I think acclimatization has finally been achieved. No more dyspnea after the 25 minute walk to or from the hospital. One underestimates how high up we really are here in Kigali, and the stress of the hills and the heat can really take it out of you by the middle of the afternoon.
Over the course of this first week, we have already seen some interesting cases. One was a middle-aged woman with a stab wound to the chest, deep enough so that one could see mediastinum and lung move as the patient exhaled. The patient was stable enough so that the case could be done approximately 20 hours after initial presentation, with surgical management in the OR consisting of chest tube placement and wound washout and closure. On the OB side, Mohamed helped manage a patient who required a hysterectomy and had a presenting hemoglobin of 4.
As a resident, I think it is important to realize and accept that there are other ways of doing things besides those with which we are familiar during training. If there’s one thing that I have come to appreciate this week, it’s flexibility in anesthetic planning. Sometimes some catheters, monitoring equipment, or medications just are not available. One must adapt. For example, all the Datex-Ohmeda anesthesia machines were being utilized, so an unplanned GA had to rely on manual ventilation with thiopental pushes, then a Glostavent. This was my first exposure to this delivery mechanism.; I must say I was impressed. Another example: for a prone case, there’s no such thing as a “prone-view pillow”, so one must be fashioned out of rolled up blankets and towels. The Rwandan residents and anesthesia techs are quite adept at making things work.
Newer model Glostavent, being used in a PACU patient. The compatible vaporizers can hold halothane, thus also enabling delivery of isoflurane.
We had another morning report today, with a great review of the issues associated with blood loss/conservation in a limited resource setting. Afterwards, I went to the OR while Mo helped with final exams for some senior residents.
In the staff locker, we find a copy of Dr. Yemen’s Pediatric Anesthesia Handbook!
As it is Friday, the OR wrapped up earlier than usual. I decided to head out to explore the neighborhood around the hospital while Mohamed finished his examination. 30 min later I stumbled upon Hotel de Mille Collines, or the hotel in the film Hotel Rwanda.
View from balcony of Mille Collines.
Tomorrow we set off for Akagera National Park for a short respite.