Rwanda Coming Soon....

Hey Everyone,

this Saturday (March 31) I leave for Rwanda! I'm going to be teaching anesthesia techniques to local residents and nurses for the month of April. This is part of a joint program with the American and Canadian Societies of Anesthesiology. I became involved in this program at the suggestion of a former professor at Stanford, Alice Edler.

For several years, Alice has been taking Stanford anesthesia residents to countries such as Tanzania and Ghana to help in teaching local physicians under sponsorship of the American Society of Anesthesiology's (ASA) Overseas Teaching Program (OTP).

I'll be teaching various techniques in pain management - both acute and chronic. Acute pain is a phenomena all of us have experienced in our lives, and typically follows tissue injury - which includes post-surgical, trauma or an acute disease process. Typical medications for the mitigation of acute pain runs the gamut from drugs as simple as ibuprofen and tylenol to more potent opioids such as morphine and demerol. In addition, local anesthetics such as lidocaine, and it's longer-lasting cousin, bupivicaine, can be quite handy when used to block pain transmission signals along nerves. Nerves can be "blocked" with local anesthetic meds at any point from their origination in the spinal cord all the way to the distal extremities.

The application of local anesthetics typically involves the use of needles to deliver the drug to its site of action. Nerves lie beneath the skin (both shallow and deep) and therefore are hidden from view. Finding them requires a knowledge of human anatomy and specialized instruments. Stay tuned, cause we'll be discussing these instruments later.

Pain becomes chronic when it lasts 3 months of longer, and may or may not involve ongoing tissue damage. Chronic pain is typically much harder to effectively treat than acute pain, and unfortunately, in large section of patients, may never be cured completely. Sometimes the best we, as physicians, can hope to do, is reduce someone's pain enough to restore some degree of function. Improving function can mean being able to take a walk with a spouse, hold a child in your arms, return to work or simply being able to sit in a chair. It is the field of chronic pain the I'll be studying during a fellowship year beginning July '07, at the University of Iowa.

For many of us, the name "Rwanda" conjures images from the Genocide brought to our attention recently in the film "Hotel Rwanda". In the spring of 1994, during a period of only 100 days, nearly a million people (roughly 1 in 10 citizens) were slaughtered along mostly ethnic divisions. The genocide came to an end when the rebel movement, composed of mostly ethnic Tutsi and led by current Rwandan president, Paul Kagame, seized control of the capital city of Kigali.

When telling friends and family of my plans to teach there, several have asked, "is it safe there?" From what I've read, and messages from other docs in the field, the answer is a unanimous, "yes!" It seems as if the people of Rwanda are struggling to simultaneously remember the past, yet move forward as a unified country.

Coffee has once again become an important export crop for the country's growing economy. The tourism industry, know for it's national parks and endangered mountain gorillas, is also on the rise.

A recent surprise discovery to me, is that Rwanda apparently has quite a bicycling community. In fact, local bike component manufacturer, Ritchie has adopted Rwanda for a very enthusiastic outreach program with the appropriate title, "Project Rwanda." The picture here was borrowed from the Ritchie website, showing a young Rwandan lad on his wooden bicycle. Check out more of these great pics here.

This recent news has prompted me to bring along my Surly/Xtracycle made famous right here in the "Chronicles of Mania" report on the Costa Rican Bike Adventure. I think the bike will be a perfect means to transport myself around town and mix it up with the local peeps.