The connection to WordPress is a-g-o-n-i-z-i-n-g-l-y slow tonight, so this will be a brief post.
Hard to believe, but it’s our last week in Rwanda already! Five more days and we’ll be back in Charlottesville…
We did the last of our academic days today. Morning report with the technicians and medical students was good, as always. Around 8 it started raining hard, with the result that at 9 only two residents had appeared: most don’t have cars, and were apparently waiting out the rain. So I didn’t start my lecture on head injury until 10.
The case presentation by the resident that followed was, I thought, really good. Nothing went wrong in the case, but it exemplified an issue that we also deal with on a regular basis: taking slow steps that individually don’t look bad, until you suddenly realize you’ve put yourself in a dangerous situation. This case was an abscess drainage on the ankle, done with regional nerve blockade in the prone position. The block didn’t work very well, the resident added some sedation, then some ketamine, then some opiate, and then some halothane, and then realized he was actually giving a general anesthetic in a patient with an unprotected airway in the prone position…
During lunch in the cafeteria, Damascene, the faculty member we are working with for the simulation sessions, was called urgently to go see a patient in the obstetric recovery room. We followed and found a patient who indeed had very low oxygen saturations. The obstetrician felt she needed intubation. Damascene, by suctioning her and making her cough some, managed to bring the oxygen saturation back to normal levels, and saved the patient an ICU admission.
Damascene and Paul’s simulation session today was about a meningioma resection, and I got to play the patient this time!
In the evening, Emmy picked us up for dinner at his house with Mary, his girlfriend. We also finally got to meet their little son, David.
Mary had cooked an excellent and very African meal: ugali (cassava porridge), tilapia in sauce, and mixed vegetables. It was also a good introduction for Paul to eating in Africa: from Mary coming around with a pitcher with hot water to clean our hands before the meal, to eating with our fingers.
All together it was a wonderful evening. We’re very happy to have friends like these in this country.