Dr. Livingston’s blog

Saturday, January 7, 2017

preparing for the residents

It’s been a quiet Saturday, as I prepare for a busy month and the arrival of Kitt and Kyle tomorrow afternoon.  Christophe has stocked our fruit and vegetable supply from the local market and bought a selection of Rwandan beer. We’ve started a slight teaching exchange of English for Kinyarwanda. Sadly, my Kinyarwanda vocabulary remains stuck at about 20 words, and even that might be an exaggeration.

Kigali has implemented a program of closing the road between the city centre and the airport one Sunday each month so that people can get more exercise. Great idea! Christophe and I are going to check it out tomorrow morning.

Although there is now wifi in the apartment (yay) it does not seem to be strong enough to post photos. Stay tuned. I’ll do my best to ramp in up when my companions come.












Thursday, January 12, 2017


I first met Paulin in November 2008 when he was chief resident. He showed great potential as a future leader. Today he is program director and acting head of anesthesia. He brings incredible energy to our mutual vision of creating an excellent anesthesia department.

We spent an office day together working on multiple projects: planning clinical and academic teaching for September this year when there will be 30 residents in the program, teacher assignments, simulation curriculum, education for non-physician anesthetists, improving pain management in Rwanda, working for better maternal safety, collaborative research projects and Paulin’s own career path. It was a rich and rewarding discussion. I feel so fortunate to have a friend like Paulin.

Needless to say, we had to fuel this productive day with a little coffee from Bourbon Café.








Monday, January 16, 2017

Rain in Rwanda

From Patty (written on Monday):
There has been no rain in Rwanda for a month but the skies opened today and the rain pelted down on the mental roof of the simulation centre in the middle of academic day. It was acoustically impossible for our class to continue as a whole, so we broke up into group work. The residents worked in pairs to explore problems and solutions to safe anesthesia care in Rwanda.  Fortunately, the rain stopped in time for a rewarding discussion of their ideas.

Kyle did the bulk of our morning teaching.  We had an enthusiastic Jeopardy session, once again.  It was great having Angela and Ruth to help with teaching today.  We ran three afternoon simulation stations, with Angela doing a stellar job at neonatal resuscitation.

From Kyle:

After a busy weekend, it was a bit of a shift to get back to business. Monday is the residents’ academic full day though, so we got up and got ready.

Today’s topic was on hypertensive diseases of pregnancy: mostly preeclampsia and eclampsia, as well as the related HELLP syndrome. A somewhat nuanced topic, it is important to review as these conditions are one of the leading causes of morbidity and mortality in pregnant women. This is particularly true in Subsaharan Africa, where the incidence of hypertension, an important risk factor for this disease, is especially high in women of childbearing age.

We all put a lot of energy into today’s session and were not disappointed, as the residents were generally very well-prepared. We completed a solid review of the diagnosis and management of each condition, made anesthetic plans for several hypothetical cases, and played a predictably rousing game of jeopardy.

We also participated in the residents’ weekly problem rounds and then had a quick lunch meeting with Eugene and Alcade, residents who will be joining us in Halifax for several months later this year. Action items identified included coats, boots, and a primer on how much less terrifying it is to cross a street in Halifax.

In the afternoon we took the residents through several simulation sessions, prominently featuring Patty as a distracted nurse, Kitt as a mom-to-be with a bad headache, and Ruth and Angela using music and other fun to review neonatal resuscitation. I even got to channel one of our PGY-1 sim mentors: “so, how did that scenario make you feel?”

We finished our very full day with a session on needs assessments and advocacy. We took a very simple, issue-based approach to deficiencies the residents have identified in their system, with problem solving and goal-setting to determine solutions. Many of the residents are very motivated to make changes here, and are clearly striving to improve the system in which they hope to someday practice. They definitely face greater challenges learning here than Kitt and I do at home.
















It also rained for the first time since we got here! A torrential downpour for about 20 minutes, and then sun again. I’m not sure it was enough to solidify my increasingly tenuous morning shower privileges… I hope for everyone else’s sake that it does!

Finally, with our work done, we had a quick debrief over tea and a celebratory dinner at Heaven, one of Patty’s favourite restaurants. Tomorrow she and Angela meet with the minister of health, while Kitt and I head back to the hospital and get started on next week’s material. The fun never stops here in Kigali.