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 dosagesfor 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.