by the shores of Lake Kivu

Faye has already given a great description of the SAFE Course.  As difficult as it was to keep it all together, the course ran smoothly and many people commented that they had never attended such a well-organized program.  They did not think it was possible to teach without power points, so were surprised they could learn so much by interactive teaching and learning.  One woman told me, “I used to think anesthesia was boring but now I want to read and learn”. 

Megan and I traveled to Gisenyi this weekend for a much needed break. She had been in Rwanda for nearly a week and had only see the inside of the Dereva Hotel.  We traveled with my son, Alex, and Emmy.  Emmy is our supreme driver and friend.  He gave Megan some background on the land of a thousand hills.  There has been plenty of rain recently, so the countryside is brilliant green.   Each year the roads are better than the previous year.  Now there are highway signs!  The country looks great.

The four of us had lunch at by the beach at the Serena hotel and relaxed.  Then Megan and I went to Paradis Malahide but Alex and Emmy traveled back to Ruhengeri so Alex could visit the gorillas the next day.  We rested by the water and watched the fishing boats heading out for a night of fishing on Lake Kivu.  The men sing as they paddle out.  That evening we had dinner by the fire pit in the lodge and watched a performance by a group of highly energetic traditional Rwandan dancers.  The drummer was seriously talented. 

 

After a delicious breakfast on the shores of Lake Kivu, Megan and I travelled back to Kigali and spent the afternoon at the Serena Hotel revising plans for the SAFE Course this week. Sender, our surgical friend from McGill, arrived yesterday.  Our big group gathered again for a fine dinner at Khana Khazana.  Today it’s back to work at the Dereva Hotel in Rwamagana…

The Inaugural SAFE Obstetrical Anesthesia Course in Rwanda: We Did It !!!

It is hard to believe it,  but the inaugural SAFE Obstetrical Anesthesia Course in Rwanda is now officially over.  I apologize for not having blogged sooner,  but this week has been a big blur.  Everyday was packed full of teaching, workshops, planning for the next day, and just talking with our fellow Rwandan anesthesia colleagues about how to improve the quality and safety of anesthesia in Rwanda.  After over a year of planning, I can't believe we pulled it off.  It is truly amazing and would have been impossible without everyone's hard work and commitment.

I thought I might give a brief summary of the week.  Monday night the participants arrived at the Dereva Hotel in Rwamagana.  Despite visiting the hotel last year, I was somewhat apprehensive of the hotel's ability to host the course and whether they could pull it off.  Realistically it was our best option.  I was pleasantly surprised...  the hotel was incredibly accommodating and the service by the staff far exceeded my expectations.  Everyone was incredibly kind and eager to help.  It was great!

Tuesday,  the day was devoted to a train-the-trainer course for 12 participants who had been selected as future SAFE Course trainers and the remaining 50 or so participants participated in Building Safe Teams which focused on communication and  teamwork skills.

Teaching Surgical Airway skills

Neonatal resuscitation with neo Natalie

Simulating Maternal Trauma

Wednesday started the official SAFE Course.   We began the day with a pretest (both obstetrical anesthesia knowledge and skills). The day was then divided into a few didactic lectures that would last approximately 30 minutes, and the remainder of the day was built around small group workshops with 6-8 individuals.  Topics included obstetrical anesthesia issues such as: spinal anesthesia (how to improve your blocks), benefits of spinal anesthesia, rapid sequence induction, surgical cricothyroidotomy, hemorrhage, preeclampsia, neonatal resuscitation etc.   The workshops were either a discussion, development of a skill, or working through a scenario with a discussion to follow.

Woon Cho  our official timekeeper!

Thursday and Friday were more of the same with the day starting at 8:00 and concluding around 5:00  At the completion of the course we had the participants repeat the skills and knowledge test.  It was amazing to see all that they had learned.  I had the opportunity to  teach neonatal resuscitation and run the skills test in neonatal resuscitation.  It was great to see how much their knowledge and skills improved with the workshops.

The course concluded Friday evening with a wonderful banquet celebration.  Every participant and trainer received a course certificate.  In addition, delegates were given lifeboxes to bring back to their district hospitals.  At the end of the SAFE Obstetrical Anesthesia Course, we will have successfully distributed lifeboxes to every operating room in 20 of the 45 district hospitals.

The week has just been amazing!  Looking forward to a little R&R this weekend before starting all over again on monday for the second round.

xo

Our youngest participant

a passion for learning

Today was the third day of the SAFE Course.  Each week we are training twelve anesthesia residents or technicians in teaching methods.  The trainers had a one-day course at the beginning and have been paired with faculty members for all the small group sessions.  Each session is run four times with a different group of participants, so the trainers keep taking more responsibility for the session. They are bright and keen to teach.  It has been completely inspiring to watch them jump into teaching with such enthusiasm.   They truly rise to the occasion. 

Many people have commented on how wonderful it is to meet colleagues from around Rwanda.  Some people work in very isolated settings.  One technician told me that she has no help in providing anesthesia.  If she needs cricoid pressure for intubation, she has to ask one of the cleaners. 

We’ve had very positive feedback on the course.  One of the teachers commented that he expected to find people sleeping after lunch but instead saw everyone engaged with the program.  It helps so much that most of the sessions are outdoors in fresh air.

Dr. Enright running a scenario

This is the supreme gazebo.

Benjamin teaching about sepsis.

No Powerpoints....No Problem

After over 1 year of preparation, it was an amazing first day.  The first day of the course was really a prelude to the SAFE course. 12 participants participated in a train-the-trainers course which focused on skills to be a better teacher and the remainder of the group participated in “ Building Safe Teams.”  The buzz word for the day was  “communication.”  How do you communicate better with your students, anesthesia colleagues, and colleagues in the operating room.  Topics included such things as Non-technical skills, an Introduction to the WHO Surgical Safety Checklist, the Universal Anesthesia Machine, Life Box Pulse Oximetry and more.

Week 1 SAFE Course Participants

Since the majority of the participants prefer french as their primary language, discussions were conducted in French, English, Kinyarwanda, or some combination of the three.  For those of you wondering about my language skills, English is definitely my preferred language so I clearly had some help.

Sophie from Lifebox explaining the WHO Surgical Safety  Checklist

Despite all the preparation and three different projectors, we were unable to display our slides for our WHO Surgical  Safety checklist presentation (there were only a few) but it just didn’t matter.  Willy, one of the local Rwandan faculty, moderated the session and it was absolutely amazing.   He did a brief overview of the importance of the Checklist in patient safety and we then demonstrated how to perform the checklist by acting out various scenarios . It was quite humorous but also very effective. The audience really enjoyed it and asked great questions. 

Much of the equipment I brought over from the US including the mannequins, ambu bags, and criocothyroidotomy trainers are finally going to good use.  A special thanks to all who donated.  I am very appreciative of everyone who has donated their time and energy into developing this course.  It is hard to believe it is actually happening.  Very exciting….

2 broken projectors.  The 3rd one sort of worked:)

Cricothyroidotomy from Synatomy. Very lifelike!

The day finished with what turned into a 2 1/2  hour discussion with several of the participants about the Anesthetic considerations for Cleft Lip an Palate surgery.    Smile Train asked me if I could provide some additional training in this area for some select individuals from these four district  hospitals.   A special thanks to Paulin who helped me give this lecture as 1/2 of our audience spoke English and the other 1/2 only french.   From their questions, I realized how fortunate I am to have the resources available at home to take care of my patients.  Despite their excellent knowledge, the lack of anesthetic equipment and medications makes caring for children in Rwanda incredibly challenging.

Stay tuned for Day 2 but really the first day of the SAFE Obstetrical Anesthesia Course…..It is going to be another crazy day

we ran on time!

Today was the first day of the SAFE Course.  After one year of planning, we finally launched the baby.  It exceeded expectations.  We have a great facility at the Dereva Hotel.  It is a peaceful setting where the only outside sounds are from birds.  Most of the sessions are outdoors in gazebos, so there's lots of fresh air and light.  Even though we had little time for the Rwandan and visiting faculties to prepare together, we still managed to adapt to what was required.  

The whole day has involved lots of hands on, interactive teaching.  We've been running scenarios with role-play and teaching hands on skills.

Megan, who works with me in Halifax, has been a stellar course coordinator.  Who would have believed that we could run on time?? Megan has had to deal with many unexpected events, such as participants showing up with young children.   

We are all exhausted and working full out, so this will be brief. 

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