Already in the blink of an eye half of my stay in Rwanda has passed. I think, how will I describe how it has been so far??
After two weeks, I am finally settling into a routine. During the weekdays I wake up around 5 am (because people start to stir and because of the rooster calling) and sometimes I actually get up and go for a short swim in the pool. Other times I roll over and sleep for another hour until I really need to be up. By around 6:45 am, the hospital transportation arrives to pick us up and take us to the hospitals in which we are supposed to be teaching. Mondays and Wednesdays are spent at the CHK (Centre Hospitalier de Kigali), Tuesdays are at the King Faisal Hospital without fail. Who we get as the morning driver is always a nice surprise, as it seems that the Faisal and the CHK have difficulty communicating with each other about who picks us up on what day.
Thursdays & Fridays are a bit more variable. It depends whether or not we are in the south of Rwanda at the university campus. If we are in Kigali, we spend one more day each at the CHK & the King Faisal. This Thursday & Friday we will go out to Butare, the university town in Rwanda.
I start my day by giving short 30-45 minute presentations in French to various groups of nurses who work closely with anesthetists. These are the ICU, Recovery room and nurse anesthetists. After finishing those, I suit up and enter one of the operating rooms to teach the residents.
The type of operations done at the CHK, the main public hospital in Rwanda, are similar to those I would expect to see done in a community setting. As expected, all the operations are done with stainless steel equipment that has been re-used many many times since the sixties, in simple rooms that often serve more than one purpose. For example, the ladies change into their scrubs in a small 5' x 3' area at the back of the anesthesia office. While the techs upload Rwandan music videos or English TV shows dubbed into French on the computer, you change behind a green drape that is the partition for the ladies' changing area. Hung at eye height, everyone can see your head and figure out you're changing, but that's not a big deal. It's simple and it works.
After donning the green habit, I now have to find myself an appropriately sized pair of white (why white i don't know) OR clogs. Most of the time the women's clogs are gone because most of the anesthesia techs are women, leaving me the large men's size 8 white clogs. Thankfully it doesn't really pose a problem because I don't do much running around anyway. The pace of the day is such that there is no need to do so. Hats and masks are not disposable and made of the same heavy green cotton that the OR scrubs are made of. Since no one can breathe through them, most people just cover their mouths with the masks. Some just don't bother pulling them over their faces. I gave the masks a trial period of one week and after feeling suffocated after two days, I gave in and used the disposable ones brought from home.
There are usually 3-4 small cases or 2-3 big cases booked per OR per day. The anesthesia technicians usually see the patients beforehand and fill in a patient information sheet the night before. The pink info sheet often has good information but curiously all patients end up with the same summary assessment score even though they're not in the same state of health. Also, everyone's physical examination is remarkable in its unremarkableness. It seems that no matter how many health problems you have, your bravery alone will make the you healthy enough for surgery.
The patients enter unclothed by wrapped in a large dark green sheet that also is made from thes same material as the scrubs. Most of the time, I am flabbergasted and impressed by the calmness of the patients who have no idea what to expect from a general anesthesia. An intravenous goes in, a mask is put on, medications are given, and off they go, just like they do here.
The intra-operative teaching goes on until noon, when I leave to get some lunch with Avi and we get ready for afternoon teaching, either a lecture session, or return to the OR. When we're at the CHK, we indulge in a superb restaurant called Karibu ("Welcome!" in Swahili), which has a great lunch buffet for the equivalent of $5 CDN. They often have French news channel on the TVs, so while eating it's a chance to catch up on world events important to the French. After finishing, we roll back to the hospital, fighting the onset of the post-prandial coma. The King Faisal provides us with hot lunches in their cafeteria, a definitely nice perk.
The afternoon teaching sessions are interactive and we've focussed mostly on basic airway assessment and management. These sessions have lasted until five PM, then the day is done. We call a hospital transport and often get them to drop us off at one of the major grocery stores before we head home.
That is how the first half of this month has flown by. I can't believe that this upcoming weekend is already the last one I can spend here!!!
