Dean On Campus Blog

Anesthesia Education in the Developing World: Canadians addressing a critical need

By Dr. Joel Parlow – Head, Department of Anesthesiology and Perioperative Medicine, Queen’s University

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The mention of “Rwanda” to most Westerners conjures up images of the horrors of 1994, when the world stood by as almost 1 million people were massacred in the space of a few months, in one of the lowest points in humanity’s history. Over the past decade, this country has pulled off a veritable miracle, transforming itself into one of the safest countries in central/eastern Africa, and poising itself to be an economic hub of the area. It is also a stunningly beautiful country of rolling hills, lakes, and of course the mountain gorillas of Dian Fossey fame.

teaching-hospitalI closed 2012 with my second stint as a visiting faculty to the Anesthesiology residency program of the National University of Rwanda, based in the capital city of Kigali, and the university town of Butare. This program was started in 2006 with the assistance of the Canadian Anesthesiologists’ Society International

Education Foundation (CASIEF), a charitable arm of our national organization. At that time, there was one native Rwandan anesthesiologist in this country of around 10,000,000 people (to put it in perspective, there are close to 40 anesthesiologists in Kingston alone!).

thoracic-anesthesiaVirtually every month since, a Canadian anesthesiologist has travelled to Kigali as a guest instructor, often accompanied by a resident, and sometimes by other personnel, such as a pain management nurse. In the five years since my first visit, I found some very significant and positive changes, in both the country and the residency program. About 10 physicians have graduated, the majority of whom have pursued further training internationally, and most of whom have returned to their country to work and teach future generations. This year, seven new residents were admitted to the program, and the aim of CASIEF is to complete its mission in a couple of years, hopefully leaving behind a sustainable training program. I saw many positive spinoffs from our program that did not exist in 2008: regular discussion of “anesthetic considerations” before attacking a difficult case, weekly morbidity and mortality rounds (the material is endless…) and often more dedicated adherence to the Surgical Safety Checklist than at home. There was even discussion of the non-scientific roles (RwanMeds?) that residents are slowly being expected to demonstrate.

teaching-blockTeaching in a developing country such as Rwanda provides Canadian physicians with numerous personal and benevolent opportunities. While clinical missions in resource-poor countries (such as those that many of our Queen’s faculty have organized and participated in) are critical and life altering, educational programs aim to provide local staff and trainees with the means to improve their own teaching skills and knowledge. Perhaps the best role models we provide are our own residents, with whom the learners can relate to as “peers”, as well as teachers. On each of my trips, I was fortunate to have one of our PGY5 residents accompany me, and take on a good share of the teaching responsibilities. During my most recent visit, Ryan Mahaffey created and taught a number of seminars to the residents (while at the same time studying for his own upcoming RCPSC exams!). He also spent each day working hands-on with residents in the OR, imparting techniques and ideas that he has refined during his own residency.

traumaThis was not a one-way street either- Ryan and I saw some weird and exciting things in our few weeks that we (fortunately I guess) never see in this part of the world, as diseases are never allowed to progress so far into their natural history.

We commented that some of the cases we dealt with would have been considered too unrealistic to be fairly used on a Canadian fellowship exam!

He also observed how clinicians in the developing world must deal with incredibly challenging situations without what we would consider the most basic of resources. For example, we were not able to order electrolytes, despite this being the largest university teaching hospital in the country! Furthermore, most medicine in the country is practiced in poorly resourced rural hospitals by undertrained providers, leading to shocking rates of perioperative and maternal complications and mortality.

Another of my interests in participating in this program was to involve our and their residents in scholarly work, resulting in a publication in 2008, as well as a current project. Ryan, Dr. Ana Johnson (Director of ICES@Queen’s) and I teamed up with a second year Rwandan resident to examine attitudes and practices regarding the management of postoperative pain. This project will be ongoing over the next few months.

Numerous Queen’s faculty members have taken roles in the provision of medical service and education in developing countries. I believe that most of us have shared the same mixed feelings upon returning to Kingston: that the “problems” that we struggle with daily seem to pale in comparison to the very basic needs that are unmet in so many areas of the world.

 

 

3 Responses to Anesthesia Education in the Developing World: Canadians addressing a critical need

  1. reznickr says:

    Joel,

    What an great blog, and thanks for being our guest blogger. It sounds like the Rwanda experiences have been beneficial to the patients, receiving faculty, our residents and yourself. Congratulations on this terrific initiative.

    Richard

    • Bill Moore, Queen's Med '62 says:

      Thanks Richard for helping us understand medicine in the developing world. I have just returned from Southeast Asia where most people do not have modern healthcare and have little chance of getting it. All of us can learn from your sharing of what innovative leaders and residency programs can accomplish.

  2. Peter Bryson says:

    Hi Joel,
    I found your article very interesting to read and timely. I am currently in Eldoret, in west Kenya. I have joined an organization called AMPATH, stationed in Eldoret, where I am currently working for 2 weeks in a voluntary role under the auspices of the Faculty of Medicine, University of Toronto, in a clinical and teaching capacity for the AMPATH program. If you wish to learn more about the AMPATH program please check: http://www.ampathkenya.org/
    I’m supervising 2 gynaecologists who are training to become gynecologic oncologists, something that is badly needed here. When they complete their training in August 2014 they will be the only officially trained Gyn Oncologists in all of Africa, except South Africa. I’m at the Eldoret hospital most of the day time doing rounds, attending oncology clinics, doing teaching sessions and in the OR. It has been busy. Besides the training aspect I am also helping with the cervical cancer screening and treatment programs and advancing the surgical treatment of early invasive cervical cancer. Cervical cancer is the number 1 cause of death in women here, and there are more cancer deaths in women overall than AIDS, TB and malaria combined. As stated so eliquently in your article, the work is rewarding and the challenges are enormous.

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