on the way home

This will not be the final blog entry as I know Ariane has more to add and I would like to include a final reflection. Ariane and I have just reached Brussels and said goodbye. She is on her way to Israel to spend a week with her brothers and I am on the way back to Halifax.

It has been an incredible month and far exceeded my expectations. Perhaps the overwhelming theme is how vivid everything is: intensely awful smells in the OR and PACU; spectacular green terraced hills; beaming children toughing our hands on the way to work; complete chaos and imminent disaster most of the time in the OR; the bliss of a warm shower at the Serena hotel; fruit salads with mangos, passion fruit, papayas, bananas and tree tomatoes; horrific toilets; joyous teaching situations such as with the nurse anesthesia students at KHI or academic day with the residents; immensely frustrating teaching situations with some of the weaker residents in the operating theatre; our huge success at bringing OB together with Anesthesia for M and M rounds; developing a lively morning report, which was a teaching situation for the nurse anesthetists; spending time with Emmy, our amazing guide; warm hugs with our dear friends; in short it has been rich and very vivid.

It has been a complete privilege to share this with Ariane who feels this has been the best experience of her residency. She rose to the occasion again and again and kept her humour and equanimity. She learned how to teach on any subject without any warning or preparation. We shed a few tears and many laughs (rabbit eating fish, for example).

As difficult as this experience can be at times ( and it really does have horrible moments), it was absolutely worthwhile. Our partners in Rwanda are so grateful and we see such huge improvements. I am thankful to everyone who made this possible.

Lots of love to all.

Patty

Pediatrics

One of the areas of proficiency that is fairly critical to anesthesia in Rwanda is pediatrics. These cases are considerable, as 44% of the population is under 15 years of age (2005 data). Most cases are of fractures, but some common pediatric diagnoses such as pyloric stenosis exist.

Children in Rwanda for whatever reason are impeccably behaved when they come to the operating room. They are brought in alone, lie down on the OR table, and may stay there along for a considerable period of time until someone else comes into the room (note - this is for older children, babies are watched much more carefully). Sharp contrast to pediatric ORs in Canada, which are fairly chaotic: both parents and children may become hysterical, making it very difficult to get anything done. Parents who do not discipline their children (and who want to be their kid's best friend) are seen pleading with the child, arguing, or trying to bribe them. Not so in Rwanda.

Today we did a pyloric stenosis repair on a 2 month old child. In retrospect, it would probably have been easier (and safer) to have done this under local anesthetic. We were working with our weakest resident, and it was a struggle to get him to even draw up the correct drug dosages

for a 4 kg baby, not to mention the clinical skills of getting an IV or intubation. Frustrating. I have to resist the urge to do everything for him: so much easier than teaching someone who quite frankly should be considering a specialty other than Anesthesia.

The intubation was not straight-forward, but we were able to bag the patient back up each time. It has been 8 months since I have last done pediatrics, so I was nervous! But everything went well in the end.