Simulation

We did it! We ran a low fidelity simulation in the OR today with the residents. This is the first time the residents have been part of a simulation and they did a great job.

We took over an empty OR and assigned the residents roles. They were told to set up for an elective vag hyst under spinal. After they had set up, we sent in another resident to play the obs/gyne surgeon who announced there was an emergency GA Cesarian for severe fetal distress. I played the distraught patient and the anesthesia resident had to shift gears quickly.

It went well and the residents found the experience a great learning opportunity. They would like to have a chance to practice more simulations.

Tomorrow we will be going over to KHI to teach the nurse anesthesia students for the first time this trip. On Thursday we will have the group over for journal club at our apartment.

Shannon and I have really appreciated the variety of teaching experiences we've had.

Nyungwe Forest

First of all, for the record, I did not drink the Primus!

Nyungwe Forest, in southwest Rwanda, has over 1,000 square kilometres of virgin forest. Getting there is not fun – too many hours over bumpy roads getting the African massage. However, the forest is worth it. The forest is home to a huge variety trees, ferns, mosses, vines and flowers. There is silence (so rare and welcome here) except for the bird calls.

The highlight for me was the canopy walk, which goes above the treetops – 60 metres at the highest point. It was the most marvellous feeling to be suspended in air in the forest.

The lower photo is a fish farm on the way to Butare. Ariane will remember it well.

Nature's Toilet Paper

We are now back in Kigali after an excellent adventure to Butare and Nyungwe. I enjoyed our 3 days teaching in Butare. The junior residents were so keen and the pace was much less chaotic that CHUK. The anesthesia machines were pretty sketchy though. The first day in the OR we had a total ventilator failure that resulted in having to bring 2 more anesthesia machines into the room; one for its functioning ventilator, and one for its vaporizer. It was pretty crowded!

Something worth describing is the “cafeteria” at the hospital in Butare. They used to have a little place called “Yuppy is Yummy” but that is gone. It has been replaced by a building with 5 pots sitting next to a stack of plates and forks. I just peeked quickly into the pots and that was frightening enough. Patty and I decided just to grab a couple bottles of water and eat our usual crackers and peanut butter (which we carry everywhere, just like our passports). Unfortunately, beverages at the hospital cafeteria were limited to Coke and 1L bottles of Primus, the local beer. Patty got 2L of Primus and I settled on a Coke (which actually turned out to be some homemade concoction that tasted like salty rust disguised in a coke bottle).

Nyungwe was beautiful! It was just like a tv rainforest with vines and mist. Emmy convinced a guide to take us on the canopy trail even though it was closed for the day. It was around 4pm and the sun was shining. The walk was amazing. It involves a short hike down to a suspended trail over the treetops. I’ll admit that it was a bit scary with the bridge swaying as we walked, but the view was well worth it.

Yesterday we hiked to see a waterfall. Emmy joined us and we had a blast. Again we lucked into sunshine. Our guide pointed out many different trees with leaves used for traditional medicines. Nyungwe forest has 3 types of “toilet paper”: urticarial TP, procoagulant TP, and soft TP. It is important to learn the difference.

Butare teaching and further animal adventures

Shannon and I have spent the last three days working in Butare, a much smaller city than Kigali and home of the National University of Rwanda. It is cooler here and I find I am wearing a sweater much of the day (yes, I know there won't be much sympathy from Canada).

The three residents working here all joined the program in August, so they are new to me. It has been great getting to know them and we have both been impressed by their organizational skills and work ethic. It seems the bar has been raised and we are starting from a better place. Shannon and I have had a chance to sit down with two of the residents each day for a couple of hours of teaching. I can't tell you how keen they are to learn. We have to cut the sessions off after a few hours when our brains turn to mush but I'm sure they would happily keep on going.

The anesthesia machines here are much older than in Kigali. The top photo is one of the ventilators we've been using.

We are back at the Credo Hotel, well known to other volunteers. Shannon has a great knack for discovering critters of all sorts. Her "roommate" (the amphibian) hasn't been seen for 24 hours but we have discovered a rat infestation down by the pool. We watched them running in and out of the drain pipes while we dined by the pool. Let's just say it put both of us into a state of high anxiety, especially Shannon, who has a huge hole under her shower. I'll let her tell you how she blocked it off. We were very thankful for Sender and his supply of zopiclone!

We have more teaching this morning then we will meet Emmy for lunch and head off to Nyungwe forest. I hope the only animals we find are some birds and maybe a few monkeys.

Animal Highlights (and Lowlights)

Everyone told me before my trip that seeing the mountain gorillas would be a highlight. I was having my doubts while scrambling up the side of a volcano, slipping in dark mud, and plucking nettles from my knees but the experience was more than worth it. I even enjoyed the difficult trek because the view was amazing.

At first the gorillas were mostly up in the trees but they came down as our group approached. We got to spend an hour watching them play and eat. Of course, the babies were the best part. They were extra cute and totally uncoordinated. “Charles”, the silverback and alpha male of the family was huge and lazy. It seems as though he is getting a head start for next Movember after being totally humiliated by Hinkewich in 2010.

Today Patty and I made the journey to Butare. The scenery was so beautiful and we even saw a rainbow in one of the valleys. I was pretty excited about Butare until about 7 minutes ago. Patty and I checked into the Credo Hotel and my room has a double bed, a real toilet that flushes, and a demonic amphibian. At first I thought the newt was just another Malarone hallucination. I was hoping it was really just a lizard so that it would have scales and not wet skin in case I stepped on it in the dark. Patty’s suggestion was to open my patio door (to let more of them in?). Do you see how its eyes glow? Pure evil. Good thing Sender doled out some Zopiclone before we left.

off to Butare

The anesthesia residents at academic day. They are great guys!

Shannon and I continue to enjoy academic day on Monday. The residents are keen to learn and very involved. We keep our sessions highly interactive and try to connect as often as possible to cases. There is always one presentation each week by one of the local residents. The quality continues to improve and they are also much more comfortable with English.

Our morning report is also going well. We are making that very interactive, as well, and use this as an opportunity to teach the nurse anesthetists (techs).

We are encouraging the residents to communicate with the team and to develop leadership skills. There is definite progress but still much more to be done.

We will leave for Butare in a few minutes and will be there until Friday. We are planning to spend Friday night in Nyungwe forest and hike on Saturday. Butare will be good as we will have a chance to work with the three new residents.

Virunga

Shannon and Emmy - road to Northern ProvinceMy African dress

After work on Friday, we drove with our friend and guide, Emmy, up to the Northern Province. I'm sure Shannon will write about her impressions of the countryside. We stayed at a funky little place in Kinigi. It was so cold Shannon had to wear fivelayers to bed (I forgot to tell her to bring thermal underwear to Rwanda).

The next morning, I rode Emmy's bike to the Headquarters where people are assigned to the gorilla groups they will visit. It was my first time on a bike in Rwanda and such a great pleasure. Having seen the gorillas on the past two visits, I decided to hike to Dian Fossey's tomb and the site of the Karisoke Camp. Shannon did the gorilla hike (again, I'm sure she will write about that).

I was the only visitor hiking to Karisoke, so headed out with a guide, a porter, and three armed soldiers. The hike was straight up hill and it was very muddy. It was significant physical exertion! We got to the site after 2 1/2 hours. There is almost nothing left, since after Dian Fossey was killed, people took anything and everything. However, the location of the buildings has been marked and there is Dian's tomb, which is right next to her gorilla friend, Digit, in the gorilla graveyard.

We stopped in Ruhengeri at the Muhabura Hotel for some lunch and had a rainy drive back to Kigali.

Sender arrived last night. He is a surgeon who is heading up a teaching program for the surgical residents, much like what we are doing for anesthesia. Ariane and I know him from March. He will be staying in our apartment for a while until the surgical apartment is ready. He's great fun and it's good to see him again.

I've spent most of today working on a talk to present at the Safer Surgery Conference. I did have my early morning two loops of Nyamirambo hill and we just got back from our swim.

On to week two....