Counting Drops- International ICU Rotation in Kigali, Rwanda

Erin Blackstock, MD

Resident in Internal Medicine, MGH

PGY 3

Practicing in Rwanda’s CHUK Intensive Care Unit has unmasked my dependency on pharmacy, respiratory therapy, and critical care nursing; the frequently overlooked, yet invaluable members of our ICU team.  Early in the away rotation, I noticed a bottle of propofol infusing without a pump.  I asked the resident, “How do we know the infusion rate?”  He replied, “15-20 drops/min is estimated to be 1 cc/min.”  With this new knowledge I then set to work calculating the infusion rate for our patient, bringing back the math skills I had used in grade school – making sure I kept the units straight.  

At MGH I would have just entered an order with prepopulated recommended dosing ranges, then pharmacy, nursing, and our pump’s computer systems would have ensured the patient received the correct and at a minimum a safe dose of the medication.   

A few patients later on rounds, we found ourselves trying to troubleshoot a problem on the ventilator.  As a budding pulmonologist, I thought my ventilator skill set to be advanced for a third year resident.  While I may be able to suggest changes for patients with challenging physiology, I quickly realized that I typically rely on our superb respiratory therapists to monitor and correct many problems with the vent. 

I was struck that in our context, our resource-rich environment, we can find our skill set limited by the tremendous support available to us.  While partnering with these additional team members undoubtedly benefits patient care, if we do not intentionally seek out these additional skills, they will be sorely missed in more limited settings.  As I return to Boston, I have been inspired to seek out additional training from our respiratory therapists, pharmacists, and critical care nurses so that next time I find myself in a developing country’s ICU I will feel more equipped to care for those patients.