Sunday, February 9, 2014

home again

Mat and I are back in Halifax after a very long journey. It was probably 30 hours of travel, or more.

This is what I woke up to.



Canadian winter can be most beautiful - sunshine on bright snow, cold air, blue sky...

I am always struck by contrast when returning from Rwanda.  It is a great privilege to live in two places  and to have Africocanadianization (as Paulin calls it).  It was wonderful to have Mat's companionship and, of course, great to share Rwanda again with Michelle.  The Rwandan people are incredibly warm and appreciative.  We see improvements in medical practice and overall infrastructure each visit.  There are always moments when I ask how much longer I can keep doing this – usually when in the midst of GI illness, after a couple of days of not eating – but I will try.  Rwanda is all about open heart.  I feel very fortunate to be able to live in two very different, but wonderful, worlds.

Stay tuned for next January...

With love,

Patty

Thursday, February 6, 2014

Mat teaches cricothyroidotomy

It's day 2 of the Basic Surgical Skills course and Dave and Brock are seeing a lot of progress with the residents.  This is the first time they've had direct instruction with hands on practice.

Mat taught the cricothryoidotomy session and found the residents were keen learners.

Orientation to the anatomy

Effective, but gross, neck model

Demonstration

Practice

Getting ready for day 2

Dave teaches chest tube insertion

Chest tube practice

Abdominal wall closure (don't pop the balloon inside)


Wednesday, February 5, 2014

more from michelle

Hi gang,
to the Halifax crowd....hang in there with the weekly snow storm!  If it makes you feel better there have been a couple of monsoon rain storms but luckily they only last about 1/2 hr.  And warm rain is better than snow any day.

There is not a lot of time to sit down at the computer and write.
We are busy with the " Basic Surgical Skills" course today and tomorrow.  Day one went very well.  They are a bunch of enthusiastic and engaged first year surgery residents.  Two of our Dalhousie surgeons Dr. Vair and Dr. Amirault flew here just to teach the course.
They are fantastic instructors and bring a wealth of knowledge.
For me it is just like a good day in the Skills Centre except we wash the instruments by hand at the end of the day.

Enjoy the opening of Olympics....I will really miss that and all the great action.  Go Canada Go!
Sounds like it is a good thing that they are starting as some of you are telling me how bad my Canucks are playing.

xo michelle



Michelle, could anyone be more glamorous handling pig bowel?

Course

youth and experience


Our surgical colleagues, Brock and Dave, have joined us this week to help teach the Basic Surgical Skills course for first year surgical residents.  This is a two day course with introduction to surgical essentials.  The residents are able to learn together in a relaxed atmosphere.  Two senior surgical residents are helping teach, thus building sustainability for the course.  

Mat and I have spent some time in the ICU in the last couple of days.  The whole disease profile we see in Rwanda is very different than in Canada.  There are many paediatric, obstetric and trauma cases.  Obstetrical complications, that would be rarely seen in Halifax, are common.  There are many cases of sepsis and also complications from infectious disease.  Generally, the people are fit and strong but one thing goes badly awry. 

I feel pleased with what we've accomplished this month.  I am able to give a little more with each visit as I continue to learn about the local needs.  The understanding that has come from long term relationships is incredibly valuable.

Mat has had more teaching opportunities this month than ever before in residency.  Some teaching, such as our formal presentations, has been well planned but often he is called upon for impromptu teaching.  He definitely understands that it is not simple and even good teaching does not ensure learning.  Nevertheless, we have both had exciting teaching moments.  

It works very well for a bright young resident to teach with a more "mature" staff person.  His knowledge bank is mind-blowing; I bring local knowledge, partnerships, perspective and understanding of the working environment.  We are a good team.  



Basic surgical skills course

Knot tying
Michelle with Christophe, who looks after the apartment

Monday, February 3, 2014

final academic day

We are into our last week in Rwanda and I'm starting to feel sad.  The time has been wonderful but it's gone much too quickly.  There have certainly been moments of frustration and disappointment but they are far outweighed by successes. It was a pleasure to teach the Respiratory block with Christian.  He taught some of the morning sessions and ran a number of simulations.  This afternoon we had the final quiz – it was all short answers and proved to be difficult.  Christian was with me to give individual feedback to each resident.  This was so helpful as he was able to make some points in Kinyarwanda and to share his experiences with the residents on the exam process and importance of studying hard.  In short, the experience with Christian was a great example of the co-teaching we would like to do more of with our Rwandan colleagues.

Michelle is on fire.  She is now shifting her attention from the simulation centre (already thriving) to the operating room nurses.  She met a very committed OR nurse today (Australian) who plans to spend a few years in Rwanda helping to build the program for OR nurse.  I think Michelle just found the right partner.

Academic day

Mat getting ready to be the simulated patient

Christine writes the exam

Christian debriefing simulation

Sunday, February 2, 2014

Mat's thoughts on Butare


Butare is a gem.  Great teaching, great hospital, great staff great residents, great Fanta, great samosas. What else do you want? How about coffee? Well guess what? They have that too! Possibly the best cappuccino in the world. Yep, the world. In Rwanda. Amazing. They need to have a "to go" system. Because the guy that works at cafĂ© connexion is certifiable (like the coffee).  Also, he described his business model to me. It reminded me of my lemonade stand (sell refreshing lemonade for less than cost and then have dad bail me out).

Anyway, split my time between the residents in Butare. Great trauma cases deftly handled. And one of the residents did their first ultrasound guided popliteal block! It was like he had been doing it for 20 years. NBD.

What a time we had in the jungle!  The only bad part is karma has final caught up with me. I believe the GI gods (AKA Zeus god of thunder) punished me for my earlier comments about Dr. S.  Yeesh. Nothing a stat infusion of Serena won’t fix!

With any luck you will only have to read about 2 more of these from me.

Bam.

M

from Michelle


Hello from warm Kigali....only 28C!
Sorry to rub that in.

One of the joys of being here is lack of internet access.  When you really think about it it is a healthy break.

My journey to get here was seamless (got out of Canada between snow storms).
I was so warmly welcomed by my friends Emmy, Mary, baby David and Christophe...felt like coming to my second home.

My first day visiting the Skills Centre warmed my heart.  It is so busy and being used by many different groups of healthcare professionals.   Angelique is amazing and doing great work.  She is glowing with her first pregnancy...I was happy to unload half of my suitcase filled with baby clothes for them.

I traveled to the university city of Butare on Friday to meet Patty and Mat who have been teaching anesthesia for 3 weeks already.  They were ready for a hike in the incredible Nyungwe National Forest. 
It was a rainforest, lush and tropical.  We did 2 hikes, day one the Canopy Walk, suspension bridges over the tops of the trees and day two a 4 hour hike to a waterfall.  We were extremely lucky on that day to see a family of Mountain Monkeys swinging from tree to tree.  Rwanda is filled with beauty, not just the typical savannah grass lands you picture when you think of Africa.

The drive to and from Nynungwe from Kigili is 4 1/2 hrs  but fascinating....passing through hills planted with crops of bananas, sweet potatoes, coffee, eucalyptus, and sunflowers.  Fields are full of rice and tea.  But truly the part I enjoy most is watching people.  Walking everywhere, packing the most unbelievable things on their heads, kids playing soccer in every corner and people working hard.  And very sobering was passing the Kigeme Refugee Camp (the last photo) for Congolese refugees.
We are incredibly lucky to be Canadian!

So it is time to prepare for a week of work....I am excited to help run the Basic Surgical Skills Course this week with Dr. Vair and Dr. Amirault as well as the Rwandan doctors.

big hugs to everyone and GO SEAHAWKS GO!!!

xo michelle

Christophe with his Canadian Olympic t-shirt

Sim centre

Kigeme Refuge Camp

Patty and Mat before the Canopy walk

Igishigishigi tree ferns

Nyungwe Forest and waterfall

Saturday, February 1, 2014

resident rock

Tea plantation around Nyungwe Forest Lodge

The waterfall hike is a four-hour hike in Nyungwe Forest.  It begins in a tea plantation but the path goes through the lush rainforest, along a couple of rivers and finally ends at a gushing waterfall.  It is an enjoyable hike that I’ve done many times.  There is a rock near the waterfall where I’ve photographed all the residents I’ve travelled with, except Genevieve (we did a different hike). 


It has been wonderful to share my time in Rwanda with an excellent group of residents, some of whom are now staff anesthesiologists.  


Genevieve - 2008
Ariane - 2010
Shannon - 2011




Terri and Lauren - 2012


Michelle - today
Mat - today