"People don't have allergies in Rwanda"

It seems like the days just keep getting better and better.... We started off with our first day of teaching at CHUK, the main teaching hospital in Kigali, with academic day. The day started off with morning report, where all of the cases from the night before are discussed – most of them were pretty tame compared to what I’ve heard from past volunteers, although a couple of cases brought to our attention the severity of disease that is seen in Rwanda and the often limited resources that are available to the health care professionals who care for the patients here. Despite this however, it is clear that everyone is doing the best that they can under the circumstances, and it seems like things are slowly improving in the face of tremendous challenges.

Next, Adolphe, the chief resident, presented a case that he had been involved in which was fraught with anesthesia conflicts and would be too complicated to even show up on the final exam to certify as an anesthesiologist in Canada... (sorry for those non-medical people – this may not make a lot of sense). He described a woman in her 40s who had initially presented with a bleeding duodenal ulcer. After several days in the hospital, she went on to develop respiratory distress and was felt to have pneumonia. This progressed to chest and leg pain, as well as cyanosis in the lower leg (and possibly hypotension). An EKG demonstrated ischemia, and a subsequent echo should a massive thrombus in the apex of the left ventricle, which presumably was throwing clots, leading to her leg ischemia. At which point the cardiologist put her on a gamut of anticoagulants, including bid lovenox, Plavix, and ASA. Of course then she developed gangrene and required an amputation. So here we have a woman with a recent GI bleed, who has just had a massive MI with a huge clot in her ventricle, on multiple anticoagulants, requiring an amputation. The case generated some extremely interesting discussion and had many great teaching points (including the suggestion to review the ASRA guidelines on spinal anesthesia in the setting of bid lovenox + Plavix + ASA)!




After a quick lunch in the garden at Karibu Restaurant, as well as a much needed coffee fix for Terri, we headed back to the hospital to talk about anesthesia as a specialty and finish off the afternoon with an excellent lecture on cardiac physiology and anatomy by Terri. Since having done many interviews with previous volunteers in Rwanda as part of my research project, I had somewhat of a preconceived notion of the level of knowledge the residents would have (i.e. fairly basic). All of us were pleasantly surprised (especially Patty) to see how far the residents have come – they were engaged, asked extremely intelligent and thoughtful questions, and overall had a great knowledge base on which to build. We deemed our first teaching day a huge success and are excited for how the rest of the month will shape up.

To end off the fantastic day, we celebrated Patty’s birthday with a scrumptious meal at the Khana Khazana Indian Restaurant. We were joined by several of the Rwandan staff anesthesiologists, as well as Matt, and Kelly McQueen, an American anesthesiologist who is here for several weeks, and Patty’s “adoptive son” Steven, a Rwandan she met on her first trip here who calls her “Aunty Patty.” At dinner, we learned that “Rwandans don’t get allergies” – they are a Muzungu affliction.
It was a wonderful way to end off the day, and was made even more fantastic when all of a sudden all of the lights in the restaurant went black, a cheesy instrumental version of “Happy Birthday” came over the loudspeakers, and a procession of waiters came out with balloons and bells and birthday cake for Patty. The best was that “Happy Birthday” became a medley of celebration songs, including one which wished Patty a happy happy 21st birthday! It was hugely embarrassing for Patty which made it even better for us! A+++!!!

Lauren