precious water and air

Sometimes we forget how incredibly precious water is.  It flows freely from the taps in Halifax, so we rarely give it a second thought. Rwanda has not had rain in 3 weeks and 12 million people still need water. Many people must carry their water supply for many kilometres to their homes. Even though we are in constant negotiations with our landlord about when to turn on the water pump, we are fortunate to be able to shower at the Serena Hotel. Nevertheless, my appreciation for water is heightened by being in Rwanda.

Likewise air. At home we work in operating rooms with good air quality and forget that other anesthesia providers around the world breathe anesthetic gas all day. There are many barriers to implementing regular scavenging here but probably one of the greatest obstacles is accepting the status quo.

We spent our day at RMH, another teaching hospital with better infrastructure than the main public hospital. I worked with two enthusiastic first year residents, both female.  Historically, the residency program has been largely men, so it is great to see four women in the new first year group. They are eager learners. One had been up all night in ICU but came to the OR just to work with us. I finally had to tell her to go home and get some sleep around 1:00 PM.

It is hard for the residents.  There is a shortage of anesthesiology supervisors, so the residents are often taught by anesthesia technicians. There is a significant range of skill for the technicians - some are excellent and others rather weak. The problem is that the junior residents often get mixed messages because in many cases we teach different practices than those of the technicians. An added challenge is that there are too many people trying to give anesthesia without clarity of who is doing what. The anesthesia team today in my room had one technician, two residents, one medical student and me. This, plus the constant alarms that can't be silenced and are often nuisance alarms, leads to a very chaotic situation even for routine cases. This just reinforces that work still needs to be done.

However, the new residents are so bright and enthusiastic, I have great hope that anesthesia will continue to improve. There have already been enormous improvements since I started here in 2008.

full moon at Serena