We had a stimulating case discussion with the anesthesia residents and about 20 nurse anesthetists this morning. The previous arrangement was to very briefly mention something about each patient for the day. We have a new format of picking one interesting case and discussing it in depth. This was well received and we had a lively discussion this morning. Following this we headed to the OR and gave the anesthetic to the patient – a very sick 85 year old woman with a hemoglobin of 5.8 and gastric cancer. These were her initial vitals on the right. She had profound ST depression (better than you see here) at rest, room air sats of 92%, and weighed probably 35 kg. (Also note the room temperature, on the bottom left: 25.4 degrees in the OR, and it got hotter and more humid as the case went on).
On the right of this photo is Dr.Sender Lieberman, a colorectal surgeon from McGill who is looking at setting
up a similar teaching program for the Rwandan surgery residents. Also note the Anesthesia Team: me (Ariane), 2 Rwandan residents (a junior and a senior), as well as 2 anesthetic
techs assigned to the case. The ORs are quite new (built last year), and while they don't have a ventilation system, the anesthesia machines are basic and function: I feel like if I had to take them apart and put them back
together again, I could! The oxygen supply to the OR tends to run out partway through each case (and no backup cylinders), but just as you're bringing another anesthesia machine with an oxygen concentrator (and delivering almost no oxygen to the patient), it miraculously comes back on again. You learn to be flexible in this country.
Patty: Franco, the Dean of Medicine, Chief of Anesthesia and Anesthesia Program Director then had a meeting with the Minister of Health for Rwanda to inform him of the status of the anesthesia residency training program, discuss a few problems and ask about greater access to opioid analgesics in Rwanda. The meeting went extremely well and we were all happy with the thoughtfulness and support of the minister.
Finally, we discovered the local market – a paradise of passion fruit, papaya, avocados, mangos, and fresh shelled peas.
It is sunny one moment, raining the next or even both together.
Nice to get these updates and have a better understanding of the kinds of situations you face at the hospital.
ReplyDeletePatty, I gather you're living somewhere different this year. Where abouts are you, and what's your accommodation like? How far are you from work? Have you walked around much? Other than the changes you mentioned at the hospital, has Kigali changed much?