Rwanda Day 4: Teach a Man to Fish

January 24, 2018

I knew it was going to be a good day when I went to take my shower this morning and discovered I had a washcloth. I’ve gotten it down to just two towels needed to mop up the floor. I’m learning.

Today marked the start of the Prehospital Trauma Care course we are here to teach. As I’ve mentioned in previous posts, we are here teaching a train-the-trainer type course to a select group of 25 students who will before we leave, teach the same content to an additional 25 students. Our goal is sustainability.

We opened the day with words of appreciation and encouragement from SAMU leadership as well as Frank and Ben, the Rotarians representing Williamsburg and Kigali chapters.

Basil created the course format to intermix thirty-minute lectures on major topics that were then each followed by simulation scenarios that put the concepts learned to the test. The students rotated roles as providers, patients, and evaluators. Those playing the role of family member did some Oscar-worthy acting, which seems to be a universal thing in EMS education. I’ve yet to run a scenario in an EMS course where there wasn’t Jerry Springer level on-scene drama.

Midway through the morning, we stopped for thirty minutes to “take tea” in the garden, which of course involved hot tea, but also samosas, cheese toast, coffee, and fresh juices. I think teatime needs to be implemented into all medical education programs as it was the perfect energy boost at just the right time.

Just before lunch, I reviewed major concepts in Airway & Breathing. The students, comprised of mostly Nurse Anesthetists and ED nurses, were up to date on the latest evidenced-based debates both for and against prehospital endotracheal intubation. The anesthetists did a show of hands for us to gauge how often they perform prehospital intubation. Counts ranged from 2 in the last 3 weeks to just 1 in 5 years. We discussed methods for achieving proficiency in an infrequently performed skill, the potential value of time saved with supraglottic airways, and avoidance of hypoxia as a way to improve outcomes. Despite not having fancy toys like video laryngoscopy, these guys know airway inside and out.

We ran the students through 4 unique scenarios, with major improvements made to communication, execution of primary and secondary surveys, and critical thinking. I don’t think there was a single scenario where we didn’t end up laughing at something. Hopefully the humor will help imprint some of these concepts for the students.

In the late afternoon, we practiced a variety of hands-on skills with designated simulation mannequins purchased with funds provided by the Rotary. Students experienced their first exposure to King airway, but also reviewed tried and true techniques such as needle decompression and insertion of oropharyngeal airways.

I think the jetlag and busy schedule are finally catching up with me. My goal is to be asleep by 10pm, so if I want to make it, I’d best wrap up writing for the night.

~Steph

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