Monday was the teaching day which is supposed to be run by the Canadian volunteers however this monday Dr. Paulin wanted to give a talk on non-technical skills. These are things like communication, situational awareness and team work etc. These are things that of course really can't be taught and have to become part of the institutional culture something I don't see happening anytime soon in Canada. As the visiting professor I got to make a few sage comments at the end.
Dr. Paulin also introduced 9 or 10 new first year anaesthetic residents who are more in number than the current number of residents.
In the afternoon, we had a joint session with the surgeons again covering non technical skills and we also went over the Safe Surgery Checklist something having been involved in its development at our hospital gave me flashbacks. After that it was definitely time for a swim at the Serena.
I should mention that the anaesthesiologists and surgeons do incredible work here with very little resources. I would to see one of our OR princesses come down here to work.
Getting home I decided that a beer was in order and picked up my empties. A beer in Kigali costs 600-700 francs but the deposit is 500 francs which is why you don't have any broken glass on the streets in Kigali. In the little grocery store, I ran in Emmy who drives for us sometimes and he invited me to have a drink with him at the Blue Bar across from my apartment. We sat outside on lacquer chairs and ate goat and tilapia brochettes as well as fried bananas and talked about life. As we were about to leave a car pulled up and very inexpertly tried to parallel park in front of the bar. Parallel parking is a little dangerous because there is a three foot deep drainage ditch between the street and the bar. Having parked about 4 very drunk guys piled out. It was the first real public drunkenness I have seen in Kigali. (I have heard lots at night while trying to sleep).
Tuesday as for some reason no resident was available for OR teaching, we had off. I arose late for me had a coffee and then walked to the Bourbon cafe for breakfast. I ran into one of the HRH American docs on the way. He asked where I was going, I said for breakfast which satisfied him. I lingered at the Bourbon cafe for about an hour before walking back to the hospital I wanted to the check with the Public Relations guy who handles things for us. It turned out that for various reasons our licence applications still hadn't been submitted. In my case they needed a passport photo, even though they had a copy of my passport and so somebody drove me downtown and I got 8 passport photos.
I then proceeded to the Serena Hotel for a shower and a swim, topping it off with a latte. I then walked home in the noon-time heat.
Mary had asked that I bring back some fabric to make a quilt so I asked Christophe who helps us out if he could help me. We walked over to the local market. It was very hard to explain to Christophe or to the ladies selling fabric that no I did not want something sewn for my wife but rather the she intended to chop the fabric into squares and make what I told them was a blanket because I don't think they have ever heard of quilts.
My next mission was to get a shirt made, so Christophe took me to a tailor shop just off the market. There was no fabric there that I liked but the tailor a women dressed in a faded brown business suit said that if I provided the fabric, she would make a shirt for 10000 francs. So it was back to the market to pick out fabric, enough fabric to make 3 shirts for an ordinary person or 2 for me. The tailor took my measurement and we eventually agreed to 2 shirts, one short sleeved and one long sleeves. A during this time Christophe and the lady bantered back and forth in Kinyarwandi. I hope they weren't making fun of me.
Wednesday, September 9, 2015
Tuesday, September 8, 2015
Wondering where the lions are?
On Sunday we visited Akagera Park which is on the Tanzania border. This is Rwanda's answer to Masa Mara and Serengeti. I had visited this 4 years ago and it was my first experience with savannah until I went to Kenya which blew it all away.
I was therefore ambivalent about visiting it however Simon had never been there (I must stop letting Simon enable me), so I booked another trip for the day. My enthusiasm was piqued by the knowledge that 7 lions had been introduced into the park. Lions have been extinct since after the genocide. In order to have land for the refugees who returned, the government gave 2/3 of the park to farmers, who, when the lions started eating their livestock, poisoned the Lions. Nasty but there is a difference between trying to eek out a subsistence life and paying 10s of thousands of dollars to lure a lion out of a park so you can shoot it with a crossbow. The park is now surrounded by an electric fence.
Our driver Clement arrived at 0530 and we went down to meet him. We headed off thru the street of Kigali. This time of year it is still dark at that time. A few people were jogging and the soldiers were still on the streets. We swung thru Kigali and headed east. The sun was coming up. Everywhere you go in Rwanda you are never out of sight of another person and we saw tons of people. Most impressive were the people carrying green bananas to market on their bicycles. They would put one bunch on each side like a pannier and then would stack up bananas behind them as high as the height of the rider. I wish I had taken a photograph but I knew that it wouldn't turn out well. They would ride their bikes on the flat and would push their bikes up hill. We saw at least 50 such bikes and as well people carrying firewood or water on their bikes.
Along the way we passed banana plantations and fish farms.
About 2 hours in we turned on to a dirt road towards the park. The terrain and vegetation was starting to turn to savannah like although we still passed farms and banana plantations. There were a lot of cattle with long horns.
We entered the park through the south gate and proceeded to the entrance. Akagera is much better organized than 4 years ago. There is now a tented lodge and you are able to camp behind an electric fence. There was a reception area and you can even pay your park fees by VISA. At our driver's suggestion I bought a coffee. The lid was too big for the cup so I wore some of it but absorbed enough to make the drive over rough roads somewhat uncomfortable. During our previous visit we had entered through the north gate which you can no longer do so I was hoping for a new experience. We picked up a guide Bosco who joined us in the truck.
We headed north along a dirt road. The grass had been burned along the road which our guide told us would result in fresh green grass which would bring the game back towards the lodge. Eventually we were on a road running between the lake and a ridge which jutted up about a km away. At first we did not see many animals except some Impalas, baboons and a large lizard sunning on a rock..
At one point we ascended higher above the lake where we stopped on Bosco gave us binoculars where we could see elephants down below by the lake in distance.
We stopped at Hippo beach where appropriately we saw a number of hippos as well as some Nile Crocodiles. Later at another stop we were able to get quite close to the water where we saw a large hippo and some smaller hippos. Our guide told us that the larger hippo was mating. This means that his lover was under water. Hippos are able to submerge for up to 6 minutes which certainly limits their stamina or gives a new meaning to "coming up for air". We also saw two hippos on land.
As we got farther north we started to see more species of antelope, a lot a warthogs and just two giraffes off in the distance. We also finally saw some zebras although they were far away and not as numerous as during my last visit.
It was overall a great visit. We didn't see the lions but it is still a large park and the Lions are probably just settling in or lying somewhere gorged out because of the abundance of prey who have never known a lion in several generations. There are also leopards in the park. These are nocturnal and I didn't expect to see one.
We had a 3 hour drive back to Kigali, dropping Bosco off about half way where he would take a taxi back to the South Gate. The roads were very busy with people walking along the side of the road or just visiting. We saw bicycles carrying all matter of outrageous materials.
Clement dropped us off at the Serena Hotel where I had a shower, a beer and checked email and we walked home along the busy NR.
I was therefore ambivalent about visiting it however Simon had never been there (I must stop letting Simon enable me), so I booked another trip for the day. My enthusiasm was piqued by the knowledge that 7 lions had been introduced into the park. Lions have been extinct since after the genocide. In order to have land for the refugees who returned, the government gave 2/3 of the park to farmers, who, when the lions started eating their livestock, poisoned the Lions. Nasty but there is a difference between trying to eek out a subsistence life and paying 10s of thousands of dollars to lure a lion out of a park so you can shoot it with a crossbow. The park is now surrounded by an electric fence.
Our driver Clement arrived at 0530 and we went down to meet him. We headed off thru the street of Kigali. This time of year it is still dark at that time. A few people were jogging and the soldiers were still on the streets. We swung thru Kigali and headed east. The sun was coming up. Everywhere you go in Rwanda you are never out of sight of another person and we saw tons of people. Most impressive were the people carrying green bananas to market on their bicycles. They would put one bunch on each side like a pannier and then would stack up bananas behind them as high as the height of the rider. I wish I had taken a photograph but I knew that it wouldn't turn out well. They would ride their bikes on the flat and would push their bikes up hill. We saw at least 50 such bikes and as well people carrying firewood or water on their bikes.
Along the way we passed banana plantations and fish farms.
About 2 hours in we turned on to a dirt road towards the park. The terrain and vegetation was starting to turn to savannah like although we still passed farms and banana plantations. There were a lot of cattle with long horns.
We entered the park through the south gate and proceeded to the entrance. Akagera is much better organized than 4 years ago. There is now a tented lodge and you are able to camp behind an electric fence. There was a reception area and you can even pay your park fees by VISA. At our driver's suggestion I bought a coffee. The lid was too big for the cup so I wore some of it but absorbed enough to make the drive over rough roads somewhat uncomfortable. During our previous visit we had entered through the north gate which you can no longer do so I was hoping for a new experience. We picked up a guide Bosco who joined us in the truck.
We headed north along a dirt road. The grass had been burned along the road which our guide told us would result in fresh green grass which would bring the game back towards the lodge. Eventually we were on a road running between the lake and a ridge which jutted up about a km away. At first we did not see many animals except some Impalas, baboons and a large lizard sunning on a rock..
At one point we ascended higher above the lake where we stopped on Bosco gave us binoculars where we could see elephants down below by the lake in distance.
We stopped at Hippo beach where appropriately we saw a number of hippos as well as some Nile Crocodiles. Later at another stop we were able to get quite close to the water where we saw a large hippo and some smaller hippos. Our guide told us that the larger hippo was mating. This means that his lover was under water. Hippos are able to submerge for up to 6 minutes which certainly limits their stamina or gives a new meaning to "coming up for air". We also saw two hippos on land.
As we got farther north we started to see more species of antelope, a lot a warthogs and just two giraffes off in the distance. We also finally saw some zebras although they were far away and not as numerous as during my last visit.
It was overall a great visit. We didn't see the lions but it is still a large park and the Lions are probably just settling in or lying somewhere gorged out because of the abundance of prey who have never known a lion in several generations. There are also leopards in the park. These are nocturnal and I didn't expect to see one.
We had a 3 hour drive back to Kigali, dropping Bosco off about half way where he would take a taxi back to the South Gate. The roads were very busy with people walking along the side of the road or just visiting. We saw bicycles carrying all matter of outrageous materials.
Clement dropped us off at the Serena Hotel where I had a shower, a beer and checked email and we walked home along the busy NR.
Monday, September 7, 2015
Genocide Musuem
With lots to see in Rwanda and only three weekends here, our time is pretty well mapped out so it was nice to have a free Saturday with nothing planned.
Simon who has not lived thru kids and dogs was able to sleep in while I awoke at my usual default wake up time. It did occur to me that I had never really walked around the neighbourhood so after drinking a coffee, that is what I did. I followed the paved street outside our apartment south until after about 500 m I hit a cobbled street where I turned left and followed it for a while. There were some modest well kept houses along the street all surrounded by a wall of course. In walled compound with the gate open, kids were playing soccer on what on closer inspection was an artificial turf field. After a while the the road petered out to a dirt road which was heading east down into the valley so I retraced my steps and visited the local market before returning home.
Eventually Simon got up and I convinced him to come to the local market to buy some vegetables and fruit which we did failing miserably at haggling. We looked at some meat but the goat's heads on the counter were a little off-putting.
Simon wanted to go to the Genocide Museum and although I have been there before (if you look in the archives, I described my last visit in 2011) I felt I should pay my respects. We walked down the NR towards town, passing the hospital and the Serena Hotel. Simon wanted to do some business with the phone company so I had coffee at the Bourbon cafe after which he joined me and we had lunch.
According to Google Maps, we were now 3.7 km from the Genocide Museum. Weaker people would have called a taxi but we decided to walk. Kigali has a new street numbering system which makes very little sense mainly because there is not a single right angle intersection in the entire city and there are hills and valleys all over the place. To get to the Genocide Museum it was necessary to descend to the bottom of the hill we were at the top of and then climb halfway up the next hill. This we did and arrived at the Genocide Museum. We had to have our bags manually searched. The guard took great interest in my business cards.
I have described the Museum before and not much has changed except that whereas 4 years ago 200000 bodies were buried there, now 260000 have been buried there as bodies continue to be found. I walked around respectfully reading all the plaques (which of course I always do). There is a second story devoted to other genocides. I visited Aushwicz 10 days earlier. I am always amazed at how badly we treat our fellow man. I am wondering how many more rooms they are going to have to add to this museum.
After that we turned down a taxi and walked back which involved a big climb back to downtown Kigali. We stopped at the Nakumat to pick up provisions for our safari on Sunday and to the Serena to wash off the day's sweat.
After beers and dinner in the bar we walked home along the uber busy NR.
I should mention that the night before we had walked 45 minutes home after dark. How many cities developing or developed world could you do this?
Simon who has not lived thru kids and dogs was able to sleep in while I awoke at my usual default wake up time. It did occur to me that I had never really walked around the neighbourhood so after drinking a coffee, that is what I did. I followed the paved street outside our apartment south until after about 500 m I hit a cobbled street where I turned left and followed it for a while. There were some modest well kept houses along the street all surrounded by a wall of course. In walled compound with the gate open, kids were playing soccer on what on closer inspection was an artificial turf field. After a while the the road petered out to a dirt road which was heading east down into the valley so I retraced my steps and visited the local market before returning home.
Eventually Simon got up and I convinced him to come to the local market to buy some vegetables and fruit which we did failing miserably at haggling. We looked at some meat but the goat's heads on the counter were a little off-putting.
Simon wanted to go to the Genocide Museum and although I have been there before (if you look in the archives, I described my last visit in 2011) I felt I should pay my respects. We walked down the NR towards town, passing the hospital and the Serena Hotel. Simon wanted to do some business with the phone company so I had coffee at the Bourbon cafe after which he joined me and we had lunch.
According to Google Maps, we were now 3.7 km from the Genocide Museum. Weaker people would have called a taxi but we decided to walk. Kigali has a new street numbering system which makes very little sense mainly because there is not a single right angle intersection in the entire city and there are hills and valleys all over the place. To get to the Genocide Museum it was necessary to descend to the bottom of the hill we were at the top of and then climb halfway up the next hill. This we did and arrived at the Genocide Museum. We had to have our bags manually searched. The guard took great interest in my business cards.
I have described the Museum before and not much has changed except that whereas 4 years ago 200000 bodies were buried there, now 260000 have been buried there as bodies continue to be found. I walked around respectfully reading all the plaques (which of course I always do). There is a second story devoted to other genocides. I visited Aushwicz 10 days earlier. I am always amazed at how badly we treat our fellow man. I am wondering how many more rooms they are going to have to add to this museum.
After that we turned down a taxi and walked back which involved a big climb back to downtown Kigali. We stopped at the Nakumat to pick up provisions for our safari on Sunday and to the Serena to wash off the day's sweat.
After beers and dinner in the bar we walked home along the uber busy NR.
I should mention that the night before we had walked 45 minutes home after dark. How many cities developing or developed world could you do this?
Saturday, September 5, 2015
Surgery Camp
When we were arrived Monday we were
notified that a Surgery Camp was in progress. Surgery camp as it turns out is not about campfires, counselors,or pubescent love affairs. It involves doing
way more cases than they would normally do in order to clear up the
back-log but also partially just to see what they could actually do if they were pushed.
This Friday we discovered how they
coped with this extra demand and only 6 rooms.
Simple you do two cases in the room at
the same time.
They planned it so that one of the
cases in the room was either local or spinal as they only have one
anaesthetic machine per room. I am sure someone will or has already
figured out how to do two patients with one machine (which is what
might happen at my hospital in Edmonton if administration doesn't replace our aging machines). Having anaesthetic techs who can start
cases including spinals on their own does help.
One of the American surgeons explained
to me that they tried to ensure that a septic and non septic case
were not done in the same room.
Thursday, September 3, 2015
King Faisal
Christophe called a taxi and we were off across the city to the King Faisal Hospital.
The KFH was donated to the Rwandan people by King Faisal in the 1980s. Unfortunately the government couldn't afford to run it (where have I heard that before) and it sat empty although General D'allaire appropriated it as a field hospital during the genocide. After the genocide, the cash strapped government sold it to a South African company and it has functioned as a private hospital since.
We arrived and after the guards searched under our car for bombs with a mirror, we were dropped off at the entrance. I was smart this time and called Dr. Paulin to come down and meet us which he did in time. The OR was actually easy to find although there is a passcode to get into the OR.
Unfortunately, Dr. Paulin told me, the resident we were supposed to teach is not here because his infant son has a strangulated hernia. He apologized and said the resident really should have phoned us. I told him, if my son needed surgery, calling a CASIEF volunteer would not be the first thing on my mind; not even the second or third.
I asked Dr. Paulin if he could show us around the hospital and we got to tour the ICU, and OR and watched him start a case. It was not a very busy day with 3 rooms running, two staff anaesthesiologists and some techs. The hospital is much nicer than the other hospitals I have seen in Rwanda although a little shabby by Canadian standards.
Since I was at a private hospital I took the opportunity to ask Dr. Paulin about the Rwandan healthcare system. Patients at KFH either pay for their own treatment or if they have good insurance can come there. In addition some public patients get treated there if the treatment is not available in the public system. I asked about the public system and he said that while it is free, patients have to pay 10% of the costs which may explain why patients often get delays in their treatment.
Doctors at KFH are salaried and earn significantly more than those in the public system which I know is a source of bitterness in the medical community.
 |
| View of Kigali from KFH |
We had kept Dr Paulin away from his work so left around 1030 for the Union Trade Centre in downtown Kigali where Simon hoped to get a sim card for his I phone. I went to the Bourbon Cafe for a coffee after which Simon joined me and we had lunch there. We then walked to the Serena hotel.
I left Simon there after a while and walked home because I wanted to visit the Nyamirambo market to buy dinner. Having only been in Rwanda for 4 days, I wasn't sure whether Simon could stomach the market. On the way to the market I stopped at the "Kigali Cake Empire" to buy croissants and samozas. The KCE motto is "happiness is guaranteed" and I hope this is the case.
I walked around the periphery of the market. At one point a woman yelled out, "You must have been beautiful when you were young?" I told him that I assumed that was a complement and she told me she had been married to a white Canadian in the past.
I bought some tomatoes and peppers for probably more than I should have paid and also bought some meat from a butcher who hacked it off a carcass with a machete. I am currently simmering all that for dinner.
Wednesday, September 2, 2015
Rwanda Days 3 and 4
We had more or less a slower start to
our first day in the OR. Simon had to go back to the airport late in
the evening and so I felt we should skip morning report at 0700 and
just show up around 0730. My recollection of CHUK was that they
started slowly in the morning. As it turned out CHUK was on a
“surge” which should be familiar to Alberta physicians. The
government had mandated that to clear the backlog of cases waiting to
be done, the OR must work harder and do 60 cases per day. Nobody
told me whether this came with more resources but if their
administrators are anything like ours I suspect not.
Did I mention we still had no water in
the apartment.
Arriving in the change room we were
immediately accosted by a friendly American surgeon with whom we
chatted for a while. He was from Boston but when I asked him whether
he was a Bruins fan he said he didn't follow hockey. Like most
Americans he was bright eyed, bushy tailed and enthusiastic if only
because he had had a shower that morning, had had coffee and hadn't
been kept up all night by the Nyamirambo road all night party.
The operating room at CHUK has changed
a great deal. They have a much larger change room and actually have
a locker for the Canadian volunteers (unfortunately we had to share
it with the American anaesthesiologist who arrived bright eyed and
bushy tailed while we were changing). The OR did seem to be a little
more organized than I remember, the anaesthetic equipment is in
better repair and the turnovers were pretty quick. In mid morning ,
the hospital brought in tea, coffee and deep fried dough balls which
were much appreciated by me.
At noon I decided that we had taught
enough and we both headed over to Karibu for the buffet followed by a
visit to the Serena, where Simon who I should have figured was
seriously jet lagged slept for about 3 hours. As it was getting
towards 1700 and we didn't know whether we would be able to cook in
our apartment I suggested that we eat in the downtown tourist area.
We ended up at the Mille Colines which is the real name of the Hotel
Rwanda and ate at the pool side restaurant. Aside from the
atmosphere and history, the food was pretty good. It then started to
pour as is becoming a custom every evening so we took a taxi home.
The power was out when we arrived but
we had water ....and then we didn't. I started to put water into a
pot to boil for drinking water and after about a litre, the water
ended. I was also able to flush the toilet once and then we had no
water again. The power went on and off during the evening.
We were supposed to go to the Military
Hospital the next day which is 20 km away. We got Christophe who
helps us out to call a taxi and negotiate a fare which he did quite
efficiently and so a taxi picked us up and it was off to the Military
Hospital. We quickly veered off the NR to the east descending into
valley and then climbing up. Morning traffic was heavy. Our driver
had a hate on for motorcycle taxis and made sure he passed them as
close and as fast as possible. We eventually arrived at the Military
Hospital where he dropped us off at the Emergency Entrance. We then
had to find the OR which turned out to be difficult as nobody knew
where it was. Okay this is the Military Hospital and maybe the
location of the OR is a state secret. Finally somebody knew where it
was and walked us over there. We started to change when a very tall,
stern man came into the change room and interrogated us as to who we
were and what we were doing. Eventually we satisfied him and he lead
us into the OR and into a room where all the anaesthetic techs and
our resident were. I learned that he was the chief tech and he gave
a short welcoming speech. He told us that normally they had 30 techs
but that 10 of them and one physician anaesthesiologist were Peace
Keeping in the Central African Republic.
Peace Keeping; isn't that something
Canada used to do?
Somewhere around that time, I figured
out that we were probably the first CASIEF volunteers who had
actually gotten sucked into going to the military hospital.
We spent the day with Christine the
resident finishing up around 1400. At around 1000 very sweet tea
with milk and more fried dough balls were brought to the tea room.
The hospital also provided a very nice lunch, rice, plantain,
potatoes and peanut sauce, as well.
We had kept the phone number of the
taxi driver and he picked us up about 40 minutes after we called and
we had a fun drive to the Serena hotel, almost killing several
motorcycle taxis and their passengers. Unfortunately he charged as
almost twice what he charged in the morning but on the other hand we
probably would not have found a taxi way out in the boonies.
I had a shower and brief dip and then
savoured my first coffee of the day.
As we now had water in apartment (at
least when we left in the morning), we headed off to Simba which is
the more proletarian of the supermarkets to buy food for supper and
breakfast. Of course it started to pour right on schedule so we took
another taxi home where we still had water and I made spaghetti with
meat sauce after running through the rain to buy some beer.
I will be able to make coffee for
breakfast tomorrow. I am so excited.
Monday, August 31, 2015
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.
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.
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