Rwandan Resident Reflections in Halifax, Canada

Open link here to obtain full reflection of Dr. Rudakemwa with the strong partnership between Rwanda and CASIEF in Halifax.

This bilateral partnership has clearly been a success. After Dr. Rudakemwa completed his Canadian elective he mentioned “High level of responsibility for patient care, human factors and anesthesia, organization, scholar and social life” helped him shape his practice in Rwanda.


Recent Rwandan Resident Reflections in Canada

Open link here to see full reflection of Dr. Eugene Tuyishime. Incredible enthusiasm by Rwandan Anesthesia Residents.

“The global health office organizes the training program professionally and efficiently.”

“I hope with advocacy that someday I will be able to practice anesthesia in similar settings back home because it is an excellent experience.”

“In my opinion, many anesthesia practice improvements are possible in low resources settings starting with interventions that have little cost…”

Recent Resident Reflections from Rwanda

Open link here to see full reflection by Dr. Kitt Turney. Incredible enthusiasm by Canadian Anesthesia Residents.

“It was incredible.”

“Clinically, you wouldn’t believe some of the stuff we saw.”

“Teaching, and preparing for teaching, was exhausting and exhilarating, but most importantly, extremely rewarding.”

“The residency program has come a long way, and the residents are so keen!”

“The Rwandan people are amazing. So friendly and welcoming.”

“The gorillas. Wow.”




Wednesday, January 18, 2017

Teaching and Learning Course in Kigali

From Patty:
You have to be a very special person to sit in 32 degree weather in a hot classroom all day and stay engaged with the topic of teaching and learning for medical professionals.  Fortunately, we had a group of 20 such people.

On another note, the simulation centre is being fully used each day.  We had a big group in the front room and another group of emergency medicine learners were in the back room.  Thank goodness we have the best washroom at CHUK in the sim centre!

From Kitt:
Hello friends!

Today “Dr. Ruth” and “Dr. Patty” did a fabulous job of delivering the Teaching and Learning Course to the Rwandans. We had a mixed bag of residents and staff from the disciplines of Surgery, Emergency Medicine and Anesthesia. Kyle and I have been participants of this engaging course at Dalhousie. Today we mostly observed, with a view to delivering the course ourselves tomorrow, along with two Anesthesia staff here, Dr. Francoise and Dr. Christian.
Ruth and Patty have put a tremendous amount of work into developing this course, and it shows! I think it evolved out out of both a need for improved teaching in the medical field, as well as their own passion for fostering an environment for lifelong learning. The course is divided into 4 sessions: Teaching Small Groups, Presentations, Clinical Teaching, and Mentorship and Coaching. The sessions were highly interactive and there was tremendous participation from everyone in attendance. The sim centre was hot (it’s 31 degrees today), but the fans were working and we had some nice breaks for hydration and feeding! We are all pumped about how the day went, and Kyle and I are especially looking forward to the opportunity to help deliver another course tomorrow.

Thursday, January 19, 2017

new teachers

Ruth and I were delighted to watch Francoise, Kyle, Kitt and Christian offer the Teaching and Learning Course today for a new group of learners.  They all did a fabulous job and brought their own unique styles to the session.  Kitt had us doing squat jumps to refresh the brain.
Ruth said “the last two days went as well as they could have gone”.  High praise indeed.
Last night we celebrated at the Mongolian Grill at Serena.  You choose your vegetables and meat (or fish), which is cooked on the spot with flaming fire.
Thank you to all of you who are following the blog and for your wonderful supportive comments.

Monday, January 23, 2017

rich days of learning

From Kitt:
Hi all! I hope this finds you well.

Where did we leave off? So much seems to happen on a daily basis here, it can be easy to miss things.
After our beautiful walk through the hills of Kigali yesterday morning, Kyle, Amélie and I went to the Genocide Memorial in town.  A total of approximately 800,000 – 1,000,000 people died in 100 days in 1994. Over 250,000 people are buried on the museum site. The grounds are a place of remembrance for many visitors who lost loved ones.
The museum displays the history of not only the Rwandan, but also multiple other genocides of modern recorded times. The resounding feeling after visiting is an understanding and acceptance of the past so as to not repeat mistakes in the future.
It was a powerful place to visit.
Amélie joined us in the afternoon to run an oral exam station. Patty ran a simulation where she played an obese patient with placenta previa. (She didn’t eat dessert at dinner tonight).  Kyle and I ran a full OR scenario simulation for PPH The residents had to both manage severe hemorrhage after cesarean section under spinal anesthetic, and then convert to general anesthetic after the patient lost consciousness. Simulation can be stressful and overwhelming, but the residents are quick learners.
At the end of the afteroon session, we were visited by the same Minister with whom Patty and Angela met last Monday. The residents, Paulin, the Dean of Medicine, and the Minister had a great discussion about some of the issues facing the residency program, including, but not limited to, lack of resources and retention of clinical teaching staff. The minister seemed very receptive to their suggestions. Overall, it was a very productive day.
Patty and I are looking forward to going to Butare tomorrow, while Kyle will spend another day here with Amélie before leaving for Butare on Wednesday. Next stop, Essential Pain Management Course!

Thursday, January 26, 2017


Essential Pain Management Course

With virtually no time to prepare, we ran the Essential Pain Management Course in Butare today.  This is a simple one day course to teach fundamental principles of pain management.
This course was developed by Dr Wayne Morriss, in New Zealand, and Dr. Roger Goucke, in Australia, in 2010.  It has now been offered in over 40 countries around the world.
We had an enthusiastic multidisciplinary group today: nurses, physicians, anesthesia technicians, physiotherapists, surgeons.
Tomorrow we will train half the group to be future EPM instructors to ensure sustainability of the teaching.  Then we are off to Nyungwe Forest…

Thursday, February 2, 2017


Open heart

As I get ready to fly back to Canada tonight, I contemplate “what does this all mean?” and “why do I keep coming back?”.  There are no easy answers but the most obvious one is that I have fallen in love with a country and its people.

The experience here is about enormous open heart; people radiate genuine warmth and kindness. It is nearly impossible to reconcile the current condition with the devastation that occurred in 1994. Yet the scars are everywhere, literally and figuratively. I am filled with awe by the culture of forgiveness and the vision for Rwanda to be the best country in Africa.

Nearly all the residents we work with were old enough to have memories of the tragedy but that is changing as each year the average age of the entry class in anesthesia gets younger and younger. Perhaps, even now, some of the younger residents have no personal memories of the genocide. Each year of stability allows more time for healing.

I come back each year for both selfish and altruistic reasons. Who wouldn’t want to miss a little Canadian winter? Rwanda is spectacularly gorgeous and there is truly a culture of “no stresse”. Ultimately, though, there are few things in life as fulfilling as helping people acquire knowledge to heal others.  I feel incredibly fortunate to have found anesthesia as a career and to have this opportunity to guide young people in becoming skilled clinicians and confident teachers.  This is as good as it gets.

I am grateful to all of the CASIEF-University of Rwanda former students who are now leaders: Paulin, Christian, Francoise, Gaston and colleagues. It is wonderful to see them flourish. I am grateful to the current group of residents who show up on time for academic day (having done all the pre-reading) and hungry to learn.  I am grateful to my good friends, Angela, Ruth, and Amélie who travelled a very long way for the Teaching and Learning Course and the Essential Pain Management Course.

But today, I am especially grateful to Kitt and Kyle. They worked their buns off always with good energy and cheer. They rose to the occasion, time after time, to meet our goals and challenges. Teaching in the chaotic ORs for complex cases, designing academic day teaching, running scenarios, helping with resident teaching, keeping me laughing, and nudging me on up some very steep hills on a mountain bike. Thank you Kitt and Kyle. Truly the dream team!

I have not forgotten Michelle, who could not come this year. Michelle, I need you back, my friend.

Lots of love from Kigali,

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.



Botswana Combined Critical Care Anesthesia Opportunity!

Funded Combined Critical Care Anesthesia opportunity in Botswana. If interested please read and reach out to attached contact.





Beth Israel in Boston has a longstanding partnership with a district hospital in Botswana whereby we fund a full-time internal medicine and full-time Obgyn attending and residents do rotations. I respect the program a lot – they were very careful initially to not go in to “steal data” and publish, and to listen to the local / national agenda. They have now made some incredible strides in medical education and patient care, and are linked into the national MOH planning process. They are just now starting to write up experience and support local research projects.

The IM and OB person on the ground have expressed a desperate need for an ICU physician, as the ICU is well-resourced but not well-staffed. We need someone who will do well personally and clinically, and who can commit a minimum of a year but preferably be open to longer.

I also think its a great opportunity for a global health anesthesiologist who wants to be on the ground. I am committed to supporting from afar as someone who has experience in a similar setting, and I have a curriculum from Rwanda that can be used as desired for the ICU. This position is funded by Beth Israel.