Ana Feb 5 arrival in Rwanda

Dearest friends and family,

I made it safely to Rwanda :)

I think this may be there first time I have arrived to Kigali during the daylight.  I know it was my first time to fly Ethiopian Airlines.  Let's just say, they're not my favorite airline and the food was worse than any school cafeteria in memory.  Think bland gristle and guar gum.  I had significant layovers in both Washington D.C. and AddisAbaba, so I am pretty exhausted.  Plus, since I was delayed a week (after being taken out by that nasty stomach virus that is going around), I missed my friend and colleague, Patty. So, instead of having a few days to adjust and hang out with Patty to plan the program's next year, I will probably just crash tonight to be up bright and early for a full day of teaching tomorrow.

As always I was greeted warmly by my friend Emmy, but this year he had his wife and two small children in tow.  Luckily I had a San Francisco snow globe and a toy trolley car wrapped and stuffed in the bottom of my bag.  I had bought them in the airport for just these two little guys.  For Emmy and his wife it was refurbished Samsung phones from Amazon, and for Christophe (the house boy our program sent to college who then kept being the house boy), a Golden State Warriors ball cap.  I also handed out sunglasses donated by my baby brother, Rhett.

Every year I come, this place has changed.  This year is no different.  Developments in infrastructure, new businesses, and an increasing number of white people piling through the passport lines herald the rapid economic growth here. On the drive from the airport Emmy and I do the same recap every year now: how much we like each other as friends, where he got his newest watch, how many times I've been in Rwanda, which of the previous residents that have joined me did we like the best, which famous Americans have been in Rwanda, etc.  This year it was Leonardo DiCaprio apparently.

Emmy drives me to the volunteers' apartment in Nyamirambo (affectionately called NyamiramboVegas by Emmy) so I can get settled in.  The noise is minimal at this hour (3pm), but it will be at a soft rage tonight and every night thereafter.  It is a neighborhood that attracts young people, mostly men, to drink, play loud music, play billiards, and show off that their cars have anti-theft alarms.  I avoid the scene mostly but have found it appropriate in years past for watching soccer while eating goat on a stick.  Apparently that is a strange thing for a woman to do, but I get away with it because I'm a muzungu. 

I usually go with Emmy to the airport to pick up the Stanford residents that join me on these trips, but tonight I will hang back at the apartment.  Cynthia arrives around 7pm but there are two others Emmy needs to collect, so the car will be too full for me to tag along.  I'm trying to stay awake but feel like I've been drugged after such a long travel time.  I'm definitely dreading the morning alarm already.  The apartment feels comfortable, kind of like a second home.  I halfway unpack my suitcase, drink some cold, whole, milk from the fridge and plop down on the bed to write to you good folks.  It's always so nice to be back.  It's comfortable.  On my eighth year, as I watch the confusion and anxiety on the faces of those passengers who are clearly here for the first time, I realize how second-nature this place has become.  

XO

Open heart

As I get ready to fly back to Canada tonight, I contemplate "what does this all mean?" and "why do I keep coming back?".  There are no easy answers but the most obvious one is that I have fallen in love with a country and its people.

The experience here is about enormous open heart; people radiate genuine warmth and kindness. It is nearly impossible to reconcile the current condition with the devastation that occurred in 1994. Yet the scars are everywhere, literally and figuratively. I am filled with awe by the culture of forgiveness and the vision for Rwanda to be the best country in Africa.

Nearly all the residents we work with were old enough to have memories of the tragedy but that is changing as each year the average age of the entry class in anesthesia gets younger and younger. Perhaps, even now, some of the younger residents have no personal memories of the genocide. Each year of stability allows more time for healing.

I come back each year for both selfish and altruistic reasons. Who wouldn't want to miss a little Canadian winter? Rwanda is spectacularly gorgeous and there is truly a culture of "no stresse". Ultimately, though, there are few things in life as fulfilling as helping people acquire knowledge to heal others.  I feel incredibly fortunate to have found anesthesia as a career and to have this opportunity to guide young people in becoming skilled clinicians and confident teachers.  This is as good as it gets.

I am grateful to all of the CASIEF-University of Rwanda former students who are now leaders: Paulin, Christian, Francoise, Gaston and colleagues. It is wonderful to see them flourish. I am grateful to the current group of residents who show up on time for academic day (having done all the pre-reading) and hungry to learn.  I am grateful to my good friends, Angela, Ruth, and Amélie who travelled a very long way for the Teaching and Learning Course and the Essential Pain Management Course.

But today, I am especially grateful to Kitt and Kyle. They worked their buns off always with good energy and cheer. They rose to the occasion, time after time, to meet our goals and challenges. Teaching in the chaotic ORs for complex cases, designing academic day teaching, running scenarios, helping with resident teaching, keeping me laughing, and nudging me on up some very steep hills on a mountain bike. Thank you Kitt and Kyle. Truly the dream team!

I have not forgotten Michelle, who could not come this year. Michelle, I need you back, my friend.

Lots of love from Kigali,
Patty

Up to 180!

It got more extreme.  Kitt jumped in and did 40 laps. Then Kyle joined her for another 40, bringing his grand total today to 100 laps. Both of them had rockets on their feet. So, the total for the three of us is 180 laps.  Way to go team!

100 laps between us

From Patty,

Our time is winding down in Kigali. It has been a rich and rewarding month, so we will be sad to leave. I've enjoyed sharing this experience with Kitt, Kyle, Ruth, Angela and Amélie. Truly, the dream team!

This morning Kyle and I did the "end-of-visit challenge".  Last year, Tristan and I swam 40 laps in the Serena pool.  Kyle and I vowed to achieve this goal again today. Kyle is a strong swimmer, male and half my age, so I jokingly suggested he should do 60 laps. Sure enough, we both met our targets: 100 laps between us.  This was followed by a huge breakfast. We are spending the day wrapping up loose ends.  Kitt and Kyle are excited about their upcoming safari in Tanzania. I will be leaving Rwanda tomorrow evening.

The two things I am happy about leaving are: 1.the noisy apartment and 2. Christmas music until at least the last day of January. If they play it again today, I might go quietly insane.

Last night we had an delightful evening with one of the HRH anesthesiologists and her family. It is certainly challenging to spend a year teaching in Kigali.

Here are a few random photos we haven't posted yet. 

Next question: Will Kitt try to achieve the new 60 lap challenge?

Gaston's daughter, Gwiza, heading off to school

Gaston, Florida and Patty

Flowers in Nyungwe

Nyungwe

Emmy in nature

The Dopest Shop (what do they sell?)

Kitt with her tailored African dress

So What Bar

Rooster, unwisely in front of chicken shop

Selfie at the Selfie Club

No Stesse Moses Couture

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

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