Dylan’s Story – Wrapping up 2017

I travelled to Zambia for a family Christmas at home at the end of December. So, that’s the end of 2017 for me in Rwanda. 3 months shot past crazy fast – I knew they would, but still find myself surprised by it. I have the inevitable feeling that I’ve not achieved quite as much as I wanted to and not sure how I can do all i want to in the remaining (hopefully) 9 months.

I haven’t blogged here as much as I had wanted to. That’s really just because I’ve been insanely busy. I guess that shouldn’t be too surprising also. The Rwanda Anesthesia residency program is quite mature – CASIEF has been there for over 11 years – but there is still really no end to stuff that needs to be done.

My main role in Rwanda is to be twinned with Paulin Ruhato – the chair of the Department of Anesthesia at the University of Rwanda. The aim is to help him in his endeavours to develop the academic department. Paulin is also insanely busy – he’s also the president of the Rwandan Society of Anesthesia, he’s doing a PhD in medical education and still has clinical duties. Also, until recently he was the Program Director. I have taken on the position of acting Program Director. My goal is to set things up so that when she returns from her fellowship in Nairobi, Francoise (incoming PD) can smoothly transition into the role. If my contract is extended from 11 to 12 months as requested by Paulin, Francoise and I will have a month together in Kigali before I leave.

I’ve also been working 3 days a week in the OR most weeks. There are 7 consultant anesthesiologists for the whole hospital. One is in the Central African Republic doing peace keeping work. Francoise is in Nairobi for the WFSA peds fellowship. One is Paulin and another is Dr Jeanne who has many teaching responsibilities for undergrads at the University. That leaves 3 full time staff – Bona (chief so has admin duties), Josué and Edouard to cover the whole hospital – the maternity/gynae ORs, main ORs, ICU including on calls. But all these 3 full timers have also got responsibilities for outreach and mentorship for anesthesia providers in rural areas across Rwanda. Needless to say, it’s tight. Residents often have very light supervision. I usually focus first on peds (follow the crying in the corridor) or the sickest case I hear about. But sometimes I cover as many as 6 rooms. It’s been humbling at times, like when Dr Jeanne rescued me with a neonatal failed intubation, very suboptimal ventilation. It was a very awkward airway and I felt uncomfortable with poor suction and dim light on my Miller blade. Dr Jeanne intubated with a Mac blade I had just told the resident was inappropriate.

And there’s a lot of other stuff. There’s a huge need for supervision of local residents in their research for the dissertations for Master in Medicine (Anesthesia). My own research here. Developing leadership training. Representing the CAS at the G4 Alliance in Maputo – working on advocacy for global anesthesia. Some advocacy in Rwanda – meeting with the Minister of State along with local anesthesiologists. Speaking at the Rwandan Society of Surgery and the opening of the Scope of Practice for non-physician anesthesia providers. Joining a collaborative workshop in Kampala on task sharing/shifting in anesthesia. Keeping in touch with projects in Canada and Zambia. Chairing CASIEF. It’s a LOT!

I’m very grateful to have some downtime over the holidays. (Also a little time with old friends at the University Teaching Hospital here in Lusaka – Rwanda is new, exciting and full on, but Zambia is home.) For now I’m going to focus on overindulgance, sweating it off in the gym and some time with my kids. A very belated Merry Christmas and a Happy New Year to all!