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