Dr. Livingston returns to Rwanda (6th edition)

Nyamirambo – Saturday, January 26, 2019 (from Patty)

I brought the team to Nyamirambo last night to walk down memory lane. We took Christophe and headed to the Green Corner for delicious fish (tilapia from Lake Victoria) that is eaten using one’s fingers.

This came with Rwandan french fries, so possibly the best fish and chips ever. We wandered down the main street of Nyamirambo – full of people, shops, bars, music and joie de vivre. It had not reached full 2:00 AM fortissimo levels of noise yet, being too early. We stopped at the door of the Guma Guma bar to check that the chairs were all lined up in front of the TV (like church) for the next Premier League game. Indeed, life is unchanged in Nyamirambo. The old apartment building was dark and rather ghost like. Enough of that, we returned to the new apartment and chatted late into the night exploring Stephen’s vast knowledge of esoterica.

We are at another transition point. Tomorrow we fly to Addis Abba, Ethiopia to run a VAST Course. CASIEF has a new program in Ethiopia and we look forward to learning more. Chris is the only one of us who has been to Addis before (outside of airport transfers).

As our time in Rwanda comes to a close, I reflect on the visit. It has been productive in so many ways. There is a hunger for our continued involvement, yet at the same time there is a sense of enormous progress. The anesthesia program is well launched and able to function without us. Many people around the country have received extra training and plans are underway to embed the VAST Course as a frequent offering for continuous professional development.

On a more personal note, I reflect on time. Life is always too short but it is possible to have a rich life where time is enjoyable, meaningful and memorable. That is the gift that Rwanda has given me. Even though we have only been here a few weeks, it seems ages ago that Chris and I were wandering around for our first lunch, we cycled the dirt roads in the northern province, our first Jeopardy game with the residents, watching the fishing boats on Lake Kivu. All marvellous, all rich experiences.

My future involvement in Rwanda is an open question. I will no longer come as a CASIEF volunteer (too old and no longer practicing anesthesia at home) but I suspect I will return in some other capacity, perhaps a family visit with all the people who consider me their Canadian mum.

On to Ethiopia – Monday, January 28, 2019 (from Patty)

Our final night in Kigali, we were invited to the home of Francoise, anesthesia program director and a good friend. It was a warm gathering with family and friends. Francoise gave us a lesson in the African method for carrying a child. Chris and I both made the effort but clearly Francoise is the only one of us who looks perfectly at home with a baby on her back.

The journey to Ethiopia had a prolonged detour in Bujumbura, Burundi, long delays in the visa line, and what felt like an interminable wait for the shuttle to the hotel. We rolled in around midnight last night, tired and punchy.

First impressions of Addis – fewer trees, busy, fast paced, lots of concrete, tall buildings, enormous hospital complex, people wearing traditional clothing. We jumped right into a VAST facilitator course today with 3 staff anesthesiologists and a senior resident. Our team expanded to include Emma, an Ottawa resident, and Julian, the CASIEF-Ethiopia lead. Our Ethiopian hosts had arranged a bright airy teaching space and assembled the course materials. We quickly began rolling out the scenarios and were delighted at how well the group picked up the key ideas.

We finished the evening with a traditional Ethiopian meal – communal meal on injera eaten with fingers. We have one more day of facilitator training tomorrow before welcoming 14 participants to the VAST Course on Wednesday.

A VAST success – Wednesday, January 30, 2019 (from Patty)

Day one of the VAST Course in Addis. The participants are on time, the space is bright and cheery, the food is more or less on time, the day is bright and sunny. My concerns about people being too quiet during the first session were quickly put to rest – by mid-day people were jumping in with comments and insights and we had to curtail discussion to keep on time. We have a mixed group of anesthesia residents, NPAs, nurses and surgeons. The four facilitators we trained on Monday and Tuesday have exceeded expectations by a huge margin. They are now running and debriefing scenarios with some prompting from our team. It is a huge luxury to have a big team (to say nothing of the talent!). Dave is now a VAST Course pro. An additional bonus is the the level of English is strong and where needed our local facilitators quickly translate into Amharic. Other great moments: Laurence, the sim coordinator from Rwanda, coaching Haben, the anesthesia admin assist. My heart melted to see them sharing a chair and chatting away. I truly hope this is the beginning of a journey of simulation in Ethiopia.

Strong Women – Thursday, January 31, 2019 (from Patty)

Many of the leaders in the anesthesia department are strong, talented women. How great! The head of department and the head of the Ethiopian Society of Anesthesiologists are both female. Three of these skilled women are helping to facilitate the VAST Course. Watching them engage with participants and pull out the best performance, is inspiring. Day two of VAST is scenario heavy with 7 challenging OB anesthesia scenarios. We are tired but smiling.

Visit Dr. Livingston’s blog at < https://simcentreopening.blogspot.com/ > to see the original posts, including photos.