International Missions

I attended the recent Global Outreach course in Halifax, Nova Scotia for the last 4 days. This is a timely course as I will be arriving in Rwanda to teach anaesthetic residents next Saturday. Right now I am sitting in the Halifax airport en route to Toronto where I meet my wife and then off to Belgium for a couple of days before our flight to Kigali.

I planned this trip 2 years ago but it is almost on me now. I have been really nervous about this for the last month.

Attending the course made me feel reassured in someways, scared in some ways and depressed in some ways. There were a lot of people there who had been on missions both like the one I am about to go to in Rwanda, MSF missions, Red Cross missions, large and small missions and a fascinating surgeon/anaesthesiologist couple who had lived in Uganda for most of the past 20 years.

Some reflections:

1. I learned (actually I already knew) that we are not going to make any more than a small change at a local level if that. We are not going to make a big change in the way things are done even though we are trying to teach. We will actually only influence a small number of people.

2. If I save someone or improve just one person's life, my trip will have been a success. We are supposed to teach but there will be a time when I will just have to jump in and do things myself and this may be a good thing.

3. International aid may be making people in less developed countries more dependent however there are a lot of people in developed countries making a very good living off maintaining that dependence.

There, I have really set the bar low for my trip.

By the way in my last post I talked about some of the neat equipment I got to use.

At the top is a drawover vaporizer kit. This is portable and with an open circuit could be used in remote locations (like the X-ray department?) This vaporizer can use Halothane or Isoflurane but they make a Sevo vaporizer. You do have to use an open circuit and it would be better to use spontaneous ventilation. You can attach oxygen or just use air. This kit sells for $5000!

Below is the Glostavent machine. It runs off an oxygen concentrator but can run off ambient air. The machine uses 1/7 of of the tidal volume to power the ventilator (meaning it can run for several hours using a small oxygen cylinder). It uses a drawover vaporizer and an open circuit. It can be used without electricity or compressed gas (granted using air). Cost: $5000!

By the way you cannot use either of these devices in Canada or the US as they are not approved for use. This means that the US Navy which uses these devices has to go to Britain to train on them.

We also had a lecture on Halothane which they talked like it was some old drug. Of course when I was a resident we still used Halothane exclusively in children. And it worked pretty good as I remember. We also had a demonstation on the Boyle machine which they actually used when I was a resident (and for the first 4 years I was on staff). Quite frankly I still long for their simplicity. I felt really old when some people asked how you connected them to a ventilator and I was the only person who knew how.

We also had a fascinating lecture on ether. Except for being explosive and making 20-30 % of people nauseated it sounds like a great agent. You do have to take the bad with the good?

I will be posting more on my other blog. If you contact me I may just give you the URL.