Monday, January 30, 2017

Bittersweet day


From Patty:

It was a bittersweet day. The residents have made great progress in a short time. The discussion this morning at academic day demonstrated a more nuanced and less formulaic understanding of anesthesia. But we are sad this is our last day with all the residents.

It is extraordinary that the residents can keep focused through such a long day. The teaching day included: morning report at 7 AM, core teaching on sepsis, cardiomyopathy and malaria in pregnancy, a resident case presentation, quiz, grading the quiz over buffet lunch at Camillia’s, simulated scenario, debate on whether general anesthesia or spinal is best for C-section in patients with mitral stenosis in this context, feedback, discussion of resident research projects and review of the quiz questions. Paulin and I also met with the new Minister of Health. It doesn’t seem possible to fit all that in between 7AM to 5PM but the residents were engaged and energetic throughout. This is all the more remarkable when we learn that one of them was on call last night and had to deal with two maternal deaths. We continue to be amazed at the resilience in such difficult circumstances.

We are becoming conscious that our time in Rwanda is almost over (this visit). It goes much too quickly. I will miss the warmth of the people – always time for a hug, handshake, conversation, good manners. I will not miss the noise of Nyamirambo.  As Amélie said, it’s like sleeping in the middle of a bar. They turn the music off at 6 AM, just in time for the church bells and call to prayer.

Kitt and Kyle are out for a night on the town.  Are they at the “Selfie Club” or the “So What Club”? Stay tuned…  

From Kitt:
Hi everyone!
Our final academic day was exceptionally rewarding.  It was jam-packed with the following:
     - morning report at 7am
     - our senior resident teaching on obstetrical sepsis and peripartum cardiomyopathy
     - resident teaching on malaria in pregnancy
     - resident case report on HIV in pregnancy
     - senior resident quiz
     - simulation station on postpartum  sepsis
     - debate on anesthetic technique for severe mitral stenosis in pregnancy 
     - resident research project discussion 

The level of discussion of complicated anesthesia considerations, goals and conflicts was impressive. I am amazed by the keen attitude of these residents. Their willingness and enthusiasm to learn is without bounds. Their clinical experience as PGY1s and 2s is definitely above where mine was at the time. When I asked if anyone had heard of a patient with severe mitral stenosis in pregnancy, all of them raised their hands and said they had given an anesthetic to one! 

I felt sad when saying goodbye to the residents yesterday. I'm definitely going to miss them.  I was clinging to the fact that at least we will see Eugene and Alcade in Halifax in a few weeks. 

Kyle and I have worked hard this last month. Teaching, however, is far less stressful than the work Patty is doing behind the scenes as she tries to advocate on behalf of an entire country for better anesthesia training and practice. She was invited to meet with the Minister of Health today, and it sounded positive! Her work is never done though, and she takes both the struggles and the joys (and the endless emailing) of Rwanda home with her for the rest of the year. I have now seen the impact of her hard work here first hand. 

Thank you for this exceptional opportunity Patty!

Kitt


Lunch at Nyungwe Forest Lodge





Can you spot the monkey?

Peaceful shores of Lake Kivu

Kyle and Amélie's insane run

Celestin doing a great job teaching on malaria in pregnancy

The residents unanimously wanted to play Jeopardy again - great enthusiasm and prizes of chocolate






Sunday, January 29, 2017

Three residents on the rock

We are having an excellent final weekend in Rwanda. Kitt's pictures tell it best, see below.

I pick up from Amélie's lovely post, at the Top View in Nyungwe. After a very, very hilly jog, a delicious meal, and a few hours of work by the fire, we had a great sleep, uninterrupted by the all-night bars blasting Celine Dion that we are used to hearing in our Nyamirambo apartment.

We got up early in the morning so we could squeeze in the customary waterfall hike in the rainforest. Our knowledgeable and appropriately named mountain guide, Everest (how perfect is that!?) led us through the steep terrain down to the beautiful, noisy, misty falls at the bottom. We even managed to squeeze all three of us onto Patty's 'resident rock' to add a picture to her collection. 

As beautiful as the falls were, the hike itself was stunning. Kitt only stopped about five hundred times to photograph every interesting tree branch and fire ant. Fortunately, Patty kept us on time by jogging ahead of us on the ascent out. If our legs are a little tired today, it's probably from the steep hikes- my phone says we climbed the equivalent of 160 flights of stairs in the past two days. That's sixteen trips up from the cafeteria to the VG anesthesia lounge, for those hard at work at home.

Lunch was on a covered balcony, in the middle of a lush tea field, against a backdrop of mist-enshrouded mountains, as rain gently fell. And Patty paid! You can't make this stuff up.

It is impossible to work or read as we drove home slowly through the winding Rwandan countryside. The views are constantly changing vistas of hills and valleys, dotted with colourfully dressed people working, children playing, and overloaded rocket buses hurtling past, well over the centre line. Today's drive was even more dramatic, as we roared up and down steep slopes beside Lake Kivu. Views of water are rare in landlocked Rwanda, and today was really special.

We sadly sent Amelie home yesterday, and today are hunkering down to get ready for our last academic day tomorrow. It will be VERY full, but fortunately Kitt and I are dividing and conquering the preparation, leaving us both able to follow the throwback Nadal-Federer final, which we convinced the Serena staff to put on in the lobby. 

Graduates of training of trainers for Essential Pain Management

How sweet is this? Coffee ice cream and coffee floats at Inzozi Nziza

Amélie, Kyle and Kitt on the "resident rock" in Nyungwe Fores

   

Kitt in the beautiful forest on the waterfall trail

We stopped by Nyungwe Forest Lodge for lunch

Lake Kivu on the drive home


Patty's collection of "resident rock" photos:



Ariane 2010

Shannon 2011
Terri and Lauren 2012

My son, Alex, 2013

Mat 2014

Michelle 2014


Amélie 2015

Amélie, Kyle and Kitt 2017

















Friday, January 27, 2017

On the Igishigishigi Trail in Nyungwe Forest

From Amélie:

I wonder what makes milk from « Amen House of Milk » special ?
Would Kitt make it as a rapper called « Big-ishigishigi » ?
Is a 99,000$ (yes, dollars, as Kyle would put it) one-week gym membership really worth ?
What is the password for the Serena network « Jusus Is King » and would Jusus really lock his network ?
Would Céline Dion win « Guma Guma », Rwanda’s version of American Idol ?

These and many other things I pondered on a daily basis during my whirlwind second stint in Rwanda. This trip was imagined and planned on a cold December morning when I was working with Patty in the pain clinic block room. I hesitated at first, given that I am in the middle of the process of studying for my Royal College exam. I couldn’t, however, decline this wonderful invitation to join Patty, Kitt and Kyle in this place that I had so enjoyed in 2015. I’m very grateful for them and for everyone in the chronic pain clinic, where I had been scheduled, who made it possible for me to do this.

Rwanda is quirky at first. Names like Amen House of Milk and New Facebook bar are not very unusual for commercial establishments. The Kinyarwanda word for fern, igishigishigi, is really fun. The exchange rate for Rwanda francs is crazy and Céline Dion is everywhere. I love it. But what strikes me most, like during my last trip, is the pride with which people here carry themselves. This may sound trite, but although some people here may not have much, they are proud. And I think it’s admirable.

We’ve spent the past two days teaching the Essential Pain Management course in Huye. Despite some language barriers between us, I have hope that participants will disseminate their knowledge and knock down other barriers to pain management in Rwanda. As I sit by a roaring fire in a beautiful Nyungwe rain forest hotel, I feel very lucky to have been here this week. Back to real life tomorrow but I know these thoughts I take home with me again will carry me through these next few long months.

Love,

Amélie


Happy Amélie


Nyungwe Forest after a hard rain



Canopy walk


Our team in peace


A roadside friend (mountain monkey)




Thursday, January 26, 2017

Essential Pain Management Course

With virtually no time to prepare, we ran the Essential Pain Management Course in Butare today.  This is a simple one day course to teach fundamental principles of pain management.  

http://fpm.anzca.edu.au/fellows/essential-pain-management

This course was developed by Dr Wayne Morriss, in New Zealand, and Dr. Roger Goucke, in Australia, in 2010.  It has now been offered in over 40 countries around the world.  

We had an enthusiastic multidisciplinary group today: nurses, physicians, anesthesia technicians, physiotherapists, surgeons. 

Tomorrow we will train half the group to be future EPM instructors to ensure sustainability of the teaching.  Then we are off to Nyungwe Forest...


Gaston, a natural teacher

Amélie teaching

Amélie

Kyle, Amélie and Kitt during the lunch break


30 keen participants