Teaching Cardiac Anesthesia in Rwanda

Matthew Swisher

Resident in anesthesiology at BWH

PGY4

During our mission trip to Rwanda, a large emphasis was placed on the sustainability of our work and educating the Rwandan healthcare providers.  We had the added benefit of always working alongside two anesthesia residents for each case.  Since cardiac anesthesia is not available in Rwanda, we were able to impart the basic fundamentals of cardiac surgery, monitoring, and procedures.  Arterial catheters and central lines are not placed for anesthesia in Rwanda, so we were able to educate them on placement, monitoring, and troubleshooting.  To some surprise, they use ultrasound for nerve blocks and were very interested in applying what they have learned to vascular access.  Part of our effectiveness was strengthened by having one of our BWH anesthesiologists there for the past year working exclusively on improving resident education.  We were very impressed by their eagerness to learn and master new techniques (despite having never been exposed to cardiac surgery).

One of the Rwandan anesthesia residents, Gerald, mask ventilating a patient prior to intubation

One of the most important tenets of anesthetic care we wanted to impart was vigilance.  Rwandan anesthetic care can be very different to what we are accustomed to.  Cases are frequently staffed by non-anesthesiologist technicians, and there is not always a member of the anesthesia team in the operating room at all times monitoring patients during surgery.  Cardiac anesthesia requires a high degree of vigilance, so we hope our emphasis on vigilance can be applied to their other cases and further education.

Jeff, the other BWH anesthesia resident, supervising Gerald placing a central line

By the end of our two weeks, we noticed Gerald and Servant, the two King Faisal anesthesia residents, applying our teaching to their patient care and becoming more comfortable with cardiac anesthesia.