Never a dull moment… After our succesful final academic day yesterday, and the wonderful dinner with the residents last night, we were anticipating spending the last few days here quietly teaching in the OR. But no. We found out that a large Indian mission team has arrived, and has essentially taken over the OR capabilities of CHUK. They left one OR for emergency cases but use all the others, including the 2 ORs in the obstetric building, which are now being used to do pediatric urology cases. We asked, but the people here truly don’t know what will happen in case there is an emergent C-section to be done.
The Indian team (sponsored by Rotary International) is huge. They have surgeons of various specialties, anesthesiologists, support staff – 30 people or so in all. They have taken over one large room near the OR for storing all their supplies, and another to set up their own break room. They are very energetic and like to do things by themselves, so that the local surgeons and anesthesiologists have basically been reduced to assisting. After watching all this for a while, it was pretty clear to Kristi and me that we were not going to be doing much OR teaching today. Or, for that matter, the remainder of our stay, for the Indians are here through next week.
So here is a completely different approach to humanitarian outreach. These people (undoubtedly of good will) come with a very substantial budget, and in contrast to our shoe-string baby-steps in advancing the training program, where progress is always two steps forward, one step back, they will go back home after a few weeks having helped a large number of patients. What is not so clear is whether they have helped the system here. Interestingly, the cases that they do are by and large those that could easily be done by the Rwandans: orthopedics, some straightforward plastic surgery, and such. In the cases which can not easily be done by Rwandans, there is no teaching, and so after the Indians leave, the Rwandans will still not be able to do them.
Most remarkable, the Indians scheduled several children for cleft lip repairs – while we in the US sent teams to India to repair cleft lips! I can’t think of a better example of the ludicrous situations that can arise in the complex, uncoordinated world of humanitarian outreach. To make it even worse, there are Rwandan surgeons who can do cleft lip repairs. But, we were told, they don’t really like to do these cases, so they just let the patients wait until the next mission team comes along…
My frustration will probably be pretty notable, but I can’t help it. I’m not the only one who’s frustrated. The Rwandan staff and residents were clearly upset, as were the OR nurses and others. The style of communication does not help, as the team (in our eyes) seems condescending and even rude to the local providers – people we have come to know and like over the past month. Rwandan culture emphasizes respect and mutual understanding, and it clearly makes people unhappy to be treated without those essentials.
But one has to be practical. Since there will be no OR teaching for the rest of the week, and since the residents are clearly supernumerary in the OR, we have decided to make rounds in the ICU (“No Indians in the ICU”, as Damascene said) with all available residents in the morning, and we’ll do case discussions with them in the afternoon.
Now we’re back home, and have just finished a great meal of soup, baguette and cheese. The preparation was slightly interrupted by a temporary but complete absence of water pressure, but after running downstairs, finding someone who called someone who came to fix it, our cooking could proceed. The soup tasted wonderful. How could it be otherwise, as it was prepared on the “Marcel & Kristi Memorial Hot Plate”!