Margaret and I have now been here for a week – a whole week! I can already tell that this time is going to pass by too quickly. We have spent 5 days in the operating room with the residents and one day helping to run the academic day.
I am learning SO much, everyday. I can only hope that the residents are learning something from me as well. The residents here are simply amazing. Due to the extreme shortage of doctors, in particular specialist doctors, in Rwanda the residents have a huge responsibility almost from day one of their training.
From what I understand, medical school last 6 years after which time each new doctor must practice as a generalist physician for at least one year. Usually their posts are out in the “district” – small hospitals all over the country. Many choose to do this for much longer or for their whole careers. Others choose to return for specialist training.
At CHUK, there are 6 operating rooms in the Main OR, plus 3 in the maternity area, and the ICU (Anesthesiologists run the ICU as well). In addition to anesthesia staff and residents, there are Non-physician anesthetists (NPAs). We have spent most of our time in the Main ORs as I am focusing on teaching paediatric anesthesia and that is where the kids are!
For the entire 6 ORs, there will be at most 2 staff anesthesiologists supervising ALL the rooms, and usually there is only one staff available. There are 2 rooms that are for residents only (not for NPAs). These rooms have the cases that require “more active participation” as one resident told me. The NPAs manage the rest. The senior residents (Year 3 or 4) will often have a Year 1 resident with them to teach. But often, due to staffing, the Year 1 residents will have to do a case or a list independently.
The cases range from anything from a 10 day old baby for a laparotomy to a 76-year-old patient for gastric tumor resection. And the lists are always changing depending on which patients are ready, emergencies, and other various issues. The residents largely practice independently out of necessity, but the staff is always around and available to help or answer questions, they just aren’t able to be in the room all the time.
Last week I was with a year 2 resident as he managed 2 very young babies for neurosurgery with great skill. Today, I helped a Year 1 resident with a plan for a bronchoscopy for foreign body removal. The 3 year old patient was very sick and took a long time to recover after his very long bronchoscopy. The resident had not done an airway case until today, and it was quite a learning opportunity!
The residents have a huge responsibility for teaching junior residents and NPAs, managing cases, and knowing when to ask for help well in advance (as the staff cannot be in all of the rooms at once). And they do this with ever changing resources available to them. One day they will have the appropriate endotracheal tube available to them, another day they won’t. One day a drug is available, the next day the supply is gone. They have to be creative with their plans as well as safe.
These residents are extremely dedicated to their work. They start at 7am, they finish whenever the list is finished (often after 7pm) and then they read and prepare for their academic time. And of course they have lots of night and weekend call because there are so few of them. I have yet to hear any of them complain about their schedule…perhaps they just dont’ know me well enough yet 🙂
I feel so privileged to work with these residents. The are proving that there is a bright future for safe surgery in Rwanda.
Addendum to original post: I realized that I had not put in any context about how anesthesia residents works in Canada when I wrote this. In Canada, we have a consultant anesthesiologist (staff) for every operating room running. The residents do not run rooms without direct and individual supervision until they are very senior. And even the seniors are similarly supervised for any complex case, young child, or medical fragile patient. They are rarely, if ever, left to run a case completely by themselves. This is a stark contrast to what happens here in Rwanda.