Returning to the Pearl of Africa

After leaving Kigali on Friday morning, I flew to Uganda to visit with my friends for the weekend. I love this country. It was so wonderful to be back!

I was hosted by my friend Andrew at his place in Kampala. On Friday night, he took me to a local restaurant to meet up with a couple of other friends from my first trip to Uganda last year. It was so great to see familiar faces and catch up!

On Saturday, we went to Jinja, Andrew’s hometown (and also home to the source of the Nile). He had some errands to take care of, so dropped me off at a café/bar called Adrift Riverbase overlooking the Nile river where people go bungee jumping. On the driveway heading to Adrift, there was a random monkey just sitting calmly on a tree branch hanging over the road. I wasn’t expecting it, so didn’t manage to get a picture but it still made my day! It was a stunning view and I got some work done while I watched several people braver than me take the leap just a short distance away from the patio where I was. I also met a couple super cute little pups 🙂 As usual, any contact with animals gets me overly excited! When Andrew came back, he took me to the source of the Nile river and we had some fresh tilapia – so good!!

View from the patio at Adrift Riverbase in Jinja

My new friend popping up to say hello 🙂

🙂

Yum!

 

On Sunday, Andrew and I met Big Boss (my preceptor/supervisor from my rotation in Uganda last March) for lunch at Café Javas – a very popular chain that I went to a lot with the McMaster Internal Medicine residents last year. The passion fruit iced tea was just as satisfying as I remembered 🙂 After lunch, we drove past Mulago hospital, which is undergoing major renovations. They have built a separate hospital that is specifically for maternal and neonatal care. It’s massive!! Andrew tells me it should be opening in the new year and I’m looking forward to hearing updates from him about it. It’s really wonderful to see government supported changes to improve the care of moms and babies when I personally have met so many motivated, talented, intelligent, and hard working people that are doing everything to provide the best care they can. Of course, a new hospital isn’t a magic solution, but it certainly seems like it will help. Mulago is one of the busiest obstetrical centres in the world (if not THE busiest), with a whopping 32,000 deliveries annually. I can’t even wrap my head around that volume. For comparison, the centre where I am working has almost 5,000 deliveries annually and it is the tertiary centre for all of Atlantic Canada.

Mulago Specialized Hospital Maternal & Neonatal Centre in Kampala, Uganda

It was so wonderful to see my friends, but the weekend just FLEW by and before I knew it, it was time to head back home. I’m already trying to figure out the next time I can come back for another visit!

My flights back to Halifax were largely uneventful. Bit of a delay leaving Brussels made for a very tight connection in Montreal, and as a result, my checked bags arrived home a day after I did. At least it’s not such a big deal when you’re back home (and I definitely wasn’t going to need any of my warm weather clothes in Canada anytime soon).

Overall, this last month has been filled with so many incredible opportunities, experiences, and people. I’ve made new friends, visited with old friends, and started to feel a bit more confident about my future role in global health. As usual, this blog will remain relatively dormant until my next global health adventure. That’s not to say that I’m not practicing global health every day – because I am – but I try to save up my thoughts for the blog until I’m doing something more intensive! Thanks for reading along 🙂

Final days in Rwanda

The last week in Rwanda just flew by.

Another beautiful view of Kigali

A huge wall in the Marriott Kigali covered in local woven baskets

I was asked to help prepare next week’s exam for the core residents (core is PGY2 and up; foundations is PGY1). So I was working hard to get a question bank started that could be used for exams in the future. My hope is that people will continue to add to it, so that there is a variety of question, but I got a pretty decent amount of multiple choice and short answer questions (with answer key) organized to get it started.

Wednesday was a big day. One of the local consultants, who is very interested in regional anesthesia, came to chat with me about a patient in the maternity ward with severe mitral stenosis (for those who are non-medical: this is the scariest heart valve abnormality in the context of a pregnant patient… even if you see this patient in a high income country with extensive resources). We agreed that in our given setting, it would be best for the patient to undergo cesarean section instead of labouring for a vaginal delivery. The consultant went to speak with the obstetrical team and ultimately the decision was made to go for a cesarean section. I was asked to come along as well to help supervise a regional technique that the consultant was working with, just in case I had any useful feedback (since it’s a technique that I have had much more exposure to, but it relatively newer at this institution). I was debating the pros and cons of different doses of medication for the technique when I was saved by the new, dear friend that I referred to in my last post. Yemi (to be known as The Great Yemi, or TGY, from here on out) is an obstetrical anesthesiologist from Duke who has many years of experience in OB anesthesia and global health. I was able to learn so much just from being present while he discussed the case with the local team, providing expertise and teaching insights. Both the mother and the baby were doing well when I last followed up the next morning. Such a great learning experience – I may be in my obstetrical anesthesia fellowship, but in Canada, our resources are such that patients like this would typically have been followed and managed by a multidisciplinary team prior to their delivery. It could be entirely possible for me to go my entire fellowship without seeing a patient with such a severe heart valve abnormality.

That evening, I was invited to the home of the CASIEF chair and his family for dinner, along with TGY, for dinner and a game of Settlers of Catan (which I had heard about, but never played). We had a blast! I was truly sad to be leaving their company so soon.

On Thursday, I spent most of the day working on the core exam and meeting the core residents for evaluations. I cannot stress enough how IMPRESSED I was by their initiative and eagerness to learn. I was constantly being asked for feedback. I hope that I was able to contribute some useful clinical pearls to each one of the residents that I worked with, and I am excited to return at some point in the future (hopefully for a full month).

Friday morning I was up at dawn to head to the airport for my flight to Uganda. The flight wound up being delayed an hour or so, but I eventually arrived with all of my luggage intact (YAY!). Keep posted for my next entry!

Go Kigali Tour

As promised, here’s a bit about my weekend in Kigali last weekend.

On Saturday, I went on a half day tour of the city with a company called Go Kigali. I actually was the only person on the tour (not a particularly busy time of year for them), and it was really awesome! My tour guide was lovely and engaging. She is thinking of applying to complete a masters degree in Canada, so we chatted a bit about different cities that she was considering. We started by driving up to the top of Mount Kigali. I was surprised to find myself in a forest of tall evergreens… they almost looked like redwoods (and maybe they were, but I’m not particularly skilled at identifying trees!). I could very well have been in North America on a warm summer’s day… Until I got to the edge of a cliff and was met with a stunning view. Rolling hills, banana plantations, clusters of houses… apparently, sometimes there are monkeys in the trees on the hillside, but I wasn’t lucky enough to catch a glimpse that day. My guide told me that many people view the top of Mount Kigali as a sacred place, with some staying for a few days to fast and pray. It was truly breathtaking.

View from the top of Mount Kigali

Forest on Mount Kigali

Beautiful views on the way down Mount Kigali before we went to Gaddafi’s Mosque

We left the forest and headed back down towards the city, stopping at the Gaddafi Mosque (actual name is the Islamic Cultural Centre, but it is commonly referred to as the Gaddafi Mosque as the road next to it was built with funding from Gaddafi). During the 1994 genocide, a time when many churches wound up being slaughterhouses for Tutsis and moderate Hutus seeking safety, the Gaddafi Mosque, and many of the Muslims in the surrounding area, provided true refuge and safety. Although I was told that taking pictures of the outside of the Mosque was permitted, I chose not to take any. It felt like a sign of respect to avoid a camera.

After the mosque, we went to a milk bar. Cows have cultural significance in many cultures and countries, including Rwanda. The milk bar is exactly what it sounds like – a place where people come to have some fresh milk, maybe with some sweet bread or chapati (you may recall that I LOVE chapati!). You can also get kivuguto, a fermented milk that takes quite a bit like yogurt in a drinkable form. That’s what I had and it was deeeeeelicious!! We then stopped at a local market in Nyamirambo and my guide surprised me by whipping a knife, cutting board, water, and napkins out of her bag for an impromptu fruit tasting. We had passionfruit (my favourite – she showed me how to get all the fruit out with your tongue instead of a spoon), mandarin, and I tried tree tomato for the first time – YUM! If you ever have the opportunity to try, don’t miss it!  Behind the market, we walked past a few murals that were painted by local artists on Umuganda. Umuganda takes place on the last Saturday of each month, and Rwandans will return to their home villages and come together for community work. Each village may have something different planned for that month. For example, cleanliness is highly valued in Rwanda, and so maybe everyone will come together to clean up all the roads in their village. Or maybe, they will help to rebuild the home of an elderly community member in need of assistance. One of the murals she showed me started with the silhouette of a person sweeping, and the rest of the mural was swirling water and soap bubbles – intended to emphasize the need for cleanliness, and to discourage people from dumping trash behind the market area. I wish I had thought to take a picture, because it was quite pretty and my description doesn’t do it justice.

We got back in the car and drove to a café called Question Coffee, stopping to pick up delicious samosas on the way. Question Coffee endeavours to empower and support Rwandese (particularly women) farmers in their production and export of high quality coffee via sustainable farming practices. Although I’m not a coffee drinker, I had an affogato and had to admit that it was pretty tasty!

The driver then dropped me off at the Rwanda Genocide Memorial to end the tour. I stayed at the Memorial for a few hours, doing an audio tour. I can’t put the experience into words. The memorial includes extensive history regarding the genocide in Rwanda, mass graves where the victims of the genocide have been given reburial with dignity, and also has a part of the museum that is dedicated to other genocides throughout the world – including (but not limited to) Armenia, Nazi Germany, Bosnia, and more. It was absolutely something I wanted to see, and I knew it would be difficult and moving. The importance of genocide memorials and museums around the world cannot be underestimated if we ever truly want to learn from the horrors of the past and prevent further genocides in the future. One particular area in the museum called the Three Rooms was particularly profound. In one room, the walls were covered with photographs of victims of the genocide that their surviving family members had generously donated to the museum. In some cases, these photographs were the only photographs in existence of these people. The next room contained skulls and bones that had been exhumed from mass graves. The trauma inflicted was easily apparent on many of the remains, and I was left utterly speechless. The third room displayed some of the clothing and accessories that had been found on victims. There was a t-shirt that said “I (heart) Ottawa” and I can’t explain the emotions I felt when I saw it. All I could think of was how much the international community, Canada included, basically stood by and allowed the genocide to continue as long as it did (or even to start in the first place). There are many books available about the genocide, and I think that it is important to read them, even if it may be impossible to truly understand what it was like to live through something so horrific and tragic (and for survivors to continue to live through the aftermath).

I returned to the Marriott hotel, where I typically would go to get work done (free wi-fi). I had dinner there with a new – but already very dear – friend. I’m aware that the last half of this post may be difficult to read, and it was difficult to write. So I’ll continue my time in Kigali with another post, maybe tomorrow.

Zipline

Just a quick post to share something I recently heard about on an episode of the TED Talk Daily podcast.

Here is the video of the TED talk (I listened to an abbreviated version on the podcast):

 

Zipline is a new start-up that uses a drone delivery system here in Rwanda to deliver blood products on demand to rural hospitals throughout the country. They’ve also recently announced a partnership with the government in Tanzania.

Watch the video. I hope you get as excited as I did. Everything comes with pros and cons, and by no means do I feel that I have learned enough about this business to confidently state that I have no concerns about it… but I think it is so incredibly cool and has the potential to make major contributions to improve the delivery of global health services worldwide.

Land of a Thousand Hills

Kigali is beautiful. It’s a bustling city, but it is situated in stunning scenery – the hills, the greenery, the people… I’m not sure what exactly I was expecting when I arrived in Rwanda last Sunday, but my first impression far exceeded anything I could have imagined. I was particularly surprised by the climate – in the mid 20’s during the day, and cooling down to the teens at night. It’s lovely 🙂

There are so many gorgeous flowers all around

My walk back to the apartment from CHUK

I had a bit of an inconvenient – but not surprising – start to my time in Kigali. Only half of my luggage made it to Kigali, having gotten left behind during my connection in Nairobi with about half of the other passengers’ luggage as well. Thankfully, I was able to pick it up on Monday after my first day at CHUK (french acronym for the University Teaching Hospital of Kigali). I was enjoying travelling without luggage issues for the last couple of years, but I guess it’s back to the bad luck I used to have! One of these days, I’ll learn how to travel with nothing more than my carry-on 🙂

I’m here for two weeks as a CASIEF volunteer – that’s the Canadian Anesthesiologists’ Society International Education Foundation. CASIEF is now in it’s eleventh year partnering with the University of Rwanda in development, implementation, and ongoing support of their anesthesia residency training program. My role here is to support the local consultants and residents by helping out at the academic day, and also teaching in the operating theatres. Typically, CASIEF-Rwanda volunteers come for 4 weeks and are able to spend time at all three major hospitals in Kigali (CHUK, King Faisal Hospital, and Rwanda Military Hospital) as well as the University Teaching Hospital of Butare, a few hours south of Kigali. Unfortunately, I was only able to arrange to come for two weeks and so I will be spending the duration of my time here at CHUK. Residents from all sites attend the academic day on Mondays, so at least I will be able to spend a bit of time with all of them.

The week has been busy – hard to believe I’m past my halfway point in this beautiful country… until next time, that is. The academic day on Monday flew past. In the morning, I stay with the “Core” group of residents, the PGY2s and PGY3s (there are currently no PGY4s). One of the residents and a local consultant are assigned and my role is basically to support in whatever way I can. Due to some unfortunate circumstances, the consultant was unable to attend last week, but the resident did a great job in leading the session. There were some great discussions and I was very impressed with the degree of engagement from the group. To mix things up a bit, I used the last half hour of the session to do a little Jeopardy game with questions related to the topic that day. The residents got pretty competitive and really seemed to enjoy it, so I’ll be doing another one tomorrow as well. In the afternoon, we ran a simulation session. Again, I was impressed by the level of participation, especially through to the debriefing portion.

Monday night, I was invited out to dinner with the family of the CASIEF chair, who is here for a year with his family. We went to an aptly named restaurant called Heaven – the food was delicious and there was a traditional Rwandan dancing performance by a local group. A local artist had their artwork displayed in the restaurant as well and it was truly stunning. Great time!!

This was my favourite painting

My meal at Heaven… beet ravioli with homemade pesto and beet chips!

From Tuesday to Friday, I went to the main operating theatres and would float between the different rooms to provide one-on-one teaching: asking the residents about their case, the potential concerns, their management plans, giving feedback throughout… that sort of thing. I also started to give them all their own questions that we would discuss later in the day. They were big fans of that. I used basic physiology and pharmacology concepts for the first year residents, but gave the senior residents case scenarios to consider – almost like an oral exam format.

It’s definitely a different experience than when I was Uganda as a resident. I had a temporary medical license in Uganda and did wind up doing some clinical work – sometimes covering for a resident or consultant if they were called elsewhere, or stepping in to help with technical skills when asked. Here in Rwanda, I don’t have a medical license as CASIEF volunteers are intended to be entirely hands-off (of course, there are exceptions to every rule and extenuating circumstances can come into play sometimes). One day last week, there was a case that required nasal intubation and the resident was struggling. They handled the situation very well, asking for help appropriately. Under other circumstances, I would have stepped in and attempted the intubation when the residents were all unsuccessful, but given that the patient was not desaturating, I wound up staying hands-off and supporting them in their decision to call the local consultant for back-up. We actually had the opportunity to sit down together (the residents, consultant, and myself) to do a debriefing later in the day, which was really great.

I am slowly starting to feel more comfortable in my transition to the teaching role post-residency. Not that I didn’t teach juniors and medical students during residency – it just feels different, somehow. I feel a sense of urgency to build confidence as a teacher. It’s one thing to build confidence in my ability to take care of patients, but it’s another thing to silence that little voice of self-doubt that often pipes up when I’m explaining concepts to the residents. The last thing I want is to make a mistake in my explanation and mislead them. I think I do a pretty good job of being honest and recognizing my limitations. I don’t hesitate to tell them “I don’t know” or “I can’t remember” when they ask me unexpected questions – especially when it’s about things I haven’t reviewed for some time. Shocking how quickly you start forgetting all that minutia that you spend months and months cramming into your brain for that pesky Royal College exam!

This weekend, I did some sightseeing around the city, but I’ll save that for another post as this one is pretty lengthy already. I’m looking forward to the week ahead, although it’s bittersweet to think that I’ll be leaving so soon and heading back to the beginning of Canadian winter.

Ghana & My First Trip with Kybele

Last week was my first trip as a volunteer with Kybele – an non-profit organization that strives to improve outcomes for moms and babies worldwide. A couple of things that I really like about this organization are that they strive to create long-lasting and sustainable partnerships, and that Kybele has to be invited by an institution. This way it really puts the emphasis on local health care providers initiating the partnership, instead of a team from a high income country swooping in like they know what a local team needs (hint: we usually don’t know what the actual problems are!).

The team I was with consisted of my fellowship director, two OB-GYNs from my province, an OB anesthesiologist from the US, an OB-GYN resident from my institution, and myself. Everyone else had been there before except for myself and the resident. We all landed in Accra at various times in the evening on Saturday and spent the night at Osda Guesthouse Lodge in the city, which was really cute and comfortable. The next morning, we travelled a couple hours west from Accra to arrive in Cape Coast, where we would stay for a week.

I wasn’t really sure what to expect, since I knew that our work would be focussing on quality improvement projects, as opposed to clinical work. I didn’t know if I would have anything significant to contribute and wasn’t sure if I knew anything about QI. But I wound up being pleasantly surprised – not only was I able to contribute ideas and actually be a helpful member of the team, but I also found myself enjoying a lot of aspects of QI! I enjoy systems and organization – so auditing and chart reviews are kind of up my alley 🙂 Good to know for future projects!

We worked with a local team at Cape Coast Teaching Hospital (CCTH) – midwives, OB-GYNs, paediatricians, non-physician anesthetists, and more. It was such a great team – we all got on really well. Our local team was incredible! They were so eager and motivated to figure out the ways to decrease morbidity and mortality for moms and babies. They always had smiles to greet us and they are truly making progress towards their goals!

Osda Guesthouse Lodge in the morning before we left for Cape Coast

Sunset at Capitol Hill Hotel, Cape Coast

Some (not all) of the Kybele and CCTH teams

The Canadian team members listening to our fearless leader 😉

Sunset in Cape Coast on the walk back from CCTH

The cutest little goats running along behind the rest of the Kybele team on the way back to the hotel in Cape Coast

On Wednesday, we went to Archbishop Amissah School, a local school in Cape Coast, where several of the Kybele team members have been supporting via donations for a few years now. There was no way to have been prepared for the welcome that these kids gave us!! They basically swarmed our mini-bus, all trying to shake each of our hands and welcome us. The headmaster had arranged for the kids to play a football game while we were there – and they were so good!! I don’t know much about sports for the most part, but there was some seriously fancy footwork on that field! There was drumming and dancing to lead us over to the field – it was just such a fun experience!! The kids were pretty into my selfie stick (I knew it would come in handy one of these days!!) and we got some hilarious photos together.

Selfie time!

The girls really wanted to pose for a picture 🙂

The attitude! It kills me! 😀

Photobomb!

Friday was a holiday, and so some of us went to the downtown area of Cape Coast. We had a super yummy breakfast at a vegetarian restaurant called Baobab. The OB-GYN resident and I went to Cape Coast castle, which was a slave castle built in the 1600’s and heavily utilized in the slave trade until it was abolished in the late 1800’s. We had a tour of the castle, which was incredibly sobering. The spaces where people were packed – with minimal natural lighting, forced to sleep upon the waste of all others before them, only fed small meals twice a day – until they were shipped off across the Atlantic as slaves… there are just no words to truly describe the horror. The castle now is a UNESCO historic site, with a museum and guided tours. I couldn’t help but notice the views of the city from inside the castle. The contrast between standing in the castle, amidst all that atrocious history, against the breathtaking ocean views… I had to take a couple of photos because words would not do justice. When we joined back with the others, we wandered down one of the beaches and stopped at a hotel and restaurant called Oasis, where we enjoyed the ocean breeze (and I wished I had brought a swimsuit… although the waves were gigantic so I probably wouldn’t have found the courage to venture into the water anyway!) before heading back to the hotel.

Fishermen beyond the wall of Cape Coast castle

View of the city from the castle

Oceanside breeze at Oasis

Our week came to an end all too quickly, and we travelled back to Accra on Saturday morning. This was an incredible experience and I cannot wait until the next time I am able to participate in another trip with Kybele!!

Saturday night, I flew to Kigali, Rwanda, where I will be staying for 12 days as a volunteer with CASIEF (Canadian Anesthesia Society International Education Foundation) – supporting the local staff in teaching the anesthesia residents, in the classroom and the operating theatres. I’ll leave my Kigali updates for another post though!

Long Overdue…

It has been far too long since I last posted! I’m going to place the blame squarely on the Royal College. You see, I had to focus on studying all the time so that I could pass my exams and get my FRCPC! (“Board certified” for anyone who might be more familiar with the US system – through real life or TV/movies) In July of this year, I moved back to the east coast of Canada and started my fellowship training in Women’s and Obstetric Anesthesia. It’s been really great so far, and I’m starting to feel quite settled in.

I’m thrilled to have a couple of amazing opportunities coming up. In a few days, I’ll be heading to Ghana for a week with my fellowship director. He works with an organization called Kybele, which is a non-profit that works to improve maternal and neonatal outcomes worldwide. From there, I’ll travel to Rwanda, where I will be volunteering with CASIEF in a teaching role with the residency training program in Kigali for two weeks. And I couldn’t resist squeezing in a quick trip back to Uganda to visit my dear friends there before I fly back home.

I’ll try my best to keep blog posts updated during my travels, as I’m sure this will be another incredible experience that leaves my head spinning 🙂

“Mentors that can inspire”

I attended the Bethune Roundtable (BRT) for the first time during the first weekend of June. I apologize in advance for what is sure to be a lengthy blog post… I’ll try to keep myself in check!

It’s hard to articulate the way I felt that weekend, especially without sounding incredibly clichéd. I was inspired, educated, motivated, frustrated, overjoyed, overwhelmed, excited, hopeful… you name it, and I probably felt it. There have been so many ideas running through my head that it’s taken some time to reflect and write this post.

The BRT started with a welcome reception on the Thursday evening – it was a great way to start to meet some of the other attendees and the scholarship recipients. I was also able to spend some time catching up with an American anesthesiologist that I met on one of my last days in Kampala.

Friday and Saturday were full days – there was so much to pack into one weekend, and I’m sure the organizers had to make some incredibly difficult decisions about what could and couldn’t be included. They really packed a lot in and the seamless organization made for what was said by many to be the “best BRT ever” (as evidenced by a twitter poll, so it’s gotta be true!). I couldn’t really weigh in on that aspect, as this was my first BRT, but I don’t think it could have been better! Both days started just after 7am. There were a couple of keynote speakers each day, several panel discussions, and afternoon workshops. One thing that I thought was really smart from an organizational point of view was the way the posters were presented. When I had a poster presentation at the CAS meeting last year, I was in a large room filled with posters, where people could walk by and ask questions at their leisure. What the BRT organizers chose to do was have a moderator present a brief summary of the posters (3-4 at a time) just prior to a scheduled break. This way, everyone was able to hear a little bit about the research presented on the posters, and if you wanted to hear more, you could stop by the poster during the break. Obviously, this wouldn’t work if there were too many posters, but the BRT was the perfect sized conference. Really smart. Friday evening, there was a banquet and one of the OB/GYN faculty spoke about the history of Dr Norman Bethune. Another great way to socialize with the other attendees and further the discussions prompted by the day’s presentations. On Saturday, there were locally hosted dinners to allow for smaller groups to gather in a more intimate setting, with incredible home cooked food. I was lucky enough to go to Dr Livingston’s home, and she had made some really delicious Indian food – yum!! I thought the hosted dinners were such a nice personal (and totally East Coast) touch to add to the conference.

I can’t begin to convey how engaging the keynote speakers were…

Dr Meara, the Chair for the Lancet Commission on Global Surgery, spoke about the Lancet Commission, which calls for universal access to safe and affordable surgical and anesthesia care. (Did you know that 5 billion people worldwide don’t have this access??) He was very engaging, and set the tone for the meeting. You can read more at lancetglobalsurgery.org  and also check out this youtube video from the Lancet Commission.

Dr Kyamanywa, the Professor of Surgery and Deputy Vice Chancellor at Kampala International University, spoke about training surgical teams in LMIC and the role of global surgery and anesthesia projects. What a great speaker – he had so many quotable quotes!! A couple of my favourites (which may not be exactly correct, but close enough!): “If your theatre relies on sunlight to dry the linens, the priority might be a washer and dryer, not laparoscopic equipment”; “Equipping is different from equipment”; “You need to be able to say no”; and “We need mentors that can inspire”.

Dr Bould, the Chair of CAS IEF (Canadian Anesthesiologists’ Society International Education Foundation), spoke about collective competence in global health. He is one of my favourite speakers. He keeps the audience engaged from start to finish and also has loads of quotable quotes. A couple that particularly stick out in my memory: “Leaders are trained, not born” and “We practice together, but we don’t learn together”. There may be many competent individuals working in the same room, involved in caring for the same patient, but that does not necessarily result in a competent team. He explained how organizational competency is created through team competency that expands outside of the OR team, to include the hospital administration, to then include the larger health care system, to the Ministry of Health, and so on. We are not nearly as effective as individuals (my favourite poem, “No Man is an Island”, keeps running through my head) as we are as partners and teams.

Dr Furey, the co-founder and president of Team Broken Earth, spoke about the amazing story behind the volunteer task force and it’s incredible success. Starting with three friends and an idea, Team Broken Earth started out supporting the relief effort in Haiti after the massive earthquake in 2010 (sobering perspective: the equivalent of the population of St John’s NFLD died in a mere 45 seconds) to continuing collaborative partnerships in Haiti, Bangladesh, and more. They have helped to bring TEAM training courses to those countries (similar to ATLS, but more appropriate for the settings), a course on fracture management (as fractures make up such a huge portion of the burden of disease, especially after natural disasters). He highlighted that “the capacity to engage is there, what’s lacking is the structure.” Inspiring work.

Dame Lavender, a professor of Midwifery and Director of the Centre for Global Women’s Health at the University of Manchester, spoke about the issue of obstetric fistula prevention. I found this to be the most moving talk of the entire meeting. She presented a qualitative study of women before and after their OB fistula repairs, including quotes from interviews. It made such a huge impact to hear how deeply and completely their lives were affected by fistulas, and also highlighted that it’s not all sunshine and rainbows after they’ve had surgical repair. The issues are so complex, it might seem insurmountable, but I think Dame Lavender’s work is heading in the right direction without a doubt.

The panel discussions and afternoon seminars were also very engaging and thought provoking. There was great participation from all attendees, which made for a lot of lively discussion during the breaks and social events.

Major themes that I noticed throughout the weekend:

• 3 delays in access to safe surgical and anesthetic care: delay in decision to seek care, delay in reaching care, and delay in receiving adequate care (after arrival at a care facility). There are many obstacles and challenges to address at each of these 3 delays to enhance the worldwide access to safe surgical care.
• Collaboration: fitting, since this was the theme of the conference. We need to form long-lasting partnerships and collaborate to create sustainable and effective change in the world. This is distinctly different from one country/organization simply donating funds or resources to another at random, or imposing solutions to problems as determined by an outside observer.
• Bi-directional exchange: relating to the creation of sustainable and effective partnerships, an important point is that both parties will benefit. Everyone has something to offer and something to learn, no matter how experienced or smart you are. There are endless opportunities when you change your thinking from a teacher/student model to one of shared learning.
• Measurement: as I quoted above, “you can’t manage what you don’t measure”. There are different ways of determining that statement, but I interpret that to simply mean that there is a need to highlight the importance of data collection and analysis, research, and knowledge translation. Measurements need to be repeated longitudinally to interpret any impact of a new intervention or protocol, for example.
• Mentorship/champions: I think this concept is pretty self-explanatory. You need champions and leaders to make effective progress in any context (as far as I’m concerned). Mentorship is crucial to the development of future champions and leaders. It doesn’t have to be formalized mentorship – the people that I think of as mentors are people that I gravitated towards naturally, often through shared interests. One surgeon from the DRC, Dr Luc, stands out in my memory as an excellent champion for his country. At several separate occasions over the weekend, he described the severe lack of surgical and anesthesia providers in his country. His eagerness to create new partnerships and growth within his country is clear, and he invited other BRT attendees to come spend time working with him in DRC. He didn’t miss a single opportunity.
• Systems: in order to address the global surgical disease burden, we need to tackle the systems that create barriers to change. This means that we need to expand efforts to include government and politics. I’ve never been drawn in by either of those topics, but I’m starting to realize that I can’t avoid it in the career path that I’ve chosen to pursue. (The complex relationship between global health and politics/government is discussed very well in the book An Imperfect Offering by Dr James Orbinski)

A few highlights of the many lessons I learned:

• I have so much to learn (this wasn’t a new lesson, but attending this conference really highlighted how much I need to familiarize myself with… landmark articles, terms, history… the list goes on).
• Access to a facility that provides “Bellwether procedures” is a way to assess the surgical capabilities of a healthcare system, and include cesarean section, emergency laparotomy, and open fracture treatment.
• “Global health” is not synonymous with “international health” (global health concerns the entire world, and it does not mean that you have to leave your own country… this should therefore be a relevant topic to every single healthcare provider, if you ask me)
• Papua New Guinea has more than 800 languages and cultures. I cannot even begin to imagine the communication challenges that both patients and healthcare providers must face.
• It’s never too late, or too early, to get involved in global health. Medical students can get involved (but please make sure to educate yourself and avoid “medical tourism”… ). Residents can get involved. Faculty can get involved. Retired healthcare workers can get involved. The options are endless (clichéd, I know, but true). Read up on the topic (check out the links throughout this blog entry, another good read is Emergency Sex and Other Desperate Measures). Look within your own community and I would be willing to bet that it won’t be hard to identify inequalities in access to healthcare. The social determinants of health exist in every corner of the globe and can create massive disadvantages (or advantages) for a person, through no fault of their own. I don’t condone an “either or” approach to global health – we don’t have to choose between helping another country or our own, between helping an immigrant or a veteran. The goal of improving access to safe surgical and anesthesia care worldwide doesn’t exclude any group!

I’d love to engage in conversation through comments, or on twitter. I am eager to learn more and I strive to keep a very open mind (it is a challenge to hold back from forming opinions sometimes, but I’m trying my best!).

If you ever have the opportunity to attend the Bethune Roundtable, I highly recommend it. I’d be going next year if it wasn’t for the fact that my Royal College oral exams are a few days after the conference. But I’ll be attending again in 2018!

Bethune Roundtable 2016

This weekend is the Bethune Roundtable conference, a scientific and medical conference that meets to address and discuss global health as it pertains to the global burden of surgical disease, taking place this year in Halifax, NS, Canada. The theme this year is collaboration, although I don’t see how that could ever not be a reviling theme when it comes to global health. Collaboration is so key!! Without it, it’s nearly impossible to make effective progress towards the ultimate goal of ensuring access to safe surgical, anesthetic, and obstetrical care to every person in the world. 

I will make a bigger post in a day or two, once I’ve had a chance to digest my thoughts. But for now, suffice to say that my mind is already spinning with new information, ideas, perspectives… And it’s just the start of day two! 

What an amazing and inspirational conference. You can follow on Twitter with the hashtag #BRT2016

(I also finally got around to getting my own Twitter account, follow me @hilarykatem)

Snow

I was really hoping that I’d be coming back to Hamilton springtime. Not the case. Snow still on the ground, and temperatures hardly above zero in the forecast. Yuck.

On top of the crappy weather, I must have managed to get some sort of virus or something on my way home – either that or I ate something that didn’t agree with me on the plane. So I’ve had to take a sick day today. I’m hoping that I’m all rested up and back to normal by tomorrow as I’ll be on call and starting the first day of my cardiac anesthesia rotation!

I’m really going to miss the cheerful greetings as I walked to and from the hospitals over the past month, the friendly “you are welcome” as I enter a store or restaurant (or just upon being introduced to someone new), the lingering handshakes, the brief but intense thundershowers followed by blue and sunny skies, all the fresh fruit I could ever want (18 passion fruit for about 50 cents? Yes, please!), my new friends, the relaxed atmosphere. I will certainly miss Ugandan time… something tells me that “TIA” (This Is Africa) won’t fly as an excuse for being late now that I’m back home. I guess my Luganda will probably fade away (all ten or twenty words that I had learned haha) as I won’t have the opportunity to use it. But there are many important lessons that will stay with me (and yes, I’m fully aware that some of them sound pretty cheesy and clichéd):

• When travelling, make a concerted effort to avoid starting any sentence with “back home…” unless you are specifically asked to make a comparison. Just jump in with both feet. Don’t even let yourself too much spend time comparing in your head. Submerge yourself into the new environment and culture and learn how to work within it.
• Your mother is usually right.
• Always try to learn a few key words and phrases from a local language. If there are many local languages, just choose one and learn some of it.
• Through all of life’s stressors, don’t forget to enjoy the moment and don’t hold on to yesterday’s disappointments.
• Touch is a basic human need, and can be very powerful when used appropriately.
• I speak very quickly. Gotta work on slowing down!
• Always consider yourself as a learner, everyone has something to teach you.
• Don’t forget that your presence as a visitor can be a burden on locals. Try to be considerate of that fact.
• Even if it might feel uncomfortable at first, try to engage people in discussion about their opinions on global outreach – how they have experienced it, what do they think works and what doesn’t, what needs to change, etc.

This brings my first Uganda experience to an end. Since my plan for this blog was to document my experiences in global outreach, I don’t plan to be posting much when I’m in Canada (with the exception of any global outreach events or conferences I attend). I hope it won’t be long before I get another chance to do something like this again. Just have to get through this pesky little thing called residency and the Royal College exam!

 

One last Ugandan sunset as I boarded the plane