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
Sunday, January 15, 2012
Friday, January 13, 2012
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.
Overall a wonderful visit to Butare and I can't wait to return in two weeks.
Terri
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.
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
 |
| 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 |
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 |
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 |
Wednesday, January 11, 2012
Thank God that guy broke the toilet!
We began our day in the OR/ICU, continuing to be impressed with the enthusiasm, commitment, and motivation of the medical students and other health care practitioners here. Bona, a new anesthesia staff person who joined us in Halifax for 6 months a couple of years ago, thoroughly impressed Patty and I with his excellent management of a difficult neonatal case, in which he was a fantastic role model for the anesthesia technicians and residents in displaying his leadership and communication skills under pressure - we were very excited to see him being so effective in action!
The afternoon was spent in true Rwandan style, waiting over 2 hours for our driver to take us to Butare. I guess there was some mix up in organizing a driver, and of course remedying the problem here is not so simple as picking up a phone and calling the driver... first, one must go to the Ministry of Health to speak with someone, and that person will then go about making the arrangements. Then someone else needed to accompany the driver to our pick up location, we dropped that person back off at the hospital, and then finally, we were on the rode to Butare.
The drive was incredible - amazing green rolling hills, children skipping home from school dressed in cute little uniforms with bright smiles, and tons of new construction everywhere. Our driver was friendly and very safe and we arrived in record time.
Our hotel was a place Patty had stayed many times before and the people were very friendly. Unfortunately we were given rooms in the basement and they reminded us of rooms in a Norman Bates movie. Then as if someone was watching over us the porter was trying to help us with the toilet and he broke it! The next thing we knew we were up on the first floor in lovely rooms and had a great (and much needed!) night's sleep.
Today we're off to Butare to continue our enthusiastic teaching with some of the very keen new first year residents.
Terri
The evening got much better because we had a delightful dinner with Dr. Jeanne the Head of Anesthesia. She has a wonderful way of laughing off all the many challenges they face.
The afternoon was spent in true Rwandan style, waiting over 2 hours for our driver to take us to Butare. I guess there was some mix up in organizing a driver, and of course remedying the problem here is not so simple as picking up a phone and calling the driver... first, one must go to the Ministry of Health to speak with someone, and that person will then go about making the arrangements. Then someone else needed to accompany the driver to our pick up location, we dropped that person back off at the hospital, and then finally, we were on the rode to Butare.
The drive was incredible - amazing green rolling hills, children skipping home from school dressed in cute little uniforms with bright smiles, and tons of new construction everywhere. Our driver was friendly and very safe and we arrived in record time.
Our hotel was a place Patty had stayed many times before and the people were very friendly. Unfortunately we were given rooms in the basement and they reminded us of rooms in a Norman Bates movie. Then as if someone was watching over us the porter was trying to help us with the toilet and he broke it! The next thing we knew we were up on the first floor in lovely rooms and had a great (and much needed!) night's sleep.
Today we're off to Butare to continue our enthusiastic teaching with some of the very keen new first year residents.
Terri
The evening got much better because we had a delightful dinner with Dr. Jeanne the Head of Anesthesia. She has a wonderful way of laughing off all the many challenges they face.
Tuesday, January 10, 2012
off to Butare
We are heading to Butare today for two days and then will go to Nyungwe Forest for the weekend. Butare is a smaller city in south west Rwanda and home of the National University of Rwanda and the medical school. I believe there will be five residents there now.
Nyunwe Forest is 1,000 square kilometers and the continental divide runs though there separating the waters flowing to the Congo and Nile Rivers. There is a rich variety of plant and bird species.
Nyunwe Forest is 1,000 square kilometers and the continental divide runs though there separating the waters flowing to the Congo and Nile Rivers. There is a rich variety of plant and bird species.
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
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
Monday, January 9, 2012
"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
Sunday, January 8, 2012
An A++ Day
Today was our first day in Kigali and our goal was to get ourselves "operational" as Patty puts it. We started with our first Sunday breakfast together and then Lauren and Patty ventured off to the market and returned with a rainbow coloured medley of bean and fruit and veggies for dinner.
Then it was off to get some "cash power" which we found just down the street from us and within minutes we were plugged in again. Not that we really needed it for the day because the apartment has such a nice light during the day and as we later found out we even get treated to a sunset view from the balcony.
Then it was off to get our memberships at the Serena Hotel, we discovered a spinning class which will get our cycling legs warmed up for our cycling trip the third weekend we're here. We walked everywhere today and it was incredibly easy given all the newly build sidewalks and infrastructure. We all agreed that the streets are cleaner than they are back home and the landscaping is truly something to photograph, our favorite was these very bring orange flowers that looked like groups of pipe cleaners.
It was then off to the MTN store (that we've coined the "Mountain Store") for internet access and new SIM cards, hence the first blog post because we are now connected!! We took a detour to the Bourbon Cafe for a bite and some tea and I discovered some yummy and very strong coffee that cured any lingering jet lag.
The second plus in the A++ comes from our shopping trip to Nakumatt for more essentials. We won a gift card for a return trip! We didn't exactly understand why we were so lucky but it definitely added to our successful day.
The last item on our list was a "working dinner" with Matt McNevin, a brilliant future medical student from Canada here on a CIDA scholarship teaching physiology at the Kigali Health Institute. He will be helping us with our cardiac physiology lectures for the resident academic day. We had a great evening and in exchange for dinner Matt gave us some much needed physiology tutoring.
Looking forward to our first day of work tomorrow!!
Terri
Subscribe to:
Posts (Atom)