the calm before the storm

We’ve had a whirlwind past few days and sincerely apologize for not posting sooner. 

I keep coming back to the theme of happiness, which is seen with a few examples:

Aimée, who is helping us with the conference, has overcome her own suffering to form a group that supports mental health and happiness.  She shared her insights on what makes people truly happy – family, friends, community, and respect.

The children at the orphanage where Alex has been volunteering live with very little but Alex says they are the happiest children he’s seen.

There were more moments of shared happiness at Khana Khazana for dinner on Wednesday.  Our group was Alex, Faye, Emmy, Steven, Paulin, Bona, Adeline, Sophie, Christian and I.  Steven, who five years ago was sweeping the streets of Kigali, is currently clerking in a law firm and attending law school.  He proudly told me that instead of jeans he now wears nice pants, shirt and tie.  The most striking change is his affect; instead of feeling hopeless and dwelling on his tragic experiences during the genocide, he is moving forward with great determination.  He calls me Mum, so it was a great pleasure to introduce him to my son, Alex.

Bona and Paulin were reminiscing about the six months they spent with us in Halifax.  Once they put the wrong kind of soap in the dishwasher and created a lake in the kitchen.  Paulin, brought a large supply of corn into Canada (clearly he got it past customs?) because he didn’t think he’d be able to find corn in Canada.  They were laughing about their first day in Canada when we were walking to the hospital after a large snowstorm.  Bona let me go first and was very careful to place his feet only in my footprints to avoid falling into what he assumed were inevitable holes in the sidewalk.  I guess he was willing to let me take one for the team.  

The evening at Khana Khazana was warm, touching, funny, poignant and magical.  We all stood out in the parking lot late into the evening, not really wanting to say goodnight.  There was laughter and many hugs.

Since then, I’ve visited the Gisimba orphanage where Alex is volunteering.  In the mornings he is teaching at a kindergarten next door to the orphanage.  My work is easy in comparison.  He has a room of 45 lively four to five year olds who speak little English.  It was great watching him teach the kids numbers and all of them singing, “if you’re happy and you know it clap your hands”.

Yesterday we travelled to Butare to meet Drs. Jeanne, Theo and Gaston for faculty orientation for the SAFE Course.  We look forward to having more time with them soon.

We continued on to Nyungwe Forest in southwest Rwanda.  It is a beautiful rainforest that is over 1,000 km² and full of a rich array of flora and fauna.  There are many hiking trails, including one that leads to a steel canopy above the treetops.  It is 200 meters above the ground at the highest point.  It is a most marvelous feeling to be in mid air looking out over the rainforest and mountains with the only sound being calls of birds or monkeys.  

We slept at a lodge near the tea plantation and hiked to the waterfall this morning.

Our time in Nyungwe was a badly needed break and chance for us to rest before we head to the Dereva Hotel on Monday to set up for the SAFE Course.

Safe Course Orientation

It is good to be back in Rwanda.   Each of my visits here has been so different.  The first was to survey the district hospitals, then I was in Gitwe on a short term service trip, last march I worked as a CASIEF volunteer to help teach the Rwandan Anesthesia residents, and then this trip to help coordinate the first SAFE Obstetric Anesthesia Course in Rwanda.  Each trip has been an amazing experience and has brought its own set of challenges and successes.    It is amazing the progress that has been made, but there is still so much left to be done.

We have literally been spending endless hours over the last year organizing the course.  It is exciting to see that it is actually happening.  Even though we are now in Rwanda, there is still much to be done in preparation.  Patty has nicely highlighted all that has been going on since we arrived. 

The last few days have been quite a whirlwind as we have been busy orientating the Rwandan Anesthesia faculty to the specifics of the course.  The course has approximately16 faculty but only 4 are from outside of Rwanda. The SAFE course is different from many other refresher courses offered in Rwanda as it has very little didactics and really focuses on small group workshops over a 4-day period.  We are are excited about the active teaching but at the same time it is much more challenging to coordinate and actually implement.

Patty and I agreed it would be much better to have small groups sessions. Trying to coordinate all of the faculty from the various schools and hospitals would be almost impossible.  We are conducting 2 trainings a day.  One at each of the hospitals where the various faculty work. We are definitely getting better at it but it can be quite difficult. All of the faculty speak English, but my accent and the fact I speak quickly doesn’t help.  The common theme among all of the faculty is they are very excited about participating in the course and the prospects for improving anesthesia care and safety in Rwanda.

Just to highlight all of the  training this week:

Tuesday we went to Kanombe Military Hospital and then to King Faisal

Wednesday we spent at KHI and then CHUK and Friday we will head to Butare to orientate the faculty at CHUB.  

In addition to our training sessions, we are working on a plan to distribute all of the lifeboxes donated by CAS to the district hospitals. As you can imagine, we have been quite busy.

Last night we celebrated Patty's birthday with many of our Rwandan friends at a wonderful Indian restaurant.  Emmy brought a birthday cake and the restaurant turned down the lights and everyone sang happy birthday Rwandan style.  It was a wonderful evening with old friends.

A special thanks to the AAGBI and the WFSA  for donating Anesthesia Handbooks to the all of the Anesthesia Tech students at KHI

Visit to Dereva

Yesterday I finally got to see the Dereva Hotel, which will be the conference location for the SAFE Course.  It is about one hour east of Kigali.  We selected a relatively isolated location with the hope that people would be able to focus completely on the course and also get to know each other.  

The hotel is not fancy but the grounds are beautifully landscaped.  The SAFE course is almost entirely small group workshops.  There will be eight stations running concurrently.  Some of the teaching will be in outdoor gazebos, so we hope there won’t be torrential rains.  

Our dear friend, Emmy, drove us to visit the Dereva and we also travelled with Aimée, who has been helping with the course.

We've spent the last three days doing faculty orientation by going to visit people at their hospitals.  Faye will write more about that.  It has been very helpful to meet the course faculty in small groups to make sure we have a common understanding.  

We will attempt to run simulated scenarios for groups of eight in these little gazebos. 

Emmy and Aimée - warm hearted and joyful.

Today we visited Etienne and Christine at Kigali Health Institute for faculty orientation.  Etienne is in charge of education for the anesthesia technicians.   He has been kind enough to receive the remaining 200 Lifebox pulse oximeters that will be distributed in Rwanda.  These will make an incredible difference to patient safety.  

We are, quite literally, hiring a pick up truck to bring all the equipment to the course.

This is Etienne with 200 Lifebox pulse oximeters.

Of course we had a little swim and relaxation at the Serena Hotel.

Alex has been having an incredible experience volunteering at the orphanage.  His blog is great reading:

http://rwanda2013.blogspot.com/

Love to you all,

Patty

first day on the job

This morning we attended the anesthesia team meeting where anesthesia staff, residents and technicians discuss difficult operations from the previous night and challenging cases for the day.   The complexity of the cases is remarkable.  It is a great pleasure to see my good friends again and to meet some of the new residents.  At long last there are two women in the program!

Faye and I spent the rest of the morning sorting out equipment for the SAFE Course.  After the course we will be leaving the equipment at the simulation centre so that future courses can be run there.  This will be infinitely more sustainable than trying to fundraise for hotel expenses, as we’ve done this time.

In the afternoon we visited Christian at the military hospital. We are running a series of faculty orientations for the SAFE Course and this was our first one.  Christian is a new anesthesiologist, having just graduated from the Rwandan residency program.  He spent six months in Halifax and it is wonderful to watch his journey from trainee to staff person.

We caught up with Alex for dinner and heard about his first day at the orphanage.  I’m sure he will blog about that tomorrow, so I won’t say much.  It sounds incredible.  He’s gone to bed early – still sorting out the jet lag.

Safe arrival

The travel to Rwanda went about as well as any thirty-hour journey could.  Our flights were on time and last night we stepped off the plane into the warm, moist, sweetly scented air of Kigali.  Emmy greeted us; it is a great joy to see my good friend again. 

Alex likes Rwanda and will be keeping his own blog at:

http://rwanda2013.blogspot.com/

Last night Alex and Emmy went to the all night, lively pub across the street to watch Manchester play Arsenal followed by a bar fight by rival fans. 

This morning Alex and I met my friend, Faye, and her husband, Drew, at the Serena Hotel for bunch.  We’ve made the usual trips to Forex for money, MTN and Tigo for cell and internet access.  Faye, Drew, Alex and Emmy will be making a city tour this afternoon, while I unpack about eight huge bags of equipment we’ve brought, or had brought by other volunteers, for the SAFE Course.  Faye will be joining me in posting this blog. 

I’ll try to write more and post some pictures soon.

From snow to simulation

I'm looking out over the snowy fields, a high of minus ten is forecast for tomorrow, and it is hard to believe that in three days I'll be heading back to Rwanda for the fifth time.  This visit will be very different than the others.  Alex, my 25 year old son, will be coming to work in an orphanage in Kigali and then to climb Mount Kilimanjaro. He is bringing chess sets, soccer balls and tennis rackets for the kids.  Alex is a former national chess champion; it is wonderful to think of him sharing his talents in Rwanda.

In the past, I've been focussed almost entirely on anesthesia resident teaching.  This time I will be working with Rwandan, Canadian, American and British partners to deliver two courses in obstetric anesthesia safety for anesthesia providers from district hospitals in Rwanda.  Most of these practitioners are non-physican anesthesia technicians.  They often work in tough situations with little support.  Our goal is to equip these anesthesia providers with essential knowledge and skills to manage routine caesarean sections as well as maternal emergencies.  We plan to support people after the course with a countrywide mentorship network to help apply new knowledge into practice change.

The Rwanda SAFE Obstetric Anesthesia Course has been developed over the past year.  The original program was created by British anesthetists but we've made many adaptations and refinements for Rwanda.  It has been a massive undertaking!  The course would never be happening without the phenomenal commitment of Faye, an anesthesiologist from Atlanta, and Megan, my colleague in Halifax.  We have also been very fortunate to have highly dedicated partners in Rwanda.

The four-day course will run twice for two different groups of participants.  There are forty small group stations in each course.  I've worked hard to make these stations hands on and highly interactive.  Quite a few of the stations will involve simulation where an emergency situation is recreated with props and a mannequin or person playing the role of the patient.  The course participant must respond to the situation using the materials provided.  We hope this type of learning, where an authentic situation is recreated as well as possible, will allow people to have more comfort in managing a similar situation in clinical practice.  There will be 128 participants in the two courses and about 16 faculty.  We've heard back from many people who are very excited to be attending the program.

The second project I'm involved with is creation of a simulation centre in the teaching hospital in Kigali.  The hospital administration has committed two rooms in a small free standing building for the centre.  I will be working with Rwandan colleagues to renovate the space, provide equipment, train teachers, and help plan programs.  This will be a permanent space for simulation teaching for multiple groups of health care providers, such as nurses, medical students, residents and staff physicians.  Our goal is to have a venue for people to practice everything from simple technical skills, such as suturing, to complex team response to emergencies.

Needless to say, all of this will keep me busy.  I hope to be able to update the blog when possible.  It is very satisfying to be able to share.  I am thrilled to be returning to Rwanda; it truly feels like my second home. I can't wait to be back with all my close friends.