Day 2

I had always thought that coming back for a second time would make things easier but I continue to be amazed.

Late last night Simon the resident accompanying me arrived sans luggage.  His flight here had already been moved from Saturday to Sunday because of a concern that the connection was too short and then they lost his luggage anyway which of course means a trip to the airport this evening.

So I roused a seriously jet lagged Simon at 0600 this morning so we could walk to the hospital and make a good impression on the residents.  Keep in mind that we still don't have water so I couldn't make coffee and it is not like I could just run to Starbucks or Timmy Hos.  We made good time and were at the entrance I thought I had to come into by 0705 but there were a bunch of patients waiting on the steps and the door was locked.  I realized that in 4 years they just might be meeting somewhere else.  I remembered it was possible to get to the room from inside the hospital grounds but I also remembered 4 years ago even after 4 weeks I still had difficulty finding it, which is what happened this time.  At 0730, I said we've missed them, lets just sit down and wait until 0800 when we were supposed to meet the Public Relations guy who would help us get a licence here.  We sat in a conference room off the OR and discovered that they have free WiFi in their OR.  What a concept.

We met with said PR guy and gave him our papers and he walked us over to the conference room which was in the same place as 4 years ago, however the door was locked although there were signs people had recently been there.

Eventually the residents all arrived along with the program director.

Now some people are able to discuss any topic off the top of their heads with a power point presentation properly prepared but I am not one of them which is why I was a little perturbed to hear that the teaching program had been modified.  Our topic today was to be sepsis.  In 25 years of anaesthesia I have learned a little bit about sepsis but mostly what I have learned is that whether or not you survive is more related to karma, than to anything ICU does and less so to anything anaesthesia does.  I could have just said that and then gone to Serena Hotel pool but instead had to listen to presentations until past 1400 (with a nice African buffet at lunch).  The other issue is that that typical Rwandan anaesthesiologist will deal with more sepsis in one year than I will in my lifetime, and that maybe prevention and early detection might have a role to play  (the case they presented was a septic induced abortion which judging from the discussion is not uncommon here).  It is nice however to see the Rwandans doing research in a Rwandan context.

There was a visiting American anaesthesiologist who is there on a longer mission.  His mission provides him with a car and I bet his apartment has water.  He was quite nice although in an academic American way.  He tended to monopolize the discussion which was a bit of a relief because  beyond telling them about karma and warning them that no matter how gently you induce that patient, shit is going to hit the fan I really had nothing to say.  There was also a visiting Canadian cardiologist again on some type of long term mission who came in the afternoon.

We escaped to the soothing waters of the Serena Hotel where Simon bought a pool membership and we were both able to shower (separately).  \

It was then back to our still waterless apartment.

There have been a few changes in Kigali in four years  There are a lot of new buildings including some which were being built when I was there last there.  The most significant change is that the Mutatus the minivans which were the primary means of transport in East Africa are gone, replaced by slightly larger buses.  (I could be wrong, it could just be that they were all being serviced today.today).  This has been compensated for by an increase in the number of the annoying motorcycle taxis.  There is a disturbing increase in the number of adults now asking for money although still way less and not as aggressive as on Whyte Avenue.  Also it is now necessary to go thru a metal detector, have your bag searched or Xrayed and get patted down in order to enter a shopping mall or even the Serena Hotel.

Will eventually post pictures.