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

There are no stairs in Kibungo!

We had yet another successful day of teaching at academic day. This was our most ambitious day yet and included sessions on neurophysiology, a resident case presentation, Anesthesia Non-technical Skills, an airway workshop, and a session on hypertensive emergencies. Dr. Paulin joined us for the afternoon teaching and did an incredible job teaching the residents about hypertensive emergencies. He also reviewed how to take a history on functional status with the residents and reminded them how to tailor their questions, such as not asking if a patient can climb stairs without getting chest pain if they're from a place with no stairs! The residents continue to be so keen and enthusiastic at academic day and we're encouraged by how much reading and preparation they're doing.

Patty's accommodation at the Paradis Malahide!

Lauren and I are still recovering from our 9 hour gorilla trek, 9 hours!!! We did end up seeing the Susa group and had such an incredible experience spending time with over 15 gorillas! One even took a liking to me and was posing for the camera. This week we head back to Butare again for more resident teaching and we're also holding journal club this week as well as M and M rounds, busy busy busy!!!

More news to come in the near future!

Terri

Intore Dancers welcoming us to our gorilla trek

My "special" gorilla friend!

Getting a good bite to eat

Relaxing after a big meal, he looks like he's watching TV!

not the muzungu cycle tour

Lauren and Terri managed to see the Susa group of gorillas, which is the largest gorilla family.  They are still working their way down the mountain, as the Susa group is very high up at the moment and the hike up to see them was six hours!

After four trips to Rwanda, I can definitely say that today was my greatest immersion in African culture.   I had a 28 km cycle tour around Gisenyi with a guide.  We began on paved roads along the shore of Lake Kivu but were soon cycling potholed dirt roads on the far side of Gisenyi.  The streets are lined with simple dirt houses and there are people everywhere.  Children call “muzungu, muzungu, how are you?” while running after the bikes. Women carry everything imaginable on their heads.  There are fields of vegetables or flowers here and there.  Small shops carry vegetables and the ever-present cell phone cards.

We made a number of short stops including a huge market full of fruits, vegetables and used clothing.  People were laughing their heads off at us with our bikes and me wearing a Project Rwanda cycle jersey and bike shorts!  It helps to not worry about one’s image…

We got lots of thumbs up and cheers of enthusiasm from the Rwanda cycle team when they cycled past on their road bikes and spandex gear. 

We also stopped at a community centre that serves people with disabilities.  They teach disabled adults various crafts (sewing, knitting machine, woodwork, basket crafts) and have a program for deaf children and mentally challenged children.  The centre is sponsored by the zoo in Columbus, Ohio.  Don’t ask me the connection! 

My guide introduced me to a friend of his.  This person has had both hands amputated midway down the forearm – clearly an act of war.  It is incredibly sad and I can’t imagine how he is able to live with this horrendous disability.

This is a country of such contrasts.  Almost without exception, the Rwanda people I’ve met radiate kindness.  The land is spectacularly beautiful.  I am looking out over Lake Kivu where people chant and sing while race large wooden canoes.  

Lake Kivu

This morning I met with a group of six nurses from several wards at CHUK to hear their challenges in caring for their patients with pain.  It certainly is tough.   We explored the obstacles and some potential solutions.  I am always inspired to see such committed staff despite the enormous difficulties they face.

We packed our bags and left Kigali in the early afternoon.  Our driver dropped me off in Gisenyi, on Lake Kivu, before taking Lauren and Terri to Kinigi.  They will be trekking to see the gorillas tomorrow.  I’ve been able to see the gorillas before and preferred to have a quieter weekend in Gisenyi. Tomorrow, I will join a small group to do a cycle tour of Gisenyi!  Lauren and Terri will meet me tomorrow evening after the gorilla trek.

The Paradis Malahide is a slightly funky hotel on the shores of Lake Kivu.  The gardens are lush with greenery and mango, banana, avocado, and orange trees.  This evening I watched a race of traditional boats on Lake Kivu.  

When monkeys attack...

 On very short notice Bona managed to gather together a group of about 50 surgeons, anesthetists, nurses, and technicians to discuss the implementation of the WHO Surgical Safety Checklist.  Bona spoke passionately about dreams and dedication being a powerful combination.  It is very inspiring to see him manifesting such leadership.
There was also a meeting of the Rwandan Pain Society today.  Paulin founded this organization about one year ago and they have accomplished so much.  We spoke about the need to begin educational programs this year.  Perpetua, the wonderful Director of Nursing, has arranged for me to meet with a small group of nurses from a variety of services on Friday to explore how they are implementing pain management strategies on their wards.

Mountain Monkey :)

Deep in the Nyungwe Forest

The Resident Rock

Gilbert and his ladies

Lauren and Terri have been doing some great teaching with the residents.  We have been working hard to promote non-technical skills like communication, planning and anticipation.  There is still a challenge transferring theory to good clinical practice.
Outside of work, we've been swimming at the Serena Hotel and relaxing by the pool.  I probably shouldn't tell you but Kigali has a near perfect climate! Lauren and Terri are knocking back some very large beers as I write.
We had a most wonderful day last Saturday.  We hiked to the waterfall near Gisakura Guest House.  After being told we were very unlikely to see any monkeys, about 5 minutes into the hike, we came across a large group with four different species of monkey.  They were leaping through the trees around us and one even threw a small branch at us.  After the hike we headed to the Nyungwe Forest Lodge for lunch in an most idyllic setting overlooking the tea plantations.

Tea plantations surrounding the Nyungwe Forest Lodge

The Kamiranzovo Waterfall

Coming up this weekend is a trip to Gisenyi and gorilla trekking for Lauren and Terri.  They have promised to post some photos tonight.
We have some very challenging peds cases tomorrow...
Love to you all.
Patty

More monkeys!!!

Relaxing poolside at the Serena

A quiet day in Kigali

Terri and I began the day with a run up the Nyamirambo hill.  On the way back, we stopped in the local market just as it was opening up and stocked up on fruit and vegetables.  We spent the rest of the day working on our teaching program and enjoying the pool at the Serena Hotel.  Sender (McGill surgeon) and Heather (McGill surgery resident) arrived tonight and joined us for dinner along with Paulin and Matthew (our physiology expert). 
Patty