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Q&A with Stanford Anesthesia's Residency Director

RWANDA February-March 2015 Christopher Miller MD, MPA CA-3 Anesthesia Resident

Posted 8:59 AM, April 16, 2015, by amaca

Senior resident Chris Miller just got back from a month in Rwanda. He has written the nice essay below to summarize his experience which I wanted to share with you. Thank you Alex

Thanks to exceptional support and the strong backing of the Department of Anesthesia, Perioperative and Pain Medicine at Stanford, my month long trip to Rwanda from February 7th to March 7th proved to be one the most educational experiences of my life, and for that I will be eternally grateful.

Starting in 1996, the Canadian Anesthesiologistís Society International Education Foundation (CAS IEF) has had as its central mission the idea that safe, effective anesthesia and intensive care medicine should be available to all people, regardless of geography or financial ability. It was through this organization that a Stanford anesthesiologist and critical care medicine attending, Dr. Ana Crawford, and I traveled to Kigali, Rwanda with the goal of teaching and learning from the countryís anesthesia residents and anesthesia technicians. In a land of 14,000,000 people, there are currently 17 anesthesiologists, making the education of the current residents critical, as they will be charged with caring for hundreds of thousands of patients in their careers and will most certainly shape the future of the profession in their country.

During each of the four weeks we were in country, we followed the residents from hospital to hospital to teach intra-operatively as much as possible. Every Monday, however, was a full day of didactic teaching located at the main hospital in Kigali, granting us an opportunity to teach the entire residency class and structure our lessons to acknowledge their clinical strengths and improve on self-reported and observed weaknesses. Given that CAS IEF operates in Rwanda 12 months a year, a set curriculum had been developed to make sure all areas of anesthesiology are covered over the course of a residentís four years of training. Our month was dedicated to critical care medicine, and we were able cover multiple topics, including: sepsis, fluid and vasopressor management, interpretation of EKGs, ventilator physiology, neuro-critical care and the skills involved with transthoracic echocardiography.

In addition to teaching the residents, we also had the opportunity to teach at the largest anesthesia technician school in the country, whose students are high school graduates who then participate in a 3-year anesthesia-training program and then graduate to provide the majority of anesthetics in Rwanda. Every Tuesday and Thursday we lectured on topics ranging from the management of Traumatic Brain Injury to Acute Respiratory Distress Syndrome, both of which are seen in exceedingly high numbers in Rwanda. In all situations and settings, we found residents and students with truly impressive dedication to their patients and education and were a joy to be with.

Our month ended in the Southwestern Province, teaching in a 3-day course on Obstetric Anesthesia and the management of critically ill pregnant women. A total of 30 participants (physicians, nurses, emergency department staff) completed this S.A.F.E. (Safer Anesthesia From Education) course and were then made responsible for teaching their colleagues throughout the next year with support from CAS IEF and their local hospital administration.

Without a doubt, this month was one of the most tremendous of my life and I am thankful for the opportunity. As CAS IEF and Stanford continue to support the advancement of anesthesia and critical care in Rwanda, further trips have been planned for this October and next February. I plan to pursue every chance to return to this incredible place and continue to push forward the educational objectives outlined by our Rwandan counterparts. Thank you!

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