I'm not leaving.

So, we've attended our last morning report, said our teary goodbyes, had a swim at the Serena Hotel, packed our stuff and drowned one last cockroach. Emmy will be here to pick us up in about half an hour. I've been spending the last few minutes frantically figuring out how to lock myself in the safe from the inside. It is a bit cramped in here, and my internet connection is fading but otherwise I won't complain.

This really has been an amazing month. I've met so many wonderful people and seen such beautiful things. There have been some difficult times as well, but far outnumbered by the good. I was telling Patty that I feel a bit selfish for all that I am taking away (not just the banana beer) but I hope my teaching was effective and the residents seemed truly appreciative.

Except for a few large blowouts, Patty and I got along well and are planning a trip to Namibia. It's not so much that she enjoys my travel companionship rather she is using my special ability to secure emergency exit seats on all our overseas flights (awesome!!)

Thanks for reading and emailing and I'll see you soon. Can someone please shovel my driveway before I get home?

saying goodbye

In a few hours we will get on the plane for a very long journey home. We are both very sad to leave Rwanda and would happily stay for another month.

I began the day with a final run up Nyamirambo hill. There was a slightly overweight woman running on her own and we teamed up for a bit. It is heartwarming to see all the runners and especially women, as we never saw any female runners last March. She told me that she runs every morning as she has back pain and it helps. Maybe she can talk to some of my patients!

Nyamirambo hill starts off as a steady incline before reaching Everest like gradients. At the top, you turn onto a cobblestone road and have a view of Kigali and the surrounding hills. There are many birds, as the cobblestone road goes through a quiet neighbourhood with trees and flowers. It is a brisk descent to the market, which is already a hive of activity at 6:00 AM. There are men with huge bags of coal, made from eucalyptus trees. There are always tons of fresh fruits and vegetables.

We attended morning report, started the OR list, and then made the rounds to say goodbye. It is very sad and quite emotional to receive the gratitude of all the people we have been working with and teaching this month. One nurse asked me if I would be back in two months and looked devastated when I said it would be a year. We had a few teary moments in the garden outside the OR looking at the avocado tree and watching the birds.

Shannon has been a terrific companion and we've had a great month.

Rocketbus to Kigali

We’ve just returned home from a lovely dinner out with the residents and local staff. It was great to get together as a group outside of the academic setting and learn more about everyone. Alfred, the chief resident, gave a lovely speech about the residents’ commitment to hard work and thanked Patty and I for our help over the past month. It was a little sad to say goodbye to the junior residents as they’re heading back to Butare and we won’t see them again before we leave.

Lake Kivu, our weekend destination, was beautiful. Patty calls it the Rwandan Riviera. I saw a real hot spring bubbling from the earth and cooked some potatoes for dinner. Then I poached a salmon. Patty and I got a key piece of beach real estate and watched the sunset over the mountains in the Congo while people swam and fished in the orange glow. I certainly will add this to my list of best ever sunsets. What I won’t add to my “best ever” list was the hotel without mosquito nets. I think I got around 350 bites and spent most of the night defending my eyelids from mosquito mouthparts. Now I’ve quintupled my malarone dose and gone psychotic.

Sunday’s return trip to Kigali was a success. Patty had been fretting about the trip all week in anticipation of the bus ride. We decided to take the public bus home from Gisenyi. We drew up a careful dehydration plan so neither of us would have an accident on the bus (the bus stops for NO reasons on the way home). We showed up extra early to get good seats but Patty ditched me shortly into the trip and I ended up sharing my space with half of Rwanda. I think 5 people sat in 3 seats. I even had a little boy on my lap. I tried to get him to teach me how to count in Kinyarwanda but he was too entranced by the bus TV which blared “BET” dance videos for the next 3 hours. It actually wasn’t that bad and since we drove at Mach 3 we made it back to Kigali in record time. Patty secretly loved the bus.

Gisenyi

Shannon on the beach in front of the Serena Hotel, Lake Kivu.
This photo was taken from near the top of the hill on my bike ride.
This is just outside of Kigali on the road north. In the foreground are banana trees.

Shannon and I traveled with Emmy to the Northern Province again this weekend. Our first stop was at the former home of Rosamond Carr, who was an American woman who moved to Rwanda in the 1950s and ran a pyrethrum (natural insecticide) plantation for many years until she converted the plantation to an orphanage after genocide. I have read her biography "Land of a Thousand Hills" about her many years in Rwanda. She lived to age 96 and when she died she was Rwanda's oldest citizen.

It was wonderful to visit her former home, which is still being run as an orphanage. We had a tour and met some of the young people who live there. There is a magnificent flower garden for the house and flowers are also grown as a source of income for the orphanage. They have a large vegetable garden and goats and cows, so there is plenty of food. Currently about 100 children live there. It is a tranquil place and I can well understand why Madame Carr chose to spend her final 57 years in Rwanda.

We continued on to Gisenyi, which is a small town at the northern part of Lake Kivu. It is right next to the border of the DRC. We visited a hot spring where boiling water pours out of the earth. People use the hot water to cook potatoes and wash clothes. There were a number of bathers when we visited.

Emmy brought the bike I gave him, so my big thrill was cycling about 6 or 7 kms back from the brewery to Gisenyi. There was a pretty good hill to climb, which made for a very fun descent. I could happily have cycled in the area for hours but Emmy had to drive back to Kigali.

Shannon and I stayed overnight in Gisenyi and spent some very pleasant hours sitting on the beach at the Serena Hotel and watching people swimming and the sunset.

We took a bus back to Kigali today. It was jam packed and poor Shannon had five people squished into three seats with her.

Tomorrow is our last academic day and then we will have a lovely dinner at Heaven to say goodbye to the staff and residents.

7 Shots

This has been an interesting week. Monday was another successful “academic day” with the residents performing in their first ever simulation. Later in the day we bribed the residents with candy for correct answers to their homework assignments. This technique worked very well with avid participation but there was quite a lot of leftover candy (even though I handed out many secretly while Patty was on a quick break from the classroom). The leftover candy is now being used for directional purposes. I have been having trouble finding my way around CHUK (despite being here for 3 weeks now) so Patty leaves trails of candy between the OR building, the ICU, and the maternity suite and I’m able to find my way quite quickly now between each venue.

We had our first patient death this week which is obviously very upsetting. It was a case of a 9 day old 2 kg baby with multiple congenital abnormalities for omphalocele repair. This tiny boy was much too fragile to survive despite our efforts. We’ve discussed the case over and over again and certainly we have learned a lot but I think we’ll sting from this experience for a long time.

This evening I tortured all the residents with a journal club. I think it was pretty successful in the end. The guys picked up some snacks and drinks on their way to our apartment and Patty made a delicious salad. We stressed that the most important point of journal club was the food, and then the actual article. It was great to see everyone making such an effort to work through the paper and hopefully they will continue to host journal clubs in the future.

The picture is from our big night out at the Mongolian Grill. Sender and Emmy joined us. I’m glad they came, mostly for the company… but I would have had trouble carrying Patty home on my own.

highs and lows

Shannon and Sender did not have the 7 shots!!

We've had some very sad cases in the past few days but have also had some good moments. Shannon discussed our very sad death of a 9 day old child. We are heartbroken and hope we call all find a way to learn from this tragedy.

On Tuesday we spoke to the nurse anesthesia techs at Kigali Health Institute. It was a good group of about 25 and they kept us late asking questions. Shannon and I keep bring impressed with how keen everyone is to learn. They also knew most of the answers to our questions.

Today we presented the rationale for the surgical safety checklist to a group of 25 or 30 people at King Faisal Hospital. The program was well received and many of the surgeons and anesthetists are keen to implement it. Some staff from CHK also attended with favourable response.

Tonight we had the residents over to the apartment for journal club – Alfred brought drinks and samosas and we had a lively discussion. Shannon and I were impressed with their level of preparation. Shannon's charming picture of me was taken at the Serena Hotel, where we went for dinner last night with Emmy and Sender. We joked about taking home the shot glasses for banana wine shooters for the residents if they did well at journal club.

We are planning a trip to Gisenyi this weekend. It is at the north end of Lake Kivu, which I have yet to see.

Our time in Rwanda is going quickly. I've found this trip to be easier than the others as I have a good idea of what to expect and am now with friends. I meet more of the staff and develop a clearer understanding of what is needed with each trip. It has been good to see incremental improvements – particularly the level of ability in the residents. Shannon has been an excellent traveling companion (even if she makes jokes about my drinking). It has been fun having Sender in the apartment. He will make a huge contribution to surgical training. We've made great use of our Serena pool pass!! However, it is disturbing to see the increase in traffic. The air quality in Kigali is worse than a couple of years ago.

Monday will be our last academic day and that evening we will all go to Heaven (a restaurant in the centre with beautiful views - al fresco dinning- and great food). It is the goodbye dinner with all the residents and staff, as some residents have to travel back to Butare.