Wednesday, July 31, 2013

last day

So last night Rwandan TV ran a piece about the sim centre opening in English, French and Kinyarwanda.

Here is the piece from the New Times:

http://www.newtimes.co.rw/news/index.php?i=15435&a=69130

Here are some of Michelle's photos.

Emmy is so proud of his new car

Gisimba Orphanage

Gisimba

Karim and Brune

soccer at Gisimba

An unstable load

Angelique

Jill getting ready for basic surgical skills course

The CHUK office centre and banana stand

ready for basic surgical skills course

The walk to work
Two stellar nurses

goat brochettes and the best potatoes

relaxing at the Muhabura Hotel

buying baskets on the Congo Nile Trail

little house in the tea field

Emmy and me in the sim centre

TV camera man

Tuesday, July 30, 2013

news flash

There is a major news item on Rwandan national TV on the sim centre.  Yeah!!

grand opening

The sim centre is officially open!  There was the expected amount of chaos – and a very late lunch – but we had an excellent turnout and great enthusiasm.  We had eight stations set up to demonstrate specific skills and one operating room set up with a team doing the Surgical Safety Checklist.  The centre was packed.  TV and news reporters were covering the event.  I helped the Minister of Health’s representative cut the ribbon.  It has been wonderful to see the dream become a reality.



All set up and ready to go
Michelle, Angelique and Theo


officially open

Keith demonstrates the colonoscopy trainer

operating room simulation - Checklist

scrub nurse extraordinaire 

Guest at the grand opening

Monday, July 29, 2013

getting ready

Tomorrow is the grand opening of the simulation centre.  Today we've been scurrying around getting ready.  The washroom was completed today.   This is a big deal as there has been no washroom in the sim centre till now. We are still not certain of the guest list but the centre looks great and we are ready.  There are stations set up to demonstrate how the centre can be used.   The reception will be under a large tent that is being erected in a nearby field.

We are very proud of our new squeaky clean washroom

Sim set up for the OR

Sim instrument table

Colonoscopy trainer

Sunday, July 28, 2013

weekend adventures


Jill and Keith had a fabulous weekend of gorilla trekking to the Susa group – where they saw twin babies and a baby gorilla only three weeks old.  A silverback sat down next to Keith and rubbed up against him.  They spent today cycling part way down the Congo Nile Trail and around the hills near Gisenyi.

On Saturday morning, Michelle and I met our friend Tom, who runs Rwanda Adventures, his wife, Natacha, and porter, Twisiere, a former member of the Rwandan cycling team.  The plan was to cycle to a lodge just the other side of a forest we would be visiting on Sunday.  The ride followed the Congo Nile Trail for a bit then turned inland.  It hasn’t rained in a long time in Rwanda; it is the middle of the long dry season.  The whole country is parched, which is very different from the lush greenery I’m used to when visiting in January.  Tom had sturdy mountain bikes for us and we set out along the dirt roads that pass near Lake Kivu. We passed by farms and small villages where they are growing bananas and coffee.  Tom speaks Kinyarwanda and has done a lot of work with the local villages to create an environment that is respectful and sustainable for ecotourism.   He arranges stops for snacks in the villages to support the locals.

We stopped for lunch in a field.  Tom had brought a picnic lunch with avocados from his garden, local cheese, tomatoes and chapattis. The ride was uphill for over half the day.  It was a hard slog! We expected to stay at a lodge just the other side of the forest but it turned out to be far more elusive.  After all our hard work up hill we had a two-hour downhill ride looking for this lodge.  It got a bit scary because it was getting close to 6:00 PM and we still hadn’t found the lodge.  It gets dark rapidly in Rwanda; the country is very close the equator.  I had visions of us huddling together for warmth and sleeping the forest without blankets or food.  Fortunately the mysterious lodge was found in the nick of time.  We had African tea and began to think about the options for the next day.  Ten hours of cycling plus the three-hour road trip back to Kigali did not seem possible, or enticing.  Tom said it would be possible to get towed uphill with one hand on a moto and the other on the bike.  I figured a helicopter rescue would be worth it but finally we settled on arranging a pick up truck to get us the next morning bright and early.  Our team settled down to a few Turbo King beers and some good Rwanda food.

We woke up this morning at 5:30, when it was still dark.  After omelettes and tea we loaded up the pick up truck with the bikes.  Michelle, Tom and Twisiere road in the back of the truck holding the bikes to keep the pedals from damaging the spokes.   We hiked in the forest for four hours then had a ripping fast decent to Gisenyi for several hours. We met Jill, Keith and Emmy at Paradis Malahide and heard about their great gorilla adventure. 

Lake Kivu from Paradis

The happy camper enjoying breakfast

We were a spectacle in the small villages

Tea plantation and the thousand hills

More tea

Baling out in the pickup

Friday, July 26, 2013

off to Gisenyi


This will be super brief to let everyone know we are alive and well.  I've finished three days of interviews and we are en route to Gisenyi for a weekend of cycling.  Please stay tuned for photos and update on Sunday.

xo
Patty


Rwamagana Hospital

Michelle with children en route to Gisenyi

Jill and Keith

Wednesday, July 24, 2013

visiting the district hospitals

Yesterday, Gaston, Etienne and I made site visits to a couple of district hospitals to follow up on whether anesthesia providers have been able to change their practice as a result of the SAFE Obstetric Anesthesia Course.  These practitioners work in quite isolated settings with little support and all expressed gratitude for the training they received during the course.  Our hands on approach during the course of skills practice, discussions and scenarios, where participants had to role play to manage emergencies, clearly left an impact.  We heard some very positive news about practice change.  There is now question people took the training to heart.  

We have a busy schedule of more interviews today.  Thank goodness our wonderful friend and driver, Emmy, is guiding us around.  Last night was passed at the Dereva Hotel, where we held the SAFE Course.  We were warmly welcomed as celebs.  I got the VIP room:-)  Jeremiah was beaming and wanted to know all about Megan.  Everyone wants to know when she will be back.


Research team at Kibungo District Hospital

Kibungo

Michelle's day

Keith and Jill did a fantastic job instructing the course with local faculty Dr. Alex, Dr. Dominique and Dr. Georges.
The residents were energetic, engaged and grateful....only wishing they had the course earlier in their training and requested more.
It was a great introduction to the Simulation and Skills Centre for most of them.
Angelique takes great pride in the centre and continues to grow in her role as the coordinator.

It was rewarding and refreshing for all of us!
I felt I learned as much from them as they did from the course.


Looking forward to the OR tomorrow.


cheers michelle



Keith preparing the students for their next task



Jill and her colleague Dr. Alex

Happy users of the FOMSSC


Tuesday, July 23, 2013

courses

Yesterday Michelle, Jill and Keith spend the day intensely preparing for the Basic Surgical Skills Course to be taught today and tomorrow.  This is a hands on course at the simulation centre where junior surgical residents practice many of the techniques they will need in the operating room.  Having the simulation centre is great because without being able to run courses like this the residents are often observing in the OR.  They learn so much more from doing than watching.

I met with my Australian pain colleagues and Drs. Willy and Jeanne yesterday to prepare for the Essential Pain Management Course today and to brainstorm future directions for improving pain management in Rwanda.  The needs are immense so it can be hard to know where to begin.  Nevertheless, we have a great discussion and devised plans to run future EPM Courses, arrange a Pain Education Day and work towards establishing a multidisciplinary pain management unit.  This will take a while but with keen local partners, there is hope.

I spent the afternoon teaching the anesthesia residents.  No power points! We had a great discussion about pre-operative assessment in general and the role of investigations.  Everyone participated actively.     I truly love teaching when people are so hungry to learn.

The street in front of our apartment is finally paved and there is house number!  Prior to this we were on a dirt road and the only directions we had were to take the first street to the left after the Merez gas station.

We are in the front apartment second floor

A street number at last

I have had a GI bug and am resting today but plan to go into the pain course if I feel a bit better.  Thank goodness I am only observing this one.


Michelle and Angelique, the sim coordinator, prepare pig intestine

Sunday, July 21, 2013

Steven's story

I am in Rwanda with Michelle, Jill and Keith.  Michelle, who runs the skills centre at home, was with me in February and has put her heart and soul into helping establish the sim and skills centre in Kigali.  She is completely passionate about creating situations where health professionals can learn and practice in the best way possible.  She is thrilled to be back in Rwanda and I'm grateful for her wonderful energy.

Jill and Keith have just completed their training in Urology and General Surgery respectively and are about to start jobs in August.  For a long time they've wanted to make a contribution to global health and agreed to join us in Rwanda.  They will help teach a basic surgical skills course at the sim centre in a couple of days.  It has been delightful to have their perky, enthusiastic energy.

Last night we had dinner at the Khana Khazana Indian restaurant with my friend Steven.  He is the young man Genevieve and I met at the memorial site in 2008.  Steven is now in third year law school and working during the days at a law firm.  Today he was kind enough to take Jill and Keith to the memorial in his home in Nyamata.  They all joined Michelle and me mid-afternoon and I asked Steven to tell his story about his experiences in the genocide and with forgiveness.  I cannot possibly do justice to his tale, so I won't try.  Suffice to say we listened attentively in awe of his ability to recount, to use metaphor and to heal.  He has learned much about forgiveness and is now helping his surviving family members to overcome their grief and pain.  Once again, we encouraged Steven to write his story. It should be shared widely.

We have a busy week coming up.  I will finally meet my pain management colleague, Roger, who is joining us from Australia.  We've know each other for years, collaborated on curriculum, and spoken often on skype but have never met.  He is coming to teach the Essential Pain Management course.

As always, the days here are full and magical.
View from my bedroom window this morning
Jill and Keith



Michelle hard at work preparing for the next course
Steven and me