Last Blog

Well folks it's Saturday morning and we are off to the airport this afternoon. We took the day off yesterday and visited the Kigali Genocide Memorial. It was very heartbreaking for us, and as we strolled around the gardens and viewed the mass graves afterwords we could not speak.

Then we met up with the residents for our last paper work party! This is for the senior residents to come to Canada. So now the forms are filled out, work permits are ready to submit on Monday, and we are bringing the other completed forms home with us today. YEAH. Then out for a celebratory dinner, Martin and Wanda joined us so this was great for everyone to meet.

Looking forward to coming home-Here is one last African sunset.

Love Jennifer

Farewell Dinner

Well folks our stay is coming to a close.

Yesterday we did the exam-last lecture, and then out to dinnerIt was a great gathering at Khana Kazana-14 people including Theo and Bosco-his wife and Bona's wife-and 8 ot of 9 of the residents.

Esperance also joined us. We love her as you can see from the picutre.

All the best and see you soon

Love

Jennifer

OH NO -MOTO

Dear Folks:

After a long drive on Friday after work in Butare-we reached the shores of Lake Kivu-one of Africa’s great lakes which is on the border with Congo. It is surrounded by hills, and volcanoes-some peaks are 2800 m or higher, one volcano erupting in Goma in 2002 with lava flows which go through the town. We arrived late at the Paradis Malahide, and woke up to a very loud baptismal ceremony involving many people being dunked into the lake accompanied by singing. Once the noise had settled down, breakfast on the beach, and then swimming and lounging around. The lake is also an exploding lake-with methane being actively collected from its depths-so bubbles come up between your toes, and there are some areas where swimmers have been overwhelmed by the gas and suffocated. On the bright side there are no crocodiles.

So folks I finally did it and took a moto-the roads were quiet and I paid the MOTO dude extra to go “doucement”. Doing a continuous Heimlich maneuver on the driver with one arm, and gripping to the back with my other I was only able to turn my head occasionally to observe the view, as we sped around turns, over bumps-all the while telling him that MOTO’s were “tres dangereux” and my mother would like to see me in once piece when I get home. Meanwhile Martin was speeding along beside me-taking this pic, and egging him on to go faster!.

So I forgot my bathing suit to come to Rwanda-and so the lady in the dugout-is in her black underwear-another embarrassment to Martin-but I was bound and determined to get that dug out going. I had to radio in to the German Coastguard-we’re sinking, we’re sinking-

Kwesi and I are in our last week-sometimes I completely lose it in terms of not being able to keep my mouth shut. I have been watching the surgeons gown and glove-after pushing their hands completely through the sleeves-they then pick up their gloves-sometimes wiping the front of their gowns with their bare hands-and then contaminate their gloves exteriorly as they fumble to get them on!. So suddenly I found my self saying-“I do not approve of the way you are putting on your gloves”-went and got a gown and did a full demo of how to self glove-with the surgeon and scrub nurse-Can you imagine me doing that back in Canada with a surgeon.

Its hard to believe it is the last week-Kwesi and I have been working on the exam-putting our thoughts together for our end of tour report and starting to work on individual evaluations for the residents.

Hope all is well with you and that you survived the hurricane-the weather here has been great.

All the best
Love Jennifer
PS Besides the poo paintings they may not let me into Canada because of my hair!

Off to Butare

Dear Folks : Just wanted to give you a quick update. All is well and we have finally gotten many issues sorted out-such as the internet in our apartment, where to buy cheap food, and how to get some clothes washed!!

We are off to Butare-about a 2/1/2 drive from Kigali and we are put up in a Hotel so it is a nice break from the apartment. Today is our big teaching day -so we are gearing up.

We had the senior residents over last night to help them fill in their documents so that they can come to Canada for a 6 month elective-The process is quite difficult, as the amount of documentation that is required is incredible. Anyway we hope to be able to help them work their way through it.

Yesterday was and interesting day in that it was our first time to King Faisal Hospital that was opened up in 1998 from a donation by the Saudi King. It is modern, well equipped, but is financially way out of reach for most Rwandans. They have better ICU ventilators than we have!! To be exposed to the technology again was reverse culture shock, so when I get back I am going to have fun pushing all the buttons on th machines to see what they do-I only have a few buttons to push here.

We are planning to go to Lake Kivu this weekend. It is supposed to be spectactular. So expect more pictures-It is hard to believe but we are half way through our third week here!! So will be seeing you soon.

All the best-Love Jennifer

Racoons AKA Baboons

African Racoons

Dear Folks. We are back from Akagera game reserve. What a wonderful place! It is close to Kigali-21/2 hour drive-and peaceful with very few visitors. Camping turned out to be a great idea-a break from all the dust and noise of Kigali. There was only one light visible at night from our campsite-the local hotel-all the rest were stars, and we sat in perfect silence listening only to birds and bat chirps overhead.

After driving around the reserve seeing hippos, giant crocodiles, a huge variety of birds, zebras, impalas, gazelles, giraffes we had a great lunch at the reserve lodge and then with the help of our guides set up a megatent!!. In the morning, Martin and I got out of the tent first and munching on apples, with our backs turned, did not notice the baboon sneaking for the entrance of the tent. This was a fearless huge male baboon-AKA raccoon-a foot from tent’s entrance-right next to Kwesi’s head. Needless to say we yelled loudly. While eating breakfast we had to persistently charge him with a tent pole to keep him at bay-yikes!! This makes raccoons look tame-you should see the teeth on that guy too!

So we are back at the apartment-still trying to solve issues-we finally have got some laundry done, got the place cleaned, and clean towels and sheets and I just found a great little cheap restaurant down the road.

Kwesi is working away on his presentations-and I am going to try to get a basic pharmacology review done tonight-for the first years. Across the board these guys do not know how the drugs they use on a daily basis!. They do not seem to have received any introductory course in anesthesia-and so I am going to try to do a crash course for the first years on Wednesday.

Hope all of you are well, and the weather in Halifax is being cooperative-we actually have had a few days of rain here which has been good to try to dampen down the dust.

Love Jennifer

Good times

August 13th.

Dear Folks: Well the blogs are getting more infrequent as the internet access becomes increasingly sporadic, and our fatigue at the end of the day prevents us from wandering to an internet café. After a very trying early part of the week, we had a very productive teaching day on Wednesday, with the Dr. Claude talking about anesthesia considerations of the prone position, and then practicing rolling Kwesi to the prone position, as well as a Dr. Theo doing an excellent overview of the coagulation process, and issues in anticoagulation, deep vein thrombosis prophylaxis etc.

We were then picked up at the end of the day and driven by the hospital driver to a hotel in Butare, which is a winding 2 hour drive south of Kigali. We had a dinner by the pool, and then today had as far as I am concerned one of the best in OR teaching days yet!!

With the residents we did a femoral block, subclavicular, and interscalene block and then I showed Dr. Theo how to do a TAP block on an elderly patient who had abdominal surgery for cancer. On top of that Kwesi went through all the considerations and issues of using and LMA, including having a back up plan, dealing with laryngospasm etc. I did a whole lecture on local anesthetics today also-so really amazing. Kwesi went over the nerve stimulator, and muscle relaxants.

Then off to dinner tonight with Dr. Patrick and Dr. Theo, and we had a great chat about the residency, giving some feedback about the residents and also teaching issues in both Kigali and Butare-it was a very frank discussion and I think we were able to communicate our concerns. Every time we talk to these guys we come home inspired and ready to put in our all the next day.

We are heading back to Kigali tomorrow and then going to Akagera game reserve on the weekend where we hope to see elephants, giraffes, hippos etc. And get this we are going to camp-so I am going to be huddling in a tent hoping that I don’t get eaten by a lion-HELP! Never mind the lion-I guess there are these nasty bugs called TSE TSE flies which transmit sleeping sickness-so if you see me falling asleep in the OR when I get back this is what I am going to claim.

During this time I am reading Shake Hands with the Devil-. It is hard to believe that the terrible events of the past took place here as the kindness of people has been wonderful, and we watch people great each other, holding hands and kissing. The place is vibrant-with people everywhere. Little babies strapped on backs, ladies with 30 pounds of avocadoes balanced on their heads-etc.

Well got to go.

All the best
Love Jennifer

Some more pics

The Good and The Bad and the Ugly

Dear Folks:

This is the Kwesi Gnome (the guy on the right) and a great pic fom the forest.

Sorry about the long delay. Our internet that we have been tapping into at the top of the stairs is no longer working, and so I am doing this from the hospital.

We had a wonderful weekend in Nyungwe National Forest-getting picked up at 500 am and taking a long drive (the distance is not far) through winding roads and beautiful country side. We stopped to see the Royal Palace-which has tradtional woven houses as well as a modern villa, and then arrived at the lodge in time to make our first visit to the monkeys. The next morning we were up again at 4:00 am to drive on the worst road ever. The Rwanda's have a name for this kind of driving-African Massage-as this is the kind of body pummeling you get on the ruts.We were so lucky to get a very close up view of the chimpanzees-a real thrill to see them in the wild, then back for lunch and the long drive home.

No comes the bad part-(hold on for the ugly). When we got home the power was gone again, all the food in the fidge was bad, and so no supper and also no internet. Then in the morning off to the hospital sans petit dejeuner, and an absolutely hectic day in the OR. In fact we had to do awake trachesostomies for huge intraoral lesions-but both times the surgeons wanted the patients to be intubated prior to doing the tracheostomy. I won't go into details but it wasn't pretty.

At 5:00 pm Kwesi and I were both famished, and decided to head downtown to go to the bank to get extra cash, and out to dinner. Kwesi's Visa was declined, and at that point the cell phone died. So now we are a bit down cast-so out for a good meal and then home-only to find out that someone had attempted to break into the safe by using a simple bicycle type key, which fortunately did not work, but at the same time broke off in the safe rendering it impossible to open. So now we have no access to out money, passports, medical insurance etc. We had stored everything in the safe, and since our apartment was not getting cleaned had left the door unlocked as there is a house guard on duty-bad idea!! Needless to say I spent hours awake last night wondering how the hell we were going to get in to the safe, get out papers, etc. This morning we informed the Esperance, KHI and we went to work and fortunately through the help of Bosco, Bona and Kwesi as well as many others got the thing open, but the saf now is totally dependant on knowing the code as the key is still stuck in it and so we will let Peter Slinger know the safe code when he comes.

Meanwhile I am still trying to concentrate and teach so we have been somewhat stressed. People have been really nice, and comforting so in fact again it has brought us closer to them. We are starting to chat with people in the OR and sometimes they are pouring out their personal stories to us which you cn imagine can be very moving. Anyway we have recovered and we are starting to feel a bit better.

I am going to try to attach som pictures-

All the best.

Love

Jennifer

Need a New Garden Gnome

Dear Folks:

If you need a new garden gnome-Kwesi is the cutest-John Glenn eat your heart out-see below

Its Friday night and Kwesi and I are pretty burned out-we have worked hard and been exposed to so much that it takes about an hour and a half to decompress each night over one or 2 Mutzig-which is of course the local beer. There is no question that we are putting 110% into this-and so by the time evening roles by we are tired.

Last night I thought Kwesi had flaked out early so went to bed, inserted my supersonic earplugs, and was asleep in 2 picoseconds. Unfortunately what I did not know was that Kwesi was on the stairs doing internet so I had locked him out. Despite repetitive banging on the door, I was totally unaware of his predicament. Of course the neighbours must have thought we were having a spat, and fortunately someone was available to let him in from the first floor.

We are off on a visit to Nyungwe Forest National Park with Martin and his group tomorrow. Should be fun and so I will be out of touch tomorrow and possibly Sunday.

For those of you interested in poo paintings see picture. Hope to have more pictures of the country shortly. It is very hard to take pictures of the hospital as people do not like to be photographed. I understand as there is a privacy issue.

Here are a few pics.

Hope all is well with you.

Love Jennifer-By the way the temperature has been between 28-30 degrees everyday and it has been great. The evenings have this soft warm air which is wonderful. sorry tried to load images but computer is too slow

Dung Paintings

Dear Folks: If you wish a new form of artwork to decorate your walls would recommend dung paintings. Yes you got it -poo de cow paintings made locally -they are somewhat three d and I picked up three of them this afternoon at the local art market. I know the sniffer dogs at TO airport are going to go crazy and I may have to throw away the clothes I use to wrap them in. However they are locally famous and quite attractive. Martin took us to this art market after work today, and from there we ended up eating out for three people for 30 dollars. called African Bites!

The day was good-rounds in the morning-we had a patient with severe asthma going for a lap cholectectomy-quite the challenge with the glostavent. Kwesi did some amazing one on one teaching in the OR today with Antoine, and I did oral exams with Paulin and Antoine this afternoon. Also did a brief regional tutorial with Dr. Bosco this afternoon on regional and we are going to hang out together tomorrow to do blocks.

On top of that Kwesi and Dr. Willi got together and made a anesthesia machine funtional-needs a new Datex ohmeda cell for the oxygen analyzer but thanks to all the connections I brought with me and Kwesis great knowledge re circuits and anesthesia machines-got everything tight and working pretty well. Once again thanks to Dale for telling me to bring the adaptors.

Also gave the new BP cuffs to the techs so that we can finally get a BP machine in every OR-yeah!!

So once again if you appreciate Eau de Poo would suggest these lovely Dung paintings.

All the best

Jennifer

Good teaching day

Dear Folks

This is going to be very short as it is quite late-and we have had a long but great day. This was our didactic lecture day and we had 6 hours of lectures!! The residents did 2 presentations in the morning, and then in the afternoon I had my presentation on how to manage cervical spine fractures.

We demonstrated manual in line stabilization for intubating patients with cervical neck fractures, how to log roll patients, and discussed trauma protocols.

In the evening we met up with a wonderful group of surgeons who do international outreach work-headed up by Dr. Patrick. It was great evening of discussion about Rwanda, Uganda and other developing countries. He is working incredibly hard and is the only general surgeon currently in Butare. This means he is on call all of the time. Right now they are teaching residents how to do caesarian sections, and these same residents will go on to train others. If I remember correctly there are only 15 surgeons in the whole country!!

I am heading off to bed but with the permission of the patient have shown my first patient in Africa who had a subclavian block for a humeral fracture-he is sitting straight up with the thumbs up because he has had his surgery done awake, and without pain.

Bye for now

Love
Jennifer

Very Busy Day with Great Dinner With Martin

Hi Folks. Kwesi and I were both involved in some intense teaching today, and then went out this evening with Martin to and excellent Indian Restaurant. He looks well, and is having a fantastic time. He told us about his road trip to Tanzania which involved almost 2 days of road travel each way, but was rewrded by seeing every kind of animal, and a 5 hour unscheduled road stop due to a flat tire. No one got out to stretch because it is also Lion Country.

We are doing our first day of lectures tomorrow, and so are preparing this evening.

I am posting a few pictures of us so you can see that we are alive and well.

Martin is going to take us on a tour of the Kigali War Memorial. He is obviously very overwhelmed by some of the stories he has heard and has met some of the widows and orphans that Aegis trust is helping to support. Obviously some very sad and moving stories.

We are also heading out together to visit Kyunge National Park this weekend.

I am looking forward to this and seeing the country side.

Take care all-

Love jennifer

Let there be light

Hi folks-just an addendum to last email. We thought the power was out because "hey this is Africa", but when the power came on in all the other apartments we thought-ok there is something really wrong.

As it turns out the hospital did not pay the power bill-so we were cut off-but thanks to the friendly neighbours they went to the power company-payed some cash (about 10 dollars American for 2 weeks of light) and low and behold our power is back on! Yeah. Kwesi is working away at his presentation so he is now happy!!

You know this is a first-I have never had my power cut off before-so now I know how it feels.

Take care and stay tuned for the next episode.

Jennifer

Amazing first day

Dear Folks Kwesi and I are celebrating our first day over a Mutzig (local beer) and curried aubergine over rice with tomato and avocado salad. Not bad eh.

We were picked up punctually at 7:00 am and off to the hospital we went weaving between potholes and near dead on collisions-Kwesi has now offered to sit in the front seat from now on.

We met with the director of the hospital and Dr. Willi as well as Esperance-the schedule is certainly shifting from the preplanned template but we are going with the flow.

We started making our tour of the hospital ORs which is interesting because the rennovations hve caused there to be multiple scattered ORs across the hospital grounds, the majority taking place in what was once opthalmology. As we entered the recovery room area which was packed with at least 6 stretchers in an area not much bigger than my kitchen, there was a baby looking extremely weak and being hand bagged vigorously by a nurse. Dr. Willi attempted to intubate but the baby was struggling. Shortly after that the baby ceased any respiratory attempts so I intubated the baby, and because of lack of IV access as the baby was totally peripherally shut down Kwesi put in an interosseous catheter-and we were able to bolus the baby fluid. Then we had to start looking for a ventilator and Dale you would be happy to hear this but we are pressure control ventilating the baby with an adult ventilator !! This was scrounged up from emerg. I forgot to mention that this baby was postop colostomy due to an inperforate anus. Besides this baby there was another one with an omphalocoele and what looked like multiple other anomalies. Anyway 4 hours later we proceeded with our tour of the hospital.

We met with the residents, Dr. Jeanne, and have set the teaching program up as well as going out for a coke with Paulin. I have also made contact with Martin by cell, but have not seen him because the kid has been in Tanzania on a safari tour.

So Kwesi and I are settling in-we are great supports to each other -
Forgot to mention that we ran into Dr. Patrick and another volunteer surgeon at the Hotel Milles Collines yesterday so small world !!

Got to go-did I tell you that we have no power right now-I am sitting at the top of the stairs and have to find my way back in the dark.

Take care and I will keep you posted.

Love Jennifer

We Have Arrived!!

Dear Folks:

I am sitting at the top steps of the apartment as this is the only place the wireless will pick up-and it is early Sunday morning. After thiry + hours of travel which was totally seamless we arrived last evening to be picked up by Dr. Jean Nepo at the airport.

Kwesi and I met up in Toronto as had a few days of recreation with his buddies, had a mega beer and then got on Jet Air which makes Air Canada look like a low budget transport plane. The smells of Basmati Rice and Curry coming from the kitchen and the fact that the announcements on the plane were in Punjabi awakened us to the fact that we were flying on Indian airlines.

Kwesi and I entered stage 4 sleep for most of the trip from Brussels to Kigali and so were reasonably refreshed when we got to our destination. Met a Canadian Obstetrician who is going to work at CHK also.

Apartment is fine-no hot water last night but greated to plenty this morning so feel great. Hope all is well with you. We are off to do some shopping today and wander around. Thanks to Julie for all her little notes and words of advice.

By for now

Love Jennifer

Leaving in Two Weeks

Hi folks: sitting in Patty's office and she is showing me how to set up a blog. Thank god for people who know something about computers!!. Getting excited, suitcases are starting to fill up, all immunizations have been done-(muscle groups have recovered) and my CPK is back to normal.