40/40

Today was our first hands-on day at CHUK. Patty and Lauren were off bright and early for a day in the operating room and I was charged with rounding in the ICU.
Damascene, a fourth year anesthesia resident was in charge of ICU rounds with input from the staff Dr. Bosco. I was surprised and impressed to see 5-6 medical students doing their ICU rotation (something we only do as an elective). They were each in charge of a patient and were required to see them ahead of time and then present them during rounds. I was beyond impressed at their presentation skills and their systems based approach to their patients. They were also inquisitive and asked really thoughtful questions about transfusion guidelines, pharmacology and antibiotics. I can certainly say that when I was a senior medical student my competence in managing ICU patients was not as proficient as that of these students.
Later on in the day I relieved one of the anesthesia technicians so he could participate in Patty and Lauren's study on non-technical skills in anesthesia . There I saw my first Lifebox (saturation probe and heart rate monitor designed for developing countries to provide a low-cost tool for monitoring oxygenation) in action. Although we had a good quality Datex machine and monitor, the cables for the ecg and saturation probe were not available and so it was an essential component to ensure a safe anesthetic.
Terri

Hi Everyone,
I've been ever so glad that Lauren and Terri have been keeping up the blog. Today was an excellent first day in the operating room at CHUK. There were some very scary moments with the first case (a young baby) but fortunately it turned out well. One of the most inspiring parts of the day was the interview Lauren, Christian and I did with one of the anesthesia technicians for our study. It is great to see how much dedication and commitment some people have to seeing anesthesia care improve in Rwanda. It feels like it's blossoming.

We went to spin class tonight at the Serena Hotel and are now sitting by the pool having just had coffee ice cream. This place is great!
Patty

It's interesting how you can be half way across the world, and yet things can be much the same... today, I had my first Rwandan OR experience, and unfortunately, it involved a lot of waiting around, in part for surgeons to make up their minds about their cases (our 2 cases ended up being cancelled because the surgeons changed their minds about the need for surgery - with one patient, this happened after the patient had already been lying on the OR bed for about an hour), and also because of the normal delays that we see so often in the OR - waiting for patients to arrive from the ward, organizing supplies, etc. I also had a good discussion with some of the anesthesia providers about the untrustworthy-ness of surgeons (we were only partly kidding!)... like I said, things are strangely the same everywhere in the world! I was also exposed to some of the challenges that the physicians and technicians face here when a spinal was done but took so long to work that the patient ended up getting a general anesthetic in order to start the surgery, likely because of bad or inadequate drugs. Overall, it was quite the introduction to the local OR culture!
Lauren