Sunday morning

What could be a better start to Sunday morning in Rwanda than a two hour walk with Bona followed by a massive breakfast at the Serena Hotel? The hotel even paid for our breakfast this morning as a reward for being such good customers.

Tristan has gone to visit the Kigali Genocide Memorial.  I am preparing a quiz and simulated scenario for our next teaching day (Tuesday).  Monday is a holiday for Heroes' Day.

More on Heroes' Day:

National Heroes' Day commemorates events that occurred after April 6, 1994, when Rwandan President Juvenal Habyarimana and the president of Burundi were killed when their airplane was shot down. After that, the Rwandan military began to systematically kill all Tutsis and moderate Hutus. Local officials and government-sponsored radio stations called on ordinary citizens to kill their Tutsi neighbors. Hundreds of thousands of Tutsi and moderate Hutus were killed. This is now known as the Rwandan genocide. Victims of this genocide are remembered on Heroes' Day.

During the Rwandan genocide, rebels surrounded the Nyange Secondary School and asked the students to identify the Tutsi students. When a group of students refused to do this, the rebels killed them. This heroic act is also remembered on National Heroes' Day. Wreaths are laid at Nyange in memory of students who stood against the rebel forces. The national Heroes' Day celebration at Nyange features songs, dances, and poems praising the virtues and good example of the national heroes.The people are reminded of the great value in service to the country that the national heroes have shown those who are still alive.

Just downhill from our apartment 

Jean Marie, Bona, Tristan and Patty, happy walkers

It could be rural Rwanda

Cassava plant

Graveyard in the hills

Goats wander untethered

Carrying vegetables on the head

Local shop and moto

CHAN quarterfinal

Today is the CHAN quarterfinal with Rwanda vs Congo. Busloads of Congolese fans have arrived. The Congo president has promised each player a Toyota Land Cruiser if the team wins this game. People were released from umuganda (community service morning) early to get to the stadium. This is a huge deal. Imagine Canada vs USA gold medal Olympic hockey game times ten. 

Score now 1-1.

Christophe ready to go to Amahoro stadium

Later: Congo scored in extra time, so it is all over for Rwanda.

We are happy to welcome Matt, Charissa, Lucas and Gracie to Kigali.

The Ho family, happy to be in Rwanda

teaching, ice cream and monkeys

The sky is overcast, promising more rain.  Dramatic lightening, thunder and intermittent heavy rain in the past few days. Ravens are scratching frantically on the roof.  The air is rich with the earthy smells of last night’s rain.  A cleaner is mopping up while listening to tunes on the radio.  Large thermoses of coffee and hot milk are coming. Morning in Butare.

Butare offers fabulous teaching opportunities, orderly operating rooms and relative calm.  This helps compensate for the limited food options, cold showers and don’t get me started on the Credo Hotel rats. Hence, we stay at Mont Huye.

Jeanne, Theo and now Gaston, have provided steady leadership so the operating rooms have a sense of being under control. Delightful.  Yesterday, Tristan helped his colleagues anesthetize a 5 day-old baby for two-hour surgery – smooth anesthesia and a good outcome.

In the afternoons, we gather a small group of residents for discussions on anesthesia topics. They love it.  They are coming in post call, as they are so eager to receive teaching. We’ve relocated the venue to Inzozi Nyziza (the ice cream shop) so the discussions are augmented by ice cream, coffee and the ever-present Fanta citrone.

Gaston has stepped into the role of staff anesthesiologist beautifully.  He has an onerous call load, as he and Theo are the only two anesthesiologists in Butare. This means they are each on call half the time. Unfortunately, Gaston’s wife and children live one hour east of Kigali.  This means Gaston can only be with them every other weekend. Clearly, this is far from ideal. Tristan and I had dinner last night with Gaston and discussed potential solutions. His family needs to be with him.

We are heading back to Kigali tomorrow afternoon.  Matt is arriving late tonight. It will be great to catch up with him and his family.

Beautifully manicured grounds of CHUB

Ice cream and teaching 

Tons of monkeys on the land behind the university

Our dear friend Gaston at the hotel where he is living

Tristan had to hit the little button

Yesterday was a lively academic day full of excellent discussion and participation.  It's amazing that the residents can keep engaged and curious for a full day in this heat.  I've attended the first year class and Tristan has been with the seniors. The first year class is very impressive: well prepared for sessions, keen to answer and ready for challenges.

In the afternoon we ran though three scenario with debriefing. Tristan is getting quite skilled at manipulating the vital signs so the learners see and hear the changing patient parameters.  The new speakers allow the pulse oximetry beat and changing tone to be clearly audible. Following the sim scenarios, we had journal club with two residents each taking the lead on presenting a paper.  This was around 5:00 PM and the group jumped in when the presenter overlooked a key section. "You didn't discuss the results".  So conscientious.

Towards the end, we have a visit from the new Principle of the College and Medicine and Health Sciences (Professor Jeanine Condo).  She is a lovely lady and clearly committed to academic excellence. She heard the tail end of journal club, and promised to return next time. 

Then we showed her a simulated scenario of routine anesthesia induction for a 7 year old child for ORIF radial fracture.  Tristan pulled out all the stops and gave anaphylaxis post induction.  The residents recognized it and managed it capably.  Then the temptation overcame him and he had to press the v. fib button. Sure enough the residents recognized, began chest compressions and even shocked the patient with small portable defibrillator. With their good care, our simulated patient recovered. The Principle was most impressed with the capacity of the sim centre and quality of the residents.

We finished off a full day with dinner at Heaven Restaurant with Francoise.  

We are now waiting to be picked up to go to Butare.  Previous volunteers will know, this can be a long wait.

Anesthesia residents, staff and the Principle of the College of Medicine and Health Sciences.

curing the man cold

Tristan working on the man cold with a large Mutzig.  Watching the Rwanda - Morocco game.  

relaxing weekend in Kigali

We are enjoying this weekend as a chance to catch up from a busy week and prepare for the next one.  It is lovely to have a little unscheduled time.

A few random comments...

Hike with Bona:
We did another long walk with Bona and his friend around the hills that surround Nyamirambo. Truly, it is amazing that only 10 minutes from our busy neighbourhood one can be on dirt roads with homes that could be anywhere in rural Rwanda. The air is clean, birds are plentiful and the vegetation is lush. There are lots of photos on a previous blog post. We arrived back at Serena in time to do justice to the massive breakfast buffet.

African Nations Championship:
The Rwandans are thrilled their team is 2 - 0.  The team has a poor track record, so these wins are massive for national morale. Rwanda faces Morocco later today. Tristan and I might try to find a comfortable TV screen for viewing (cold drink in hand). Apparently, the fans from Congo are the noisiest of all. One wealthy man from Congo hired 80 buses and sent them to Rwanda full of lively Congolese fans. Those who can get into the stadiums cheer their team with vuvuzelas or drums; those who remain outside set up music and dancing.

Malarone dreams:
I seem to have pretty crazy dreams most nights. Last night, for example, I was setting up a CASIEF program in Russia and had an unpleasant episode with Vladimir Putin. Where does this stuff come from?

Man cold:
Tristan has a man cold but he's been a pretty good sport about it. As long as he doesn't get GI illness, I'm happy.

Coming week:
We have a full on academic day tomorrow with teaching in the morning and simulation in the afternoon. This will be followed by journal club and dinner with Francoise.  Then we are off to Butare Tuesday till Friday.  We look forward to welcoming Matt, Charissa and their adorable children later this week.

I hope you got spared the worst of the snow.  It will be our turn soon enough. Sadly, our time is going much too quickly.

xo
Patty

Trying to heal the man cold

sports day

Friday afternoon in Rwanda is reserved for sports.  People are meant to leave work early for physical exercise.  Such a great idea! 

I've just had a workout and Tristan is off with Christophe to watch an African Nations Championship football match (Nigeria vs Tunisia). We hope it will be less hectic than the match Michelle watched (Rwanda is not playing) but maybe we are being naive. 

We spent the morning at the sim centre preparing for scenarios on Monday. This included shopping for speakers to make the sounds of the pulse oximeter and blood pressure cuff inflation more audible.

We will be in Kigali over the weekend and then head to Butare on Tuesday for four days. 

Tristan's blog post exceeded expectations.  Thanks, Tristan.

Celeste is ready for surgery on Monday

calla lilies on the way to find speakers

Tristan v2.0 - Teaching at the King Faisal Hospital

Tristan v2.0 - Teaching at the King Faisal Hospital

Little known fact: After Fievel went West in 1991, he kept going west… ending up in in Rwanda, where he settled his small Mousekewitz family, made some wise political moves, dethroned the then king, and ushered in a brief reign of peace among the mice of the country. They named the new hospital after him, but, owing to the pronunciation in the Bantu language spoken here, where “v” takes on an “s” sound, if proceeded by an ‘ie’ and followed by “el”, the spoken name sounds like Faisal, and thus the sign-maker, a gentleman named Claude (pronounced “Frank”, for similar reasons), fashioned the sign above the door to read “King Faisal”. Although terribly embarrassing for Claude, he was saved horrible public disgrace because, purely coincidentally, the major funder of the hospital was a philanthropic foundation, named after King Faisal bin Abdulaziz, who ruled Saudi Arabia from 1964-1975.  

Dylan, you can perhaps get a sense that twitter is not my ideal medium…

Okay, so Week 2 almost done and dusted, and many great experiences to relate, most of which are firsts, for me.

1. Gorilla Trekking: A few pictures on twitter and facebook already, but hard to do justice to the connection I felt sitting mere feet away from curious infants, rough and tumble juveniles, temperamental mothers and 500lb, brooding Silverbacks… probably 15, all within a ten foot radius, at one point. We got so lucky that the sun was shining and they weren’t particularly concerned about hiking all over the mountain, letting us soak up their company and snap pics to our hearts content. Just incredible.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
2. Spinal anesthesia in a 7 year old with a fractured femur: Just not done where I’ve trained, because 7 year olds shouldn’t be able to handle sitting still to get the medication into the CSF, through a small needle in the back. This little guy did though… like a champ. We had fun counting to twenty in four different languages as the anesthesia resident deftly got set up and performed the minor miracle. Both the spinalizer and the spinalized are going places… big places. OR went great. Perfect anesthesia.
3. Sim scenario: On Monday, I introduced the sim afternoon session and essentials of communication for the anesthesia residents, ran the sim and debriefed everyone afterwards, which was a great experience for me and something I’ve not done back in Halifax. Great participation by all the residents make these sessions particularly enjoyable. Thanks to Patty for paving the way. Running simulated anesthetics is quite fun, although I continually have to stop myself from sending the sim person into a vfib arrest at the click of a button. Thanks to SimMon software for practical solution to low tech sim. 
4. Teaching and Learning course: Patty’s expressed how happy this course made her (x3, I believe), and I completely agree: It was great. She did a stellar job teaching 3 of the 4 sessions and then just as the post-lunch food coma was settling in around the room, saddled me with the last afternoon session, teaching a 45 min lecture on mentorship in medicine to surgeons and anesthesia residents who have no concept of mentorship in place currently, having only seen the lecture slides the night before, with the national Rwandan football team playing a African Nations Championship game in the city concurrently… it’s hard to say no to Patty, as many of you may know.   Haha. She clearly knows best though, and I had a great time teaching and they apparently had a great time hearing about these foreign concepts and how mentoring may help in this system. The most common suggestion on our feedback cards was “More of this, earlier in residency!”.
5.  OR teaching: I was worried I wouldn’t have enough to talk about when residents asked me questions in the OR, but I think it’s a credit to my own teachers in the past few years that I seem to be reasonably well equipped to chat about most of the anesthesia related queries I am posed.

Alright, enough’s enough. You get it: I like teaching.

Until next time, Umunsi Mwiza (pronounced “Have a nice day”, again, for the above-mentioned, complicated, Bantu-derived diction. Ironically, it is the only phrase that actually sounds like it’s meaning in English, when spoken in Kinyarwandan by a native speaker)