where is the ice machine?

Butare is a refreshing change from Kigali. Everything moves just a little more slowly, the air is cleaner and the hospital feels wonderfully calm and organized. Yesterday Terri finished off some interviews and this morning Allison arrived to look at palliative care and pain management services.

Gaston has done a fabulous job of implementing an acute pain service in Butare. He has a set of pre-printed orders for routine and PRN post-operative pain medications. They are regularly using preemptive analgesics (pain medication before surgery). The anesthesia team are conscientious about preventing pain. The pain management orders need to be completed before the recovery room nurses hand over to the ward nurses. There is also a team of non-physician anesthetists (NPAs) who make daily pain management rounds on the wards. Over 300 hospital staff have received training in pain assessment and treatment.

Allison and I joined the acute pain rounds this morning. We only had time to visit one of the post-surgical wards. The NPA (Aline) leading the rounds was highly attentive and thoughtful. Unfortunately, despite the huge effort by Gaston and team there are many gaps. We found that pain was not being assessed by the ward staff and medications given were not documented properly. Some post-surgical patients were being sent home with a tiny supply of medications (enough for one day) and no clear instructions. In discussions with Aline, we identified some simple things to be done for patients (e.g.raising injured limbs). We kept wishing for ice to give people to reduce swelling and pain but there are no ice machines and refrigerators are non-existant in most people's homes. Such a simple thing but too hard to find.

While we are encouraged by the huge progress Gaston and his team have made, there is still much more work to be done.

Allison and I met Charles, the lead for palliative care. We had an excellent discussion about options and Allison is keen to return to help the team. We have also been working on a proposal for chronic pain services in Butare. Such great potential.

Our lunch reward included the mandatory ice cream stop at Inzozi Nziza.

Gaston showing pain protocols in recovery room

Beautifully manicured gardens in the pediatric ward.