Critical Care and Anesthesia Simulation in Rwanda

Daniel Gessner

Resident in Anesthesiology at Brigham and Women’s Hospital

PGY 4

Critical Care and Anesthesia Simulation in Rwanda 

During February and March of 2018 I spent a month helping to teach anesthesia and critical care in Rwanda. I travelled there under a program that is a collaboration between the University of Rwanda, the American Society of Anesthesiologists, and the Canadian Anesthesiologists’ Society International Education Foundation.  The program places North American anesthesiology residents and attendings in Kigali, Rwanda monthly to help collaborate with local leaders in developing the local anesthesiology resident program.

One of the biggest takeaways, for me, was the seemingly universal value and applicability of simulation in the teaching of anesthesia and critical care. This was my first exposure to clinical teaching in a lower resource setting. When I imagine a simulation session back at home, I think of a fancy dedicated facility with full time staff, expensive robotic mannequins and simulators, realistic monitors, and microphones and cameras throughout. But during my time in Rwanda, we made extensive use of simulation for both anesthesia and critical care teaching, without many of the resources we typically require.

The Rwandan residency program has a weekly academic day every Monday that often incorporates simulation, and their main teaching hospital has a basic but excellent simulation center, with a dedicated freestanding building and a specialist employee to help organize and coordinate simulations. The center has a full complement of mannequins and simulators, including intubation and airway models, IV insertion and ultrasound phantoms, and an anesthesia machine and monitor. It also has advanced airway supplies and equipment including fiberoptic bronchoscopes, double lumen tubes, bronchial blockers, and video laryngoscopes. We taught several well-received simulation session on regional anesthesia including upper and lower extremity blocks, and on thoracic anesthesia including lung isolation and bronchoscopy.

At the program’s sister hospital in Butare, we also used simulation to teach critical care to a

multidisciplinary group of learners in the intensive care unit, as part of a training course on a new ventilator. This group had minimal experience with simulation, and there was no formal simulation center at the hospital. We assembled equipment for scenarios from extra supplies around the unit, and set up a simulated intensive care bay including an iPad connected to a small speaker serving as a monitor. We used the setup for two days, running through multiple situations including hypoxia and emergent intubation. Instead of recording the simulations for later playback, we simply split into two groups and had one half observe as the other half did a simulation, and then swapped for a slightly varied scenario.

My experiences in Rwanda showed me that it is possible to create exciting and instructive simulation scenarios that use minimal resources but are still engaging and high fidelity.