we had to go all the way back the next day! Although we were slightly stiff in the morning we managed to get back up that first hill and with Patty's new skills in downhill mountain biking we made record time on the way back (well record for us :)). It was an incredible trip and definitely a highlight of our time here.

It was mine and Lauren's last academic day on Monday.  We filled it to the brim with teaching and left just enough time for a quiz that the residents really aced.  It was such a great feeling to know that our teaching had been effective and they had gained a better understanding of some really difficult concepts.  I think we're a really tough act to follow for those coming next month! :)

After a long day we headed to our favorite place, Khana Khazana for one last group dinner.  We were joined by Dr. Jean as well as the staff from King Faisal Hospital, and of course, the residents and staff from CHUK.  We had a great meal and even got serenaded by Eustache and Gaston on the guitar!

Just a few days left here and so much to do! Still working hard on our studies, some difficult cases tomorrow in the OR and trying to squeeze the last minutes out of this month to teach as much as possible. We will certainly need to recharge our batteries when we get back!!

Terri

Nothing beats seeing a grown man try ice cream for the first time!

We had an incredible day teaching in Butare yesterday. We started the morning with the 3 first year residents, going over things like anesthesia considerations and how to make an anesthetic plan. They were extremely enthusiastic and eager to learn, and it was very encouraging to see how quickly they are improving. They are so motivated and thirsty for knowledge – it is a pleasure and an honour to teach them!

In the afternoon, we were delighted to have two of the first years, Benjamin and Gaston, join us at the medical school to teach basic communication skills to a class of second year medical students. Without any preparation at all, the anesthesia residents blew our socks off and much to the delight of the medical students, provided outstanding and comedic presentations on how to communicate effectively with patients. They outlined with maturity that was both humourous yet extremely powerful, how they had dealt with difficult situations in the past and provided advice for the students on how to deal with challenging situations. They are amazing role models and are natural teachers and leaders. We are all so excited about the future of anesthesia in Rwanda with so many incredible residents already in the program, and hopefully the future students who will be inspired by these residents to join us in what we know to be the best medical specialty J

We also had the opportunity to speak with some female medical students (who remain few and far between) and commend them on what they are doing, as well as encourage them to thrive in a world that at them moment seems very male-dominated. They were amazed (and hopefully inspired) to hear that in Canada, there are now more women entering medicine than men.

Thursday night we held journal club for the Butare residents and had an excellent discussion about critical evaluation (I personally never thought I would have an excellent discussion about this, but seeing the looks of understanding on the residents’ faces as we explained different topics to them was really gratifying) over ice cream. One of the residents even tried ice cream for the first time - it was incredible watching his face as he first felt the coolness of the cream which then transformed into an explosion of flavour! Can you imagine going your whole life without ice cream? That's probably why they have such nice teeth here...

Friday started off with morning report in Butare, which was opened by a song and a prayer shared by the group – it was quite a lovely experience to take part in, and we think it really helps to build the sense of teamwork that we see in Butare. We then discussed some of the cases they had seen over the past few days, including some incredibly challenging cases in the ICU – things that would make us quiver in our boots if we were faced with them on a Royal College exam!

After morning report, we got a ride to Gisenyi, where we will overnight before starting on our strenuous bike ride tomorrow (I say strenuous because I know what kind of rides Patty has convinced me to do in the past!). The drive was gorgeous – fortunately the road is quite new so there wasn’t a lot of traffic on it (although that didn’t stop me from having the occasional arrhythmia as my life flashed in front of my eyes). Along the way, we passed the Rwandan cycling team (which Patty saw when she was in Gisenyi last weekend). They were biking – or should I say barreling - up the longest hill I have ever seen in my life. I think it would take me at least 3 days to walk up the hill and they were already near the top at 10:30 in the morning, still riding their hearts out! They will wear the yellow jersey proudly at the next Tour de France I’m sure!

Now we’re lounging lakeside at the Paradis Malahide in Gisenyi, listening to the incredible sounds of life. We just saw dozens of fishing boats heading out for a catch, and heard the fishermen chanting in unison as they rowed their way out into the middle of the lake. Just as they passed, a chorus of singers began their rehearsal just a few hundred metres away. It truly is magical here!

Lauren

P.S. Terri and I tried the banana wine that we bought last weekend – unless you like to lick ashtrays, I would recommend staying away from it!

Guinness and Coca

Last night we had journal club with the Kigali residents at Le Capri, a restaurant down the street from our apartment.  It was a relaxed evening over fish brochettes and the Rwandan Guinness and Coke combination. Terri lead a stimulating discussion of relative risk, absolute risk, and confidence interval.  We talked with the residents about leadership and being the change you want to see.  We again discussed the frustration of working with broken and inadequate equipment.  The residents are a great group of guys who are super keen to learn.

We are back in Butare and heading over to the hospital to do some small group teaching with the junior residents.

This weekend we will be out of communication as we are cycling along the shores of Lake Kivu on the Congo Nile Trail.  Yeah!

xxoo Patty