CHUB-take two

Today we were back at CHUB (teaching hospital in Butare) working with the 4 junior residents.  (3 first year residents and one second year resident)  The cases consisted of GYN cases (hysterectomies, mastectomies), a skin graft, varicose vein stripping, fracture repairs, and a re-excision of a hematoma after inguinal hernia repair.  On first glance, it looks like what you might see on the operating room schedule at any OR in the US.  However, when you look at a little closer, you realize there are many differences.

The most striking difference today was in the skin graft procedure.  The patient was a young woman who had been in the hospital since November after suffering a 18% 2^nd and 3^rd degree burn on her left arm and leg.  The wound is pretty well-healed except for a few small areas.  Unfortunately she has a contracture of her left arm and leg . Today’s procedure involved a skin graft to a small area on her left arm and leg.  I expected to see the zimmer skin graft mesher.  What I saw was something quite different.   A simple straight blade was used to harvest the skin.  It looked both primitive and very difficult.   What is a fairly straight forward simple procedure at home ended up being incredibly difficult and tedious.

The residents as well as the anesthesia techs were a complete pleasure to work with. They were eager to learn and well prepared.  Despite my “American” English, we were able to communicate quite effectively.   All of the operating rooms have a “surgical checklist” on the wall.  They haven’t quite adopted its use but they seem to communicating with the surgeons pretty well.  The surgeons were some of the most patient surgeons I have ever met. 

prepared syringes for induction of anesthesia..

What was really interesting was what I found hung on the wall next to the “surgical checklist.”   It was an  “Anesthesia Checklist” designed specifically for CHUB.  The junior residents use it to help remind them what they are expected to do everyday to prepare for the case.  One of the residents commented how much it had helped him to stay organized and how after a few months it had become second nature.    The effectiveness of this checklist was striking as they do not use anything like this at the other teaching hospital, CHUK, and the lack of organization there definitely shows.

Portion of anesthesia checklist

Satisfied Patient in recovery room

The day ended with a journal club with the residents at a nice restaurant in town.  I have now eaten at the same restaurant Ibis 5/6 dinners.  There are not a ton of options in Butare.  I wasn’t really ready to venture back to the Chinese Restaurant as I had learned my lesson from our last visit.  The residents chose an article looking at Tranexamic acid use in trauma.  An interesting discussion ensued and the question arose whether tranexamic acid should be included on the WHO list of essential medications.   As much as I appreciate the drug when I am doing cardiac cases at home, not really sure I consider it an “essential medication.”

It has been a full day.  Hard to believe that tomorrow will be my last day in Butare as we will head back to Kigali mid-day.  Until then…..

still not so good at figuring out the OMV vaporizer