Wednesday, March 15, 2017

Cardiac Surgery in Africa: the Rwanda Experience

Jeff McLaren
Resident in Anesthesiology at Brigham and Women’s Hospital

Posting #2: Last week and Summary

My last entry was Saturday 3/4, it is now 3/8 and we are leaving today for the states. We have completed 20 surgeries in total on 16 patients.  Of these cases 16 were cardiac cases with 2 washouts and 2 pacemaker placements for post op issues. Everyone has been doing great and recovering well though no one has gone home yet. If you recall I spoke of a patient we did last Wednesday 3/1 who have a very complicated post op course. She was finally extubated today. It was amazing to see how happy her father was to see her awake without an endotracheal tube in. All week he continued to ask why his daughter had not recovered like the others and he spent most days and every night with her. One of the more amazing things I have seen is the way the patients themselves help each other. They talk to each other about their experiences and they feel better knowing others are feeling the same way. Language barriers are so huge here and you feel at time helpless as a clinician when you can’t even explain the simplest things to your patients. Even with the translators you don’t know if what you want to convey is really getting through. Overall the mission was a success and so far all of our patients are well. What happens from here is a mystery. Many of them will remain on chronic heart failure medications to manage symptoms and all of them will be on Coumadin with follow up INR draws. This doesn’t always happen as you can imagine in a developing country where many people walk miles to get anywhere and have limited resources to pay for all this. Despite these obstacles the patients tend to do well and from what I have heard the success of this mission has very much established a strong relationship with the people of Rwanda. Last night the Minister of Health held a dinner for all of us to thank us for our efforts.

Matt and I said goodbye to our Rwandan counterparts Gerald and Cervant. Their efforts the past 10 days has been extraordinary and they have continued to work hard despite the long hours. Its hard to measure the success of such a short intervention without testing or simulation but overall Cervant and Gerald have really improved. They have become much more confident in their technical skills and their overall management has improved. The hope is that they take the lessons we have taught them and continue to practice this in their careers. Fortunately for both of them they will have the opportunity to spend some time in the US next year. Gerald will be visiting Stanford while Cervant will visit Penn State and Cornell. I think given the differences in pace between Rwanda and the US this will be a great experience for both of them. They will continue to grow and learn from top institutions that will help them become extremely valuable members of their communities in Rwanda.

Our last day in Rwanda was spent visiting some of the memorial sites from the 1994 genocide. This was an incredibly powerful and moving tribute to one of too many horrible events in the history of mankind. It is even more difficult to see this and to think that many I have worked with and spent time with over the past 2 weeks had been alive and affected by such horrible tragedy. Though almost no one speaks of the events of 1994, it is hard to imagine that they aren’t affected by it. Despite the events of 1994, the country itself is growing. Kigali itself is growing more every day with new construction and infrastructure that will help millions of people. Despite the stark contrast in medical care between the US and Rwanda the healthcare industry is growing. As Danny, one of our attendings pointed out, even though its not what we are used to, it is better than what Rwanda used to have. Any care is better than no care and the care here will get better every year. It is inspiring that the amazing people of this country are so resilient and that their government is dedicated to improving life for all Rwandans. This experience for me has been one I will never forget. The care I was able to provide in such a beautiful place with such wonderful people continues to fuel my desire to work internationally and help expand quality healthcare around the globe.

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