As I prepare for my 3rd trip to Kigali Rwanda, I am taking a moment to step back and really think about why I am going and what I hope to accomplish, and I find myself reflecting back on my first trip and how much I and my goals have changed.
The first time I went was 2 years ago, after I finished fellowship. I had spent a month in Kijabe Kenya during fellowship, working with an American Pediatric Surgeon who lives and works there year round. The rotation was pretty much organized for me, so I got some vaccines, packed my bags and I went. I loved the experience and it cemented for me what I had always known I wanted to do as part of my career.
So, when I finished fellowship and had a long wait for my US license and visa, I became somewhat stir-crazy. Don’t get me wrong, after q2 call for 2 years, having a few months off was great. I traveled, I slept, I reconnected with friends and family. But around the 4 month mark it was getting old. I missed taking care of kids, I missed operating, I missed doing what I was best at. So I emailed Dr. Laberge and said “hey, do you think I could go to Rwanda for a bit and help out before I move to the US?” Within in hours he called me- my timing was perfect. He was leaving the following week and we decided I would follow, and overlap for a few days to get oriented and settled.
After a few emails back and forth it was settled. I had my invitation letter, I got my visa, some more shots, some anti-malaria pills and I booked my ticket. 48 hours after my arrival, Dr. Laberge left for the airport to fly home, and left me in the OR in the middle of a Kasai procedure. Something I had seen once but certainly had never done. His parting words were “you know how to do this”, and then he left. I remember being terrified. This was a huge case, and basically the baby’s only chance at survival. I was overwhelmed with the weight of responsibility. Not exactly how I pictured my career starting as a pediatric surgeon.
The 2 ½ weeks that followed were more of the same. Every day I would operate and at night I would walk back to the apartment where I was staying, eat some dinner with my anesthesia colleagues, and then go to bed and try and sleep. But all I could do was worry about my patients. What if something happened? Who were the residents calling? Were they even calling? Did they know what do to? Every morning when I walked back to the hospital I held my breath until I had seen all of the patients.
As time went by, I learned to relax. These babies and kids were not on monitors, barely had any pain medicine, certainly did not have anything near the patient: nurse ratios we enjoy, but they were doing ok. Their mothers provided all of the care except medications, including wound care and feeding.
I learned to go back to my history and physical exam, and any test I ordered had to be absolutely necessary to be ordered- some were not obtainable, and the families were responsible for upfront payment for everything.
And yes, I did push the envelope, rightly or wrongly. I performed a repair of an esophageal atresia with distal tracheoesophageal fistula, despite several people telling me that no babies with that survive there. But I knew how to fix it, and felt that if someone hadn’t tried this in North America or Europe at some point, we would never know we could fix it. The operation went well, but the baby died 3 days later when their endotracheal tube plugged. There were a lot of “I told you so” after that, and I felt terrible. But the next time I was there, and had a 16-day-old baby with the same problem, I did it again, with a better post-operative plan because I now understood the capacity and resources I was working with. That baby went home.
My focus when I made this initial visit was about helping the babies and kids and doing cases. This has now shifted to teaching a local surgeon there, who has an interest in pediatric surgery, how to take care of these children: how to workup the patient, perform the procedure, how to follow these patients post operatively, and what complications may arise. At my first visit he was a final year resident and when I made my 2nd visit last year I didn’t do much of the operating, he did almost all of it. We talk about patient follow up and complications and discuss management of difficult cases via What’s App and email.
I am excited to go back- to see the faces that have now become friends and colleagues, to do more teaching and to try help build capacity for pediatric surgery.