Alright, so today was my first day on the wards at CHUK (Teaching hospital of Kigali). I came in and went to morning report where the residents present each admission from the weekend and management plans are discussed. The faculty are present and challenge the residents to defend their actions from the weekend. It kind of reminds me of “chairman’s rounds” at my hospital. The residents are the bomb. Can’t stress that enough. They are clinically very good and surgically very strong. They do c-hysts by themselves (a very difficult hysterectomy after a cesarean section for various indications). Attendings aren’t even present. CRAY. They also are forced to manage very complicated medical problems from TB, to DVTs, and a lot of HIV anti-retro viral therapy. Also, everyone has GTN. I was very impressed. It’s not your bread and butter gynecology. It’s the crazy stuff you see maybe once in your career back home or that a consultant manages that they see and deal with regularly. So after they presented the admissions over the weekend and plans were ironed out, they presented the ICU patients, and discussed the 3 deaths over the weekend.
I then started the morning with a tour by Liza. She’s the GYN ONC attending I mentioned earlier. She is still on faculty at Yale but has a contract through the HRH to come to this teaching hospital and do just that- teach. She is 100% here for the residents. She doesn’t have a clinic- her patients are resident patients. She does about 1 radical hysterectomy a week. THAT IS A LOT. There is a huge incidence of cervical cancer here. Naturally I have latched on to her and this is becoming a GYN ONC rotation. She’s exceptional. She essentially dropped her practice in the states to move to Rwanda and train the residents. Selfless much?
In any case after my grand tour of all the wards I waited to round with the GYN team. The wards are pretty standard with a few variations: wards 1-3 are Obstetrics – L&D, antepartum, postpartum. Of course there is a triage. Wards 4-6 are GYN. There’s also a special ward for “dirty wounds” so all the patients with wound complications and infections go there. There are 3 ORs. 1 for OB, another for GYN, and another for infected patients for wash outs etc.
I rounded with the residents and Liza on the GYN patients which was essentially an oncology service. Then the residents dispersed. I learned quite a bit about the healthcare system here- there is healthcare system that costs somewhere around US 35 dollars for a 4 person family and patients pay a 10% copay if they need a service. They can pay a little extra if they want to see a faculty attending. There were no cases so I read up on some of the patients and then went home to run some errands. One thing I love about Rwanda is that it is so incredibly safe. People say that all the time, but really- it is. I walked 30 mins to and from town to exchange money to pay back my beer tab and it was totally fine. Phone in hand walking down the street and not a single person bothered me. I exchanged some US dollars for Rwandan francs and bought some trinkets in the gift shop. Then I made the trek back home in the dark which went smoothly. I went back and paid my beer balance off with the lady next door, I tried to give her a little extra for her kindness but she insisted I give her only what is owed.
Well, catch ya later~