From Butare to the Nyungwe Forest...

Our first teaching day in Butare started off with delivering two new Lifeboxes, donated by Jennifer Szerb (a staff anesthesiologist in Halifax who has made multiple trips to Rwanda) and her mother. It's great to know that these are the first few of many that are on their way to Rwanda through CASIEF and are desperately needed for safe anesthesia in Rwanda.

Delivering the Lifeboxes

 We hit the ground running and began our first cases in the operating room in Butare. Residents and technicians presented the cases and together we discussed the pros and cons of different induction techniques and resolved very challenging dilemmas as a team regarding difficult intubations with minimal resources. We also introduced the option of sedation and pre-medication before moving patients with fractures to better positions for spinal anesthesia. This worked really well and both cases progressed easily without any concerns.

I also had the privilege of spending time with one of the anesthesia technicians. I asked him why he went into anesthesia as it's an unusual career to be a technician. He told me he was an OR nurse in the district hospital and there was no technician. He was often asked by the surgeon to give ketamine to patients for anesthesia and they received nothing else. He said he wanted to learn more about anesthesia and do things better so he went back to school for three years to become a technician and now works in Butare. Throughout the day I watched him work and was touched by how much care he provided for the patient, taping the eyes delicately protecting the arms and tucking them in and teaching the residents. His story really inspired me.
Overall a wonderful visit to Butare and I can't wait to return in two weeks.
Terri

The Butare team at morning report

In the evening after our day of teaching, we went for a nice run through the National University of Rwanda campus, which is a beautiful spot saturated in the aroma of eucalpytus trees. As we ran, people would call out "Esprit!" to us, the Rwandan way of encouraging fitness and well-being. We then enjoyed our dinner of croque-monsieur (grilled cheese) and sliced avocado, which somehow took over an hour to prepare.
Friday morning, we again returned to the Butare teaching hospital where we attended morning report and heard about some of the very challenging cases that they manage here. We then did some teaching with some of the residents and technicians on airway assessment and the difficult airway algorithm, which was well received and I think they learned a lot - it will be interesting to see how it is applied in the clinical setting! Patty and I did another interview for our study which was fantastic - it's really interesting to get the Rwandan perspective on things after interviewing so many North American volunteers who have given us their opinion - many ideas are congruent, but we're really starting to understand the intricacies of how things work here.

Amazing views on the drive to Nyungwe Forest

After lunch, our driver Isaac picked us up to take us to the Nyungwe Forest. The drive was absolutely gorgeous (although a bit scary at times - we passed a lot of petroleum trucks on narrow, bumpy roads with sheer drop offs on each side - good thing Isaac is an extremely cautious driver!) - the forest is extremely lush and the landscape is made up of rolling hills dotted with small farm houses... it is very idyllic!
We are spending the night at the Gisakura Guest Lodge which is in a perfectly peaceful spot with brilliantly coloured sun birds flitting about among the flowers. It will be the perfect spot for a restful sleep in anticipation of our waterfall hike tomorrow morning :)
Lauren

A beautiful sun bird