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Work Week 2 – Aug 13
This has been a busy week, a week of interesting cases and unusual conversations. Many things considered mandatory in London, Ontario seem almost frivolous here. Things like a sheet to cover the patient’s exposed body, blankets, bedsheets on the patient’s bed, pillows, alcohol wipes, paper towels, labour epidurals, screens to keep patients’ privacy, informed consents, safe sharps management, anaesthesia machine checks, the help of an RT, availability of blood for transfusion. Oh, I could go on forever!
Beth and I have decided that we are going to kiss our anaesthesia machine and glidescope when we return! She has also said that she is looking forward to her OB call. This one I am not too sure about and I will have to see if she changes her mind!!!
Here is a patient who very kindly allowed us to photograph her for teaching purposes. She came in for a mandibular tumour excision. We did promise her that her face would have a black stripe over her eyes. A very pleasant woman who lives in a remote area of Guyana and came in for surgery as she could not eat anymore.
Kaieteur falls weekend trip – Aug 13
We had an amazing weekend. We were invited to a Guyanese wedding on Saturday. An anaesthesia resident was getting married (to an OB resident!) and we were last minute invitees. What an opportunity to see a local wedding! Despite both the groom and the bride being of different faiths, the ceremonies did not take too long and then it was food and dancing. We all had fun!
We had been negotiating with various travel agents for a weekend trip to Kaieteur and Orninduik falls. Finally, after finding the right price, on Sunday morning we were at the Ogle airport to take the small 12-seater Cessna 208B to the Kaieteur Falls. It was raining heavily and the trip cancellation was looming on the horizon. However, 2 hrs of waiting was rewarded by a sudden clearing of skies and takeoff
There are no roads to this protected national park and the only other way is to hike for 7 days through dangerous rainforests (that many still do, believe it or not). Neither were we brave nor did we have the time so we flew over miles and miles of dense Amazon rainforest for about 50 minutes and then the falls suddenly appeared.
The Kaieteur Falls are about 4 times higher than our own at Niagara so one can imagine the absolute perpendicular drop of the coffee coloured water. I believe that they are the world’s largest single drop waterfall by volume. There is sheer isolation without any touristy stuff here. The 12 people on our flight, one pilot and one guide were the only souls (apart from the 2 park rangers and one local guide stationed there). Not even mosquitoes! There are carnivorous plants in the jungle that eat all the small insects. I was fortunate enough to see the little golden frog that was discovered in the jungles of Amazon in 2008 and had made the news. It did hide but not before I had taken its picture!
Orninduik falls were another 25 min flight away and as the falls are not deep, we enjoyed bathing in them. It then started to rain just as our time to return was drawing near. Our pilot was very experienced and he brought all of us safely back to Georgetown in the evening. A lovely end to an eventful week about which I will tell in my next post.
Cricket Stories – Aug 10
Today I will share with you a West Indies cricket experience. For those of you who are uninformed, cricket is a sport, not an insect! It is widely played throughout the world except for North America! Countries have their own teams (e.g. England, Australia, NewZealand, India, Sri Lanka, South Africa, Pakistan to name a few). As the Caribbean countries are small, they play as one team: West Indies and it is one of the powerful teams in the world.
Created in 2013, the Caribbean Premier League is an annual Twenty20 cricket tournament held in the Caribbean and most Caribbean teams participate individually, with each other. The matches are much sought after and we were lucky to have one in Georgetown where Guyana Amazon warriors were playing St. Kitts & Nevis patriots.
With our new found OB/Gyn friends Jennifer and Kristen, we went to the Providence stadium to see the colourful and noisy carnival last night. Remind you, Jenn and Kristen along with Beth are (or at least were) cricket naive. All three of them had a crash course in cricket, thanks to aunty ‘Google’ and uncle ‘Wikipedia’. And then it was a blast. Yours truly tried a hand at taking selfies and after many miserable failed attempts, nailed it and the proof is here for all to see!!!!
Follow Shalini’s blog at < https://traveldocanesthesia.wordpress.com/ > and see her great photos with the postings.
Block room in Georgetown!
There were a fair bit of medical students hanging around, it was their last day and they did not know what do so we started teaching them. They were delighted to practice their BMV, LMA insertion and intubation skills on a mannequin. We did make a make-shift block room in the PACU but there was no patient for us! Perhaps in the coming week?
Guyana end of week 1!
Today is the end of week 1. We have been in Guyana for 7 days now. This was a very eventful week and I will report the interesting events.
Clinical work is interesting in the Georgetown public hospital corporation. We had a teaching session with the residents (at various levels of training) on Thursday and got to know them as well. Now I can tell a few names and I am sure I will get better, as the days go by. Maxine is the senior most and will be visiting Hamilton, Ontario in a few months time. She is waiting for her CPSO license. The PGY4s (this is a 4-year program) visit Hamilton for 3 months, regularly. This is such a wonderful opportunity for the Guyanese residents as they get to see things that they have only read about.
We visited the OB suite. It is a relatively new building that was finished in 2017. There were 4 C-sections planned for the day. The place is run by nurse-anesthetists who do all spinals/GAs. Attendings are available in the building across the street in case of problems. It was Deja Vu for me and it seemed that I had stepped back in time, at least 35 years! There is minimal OB analgesia service and lack of equipment/personnel may be partially to blame. Also, the residents/attending stay in the main ORs.
Just as we were getting the hang of the Project Dawn, we had to move out on Friday as the place was needed for a larger orthopedic group. Now, we are in a hotel in the town. This is a reasonably comfortable place and we both have our own rooms but we have to eat out every night. I am worried about restaurant food for 12 nights. I have not hand-washed clothes for more than 2 decades and this is not something I am looking forward to!
On Saturday, we walked to the botanical gardens and the attached zoo. This was a nice trip and we saw some strange animals. We met one of the anesthesia consultants who was also there with his daughter. On our way back, Beth bought coconut water and we did some grocery shopping. Beth cannot stop trying to pet stray animals and I cannot stop telling her not to. Let us see who wins.
We went out with the two OB/gyn residents from USA and had a nice evening. Today, we walked to the local Bourda market and bought some fruits and vegetables. We are both craving fresh greens and fruits! No to mention “LATTE”!!!
Follow Shalini’s blog at < https://traveldocanesthesia.wordpress.com/ > and see her great photos with the postings.
We arrived on Monday, uneventfully. I was surprised that my ultrasound machine did not create any problems! Our pickup was there, waiting patiently for us.
We are staying at a place called “Project Dawn”. It is a fascinating place that was the brainchild of a nun Dr Cameron Gannon who started it as a medical centre in 2002. It is not a medical centre anymore but houses almost all of the medical/educational teams that come to Guyana for voluntary work. There is a common kitchen, the place is airconditioned and is guarded 24/7.
We were picked up by the hospital van on Tuesday and spent a very eventful day at the GPH (Georgetown public hospital). We met consultants Drs Fernando, Shankar, Acosta and Feng (?Du). There were many residents at various levels of training and I am sure I will remember their names as the weeks go by. There are 5 operating rooms for ortho, general surgery, ophthalmology, ENT, urology, gyne and some thoracic work. Cardiac teams visit off and on and do cardiac surgery as well. They tell me that there is a fair bit of trauma. The residents are all very keen to learn! Most drugs are available. Today we did a laparotomy for perforated viscus and Beth was thrilled to use halothane. Though everyone here wants to use propofol, I think I will use thiopentone on Thursday for Beth’s benefit! We are also preparing for our first teaching session tomorrow.
Like most operating rooms world over, there are no lunch breaks. An ex-nurse delivers food for a small price and many doctors buy from her. I think Beth and I will do the same. The meal is about CAD 2. Today we tried a typical Guyanese lunch of chicken wrapped in ‘roti’ that she had brought over.
Today (Wednesday) is a national holiday here so we are staying in. We went for a long walk with our bottle of water and an umbrella. The sidewalks are full of lotus and lily plants, all in full bloom. Did I mention that it rains every day?
Shalini’s blog is at < https://traveldocanesthesia.wordpress.com/ >.
The time to leave for Guyana is approaching. All paperwork and permissions have been obtained and Beth and I leave in 2 weeks time as part of CASIEF (Canadian Anesthesia Society International Educational Foundation) partnership with the Georgetown Public Corporation. We will be in Georgetown, Guyana and be teaching the residents there.
I think while teaching, I would be learning at the same time. This is a 4-week mission. Let us see. Hopefully, I will be able to keep the blog updated.
This is the last week before I leave for Guyana. The anxiety is brewing, just like the coffee at Starbucks, that I love and the flat white that I will not get for a month!
There a lot of firsts for me, first time volunteering, first time away from home for such a long time (35 days to be exact) and first time going to a place I know nothing about. I have never packed for a month, ever. Let us see what all I forget.
There is some medical equipment that I plan to carry with me. Let us see if the airlines will allow it. I have written to the airlines Toronto manager but am yet to hear from him. Soon, I will assemble the presentations and cases for teaching.
Today is DOD+3. The ultrasound machine arrived today. I had written to the company in a faint hope, not expecting a response. However, I was pleasantly surprised and after filling one form, the application was accepted and the machine arrived (along with 5 probes: 2 linear, 2 curvilinear and one phased array) in my office! It is quite compact and fits in a backpack, supplied by them. Now, the challenge is to carry it. I will keep you all posted on the progress. The only caveat is that I have to bring it back and send it by FedEx to them on my return! Leslie, my physio was suggesting that I should have collected money and paid the company so that the machine could be left in Guyana. It is a bit too late for that now, I think.
Beth and I are collecting teaching material and taking printouts of almost everything. We plan to meet at the airport and keep our fingers crossed because of excess baggage! Ciao for now.
Today is the DOD (day of departure). Suitcases are packed, all phone calls have been made, paperwork is completed (hopefully) and flight has been checked in. The only thing left is the journey to Toronto airport that may probably be the largest hassle during the entire trip (considering the traffic and 401 delays)!
A small hiccup has come in regarding the accommodation. The accommodation plan has fallen apart so it is uncertain where we will stay. This trip is going to be an adventure, I can tell. As long as it is not in the jungle and not a tent, I suppose Beth and I will be fine!
Rest from Guyana!
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2018 CASIEF Gala Dinner
Sunday, June 17, 2018.
Auberge Saint-Gabriel, 426 Rue Saint-Gabriel, Montreal
Reception 18:30, Dinner & Speaker 19:00 – 22:00
Tickets available during your CAS Annual Meeting (registration www.casconference.ca).
Dr. Dan Poenaru – Guest Speaker
Dr. Poenaru is a Canadian pediatric surgeon who has dedicated his life to treating needy children throughout eastern Africa. Motivated “by the enormous needs of African children,” not only those of Kenya, but also the numerous Somali refugees entering the country, Dr Poenaru opened a surgical practice in Kijabe, Kenya. Throughout his career, he has treated patients through civil war
and in refugee camps, exposing himself to tremendous personal risk. Dr Poenaru is the recipient of the 2014 Teasdale-Corti Humanitarian Award of the Royal College of Physicians and Surgeons of Canada and the 2015 ACS/Pfizer Surgical Humanitarianism Award of the American College of Surgeons.
To learn more about our speaker:
To view our dinner venue:
- (In English) http://aubergesaint-gabriel.com/en/rooms/grenier-hall/
- (In French) http://aubergesaint-gabriel.com/rooms/la-grenier/
View the Gala Brochure for more information.
ANESTHESIA GLOBAL OUTREACH COURSE
Anesthesia is an essential component of every health system. Despite its pivotal role in routine surgical care, it has not been prioritized globally. This is undoubtedly partially due to a global health human resources shortage and disparities in distribution of personnel globally. Beyond this, at the level of many district hospitals in low-income countries, there are simply few resources to institute physician-led anesthetic care models that are commonplace in high resource settings. Given the scope of the surgical burden of disease, attempts to remedy the situation have included equipment donations, trainee exchanges, or even assisting patients to obtain care abroad. Their sustainability and effectiveness remains uncertain.
The Anesthesia for Global Outreach Course is focused on providing anesthesia providers with the skills and knowledge to work both safely and responsibly in the low-resource setting. The target audience for this course is medical professionals planning to deliver anesthesia, peri-operative, and critical care in the low-resource settings. It is designed primarily for anesthesiologists, certified registered nurse anesthetists, and anesthesiologist assistants, however it may also include nursing, pain management, and respiratory care.
Upcoming Course Details:
BETHUNE ROUND TABLE 2017
The Bethune Round Table (BRT) is an annual interdisciplinary scientific meeting hosted at a Canadian academic centre to discuss challenges and solutions to improving surgical care to under-serviced and marginalized populations in low- and middle-income countries. The objective of the BRT is to bring together health professionals from a variety of disciplines including surgeons, anesthesiologists, obstetricians, and nurses to share their research and experiences in the delivery of surgery in low-resource settings.
Upcoming Course Details
Dates: June 1-3, 2017
Host: University of Ottawa
WORLD CONGRESS OF ANAESTHESIOLOGISTS
Upcoming Course Details
Dates: Aug 28-Sept 2, 2016
Venue: Hong Kong Convention and Exhibition Centre