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The packing of the anesthesia piece of the 2012 summer trip to Rwanda began for me during last year’s 2011 summer trip to Rwanda.  I took mental notes and digital pictures of the anesthesia medications and supplies the hospital in Mugonero had and made lists of what anesthesia medications and supplies I thought we should bring in 2012.

The Mugonero hospital has anesthesia medications but the majority of them are the ones developed back in the 1950s and 60s.  The anesthetic medications back then were long acting and less pure anesthetics which translate to slow recoveries, (or wake ups) and lots of post-op nausea and vomiting. Today’s anesthetics are synthetic, short acting and prevent nausea and vomiting, so I had a short list of medications I wanted to take with including the anesthetic drug Propofol, more on that later.   

As luck would have it, this year the Rwandan Ministry of Health has asked us to use the anesthesia medications and equipment supplied by the government of Rwanda.  That request is reasonable, as bringing in anesthesia medications and supplies leaves a large trash footprint due to all the waste in packaging and single patient use disposable items.

Like many developing countries, Rwanda cleans and re-sterilizes most of the materials used on a patient. This is unlike hospitals in developed countries which throw away a good portion of the medical supplies used on a patient because it is cheaper to buy new supplies rather than pay someone to clean and re-sterilize them.

I’m okay with using cleaned and re-sterilized equipment. I can even use a lot of the older anesthesia medication, because I trained with them when I first learned anesthesia in the Army at Fitzsimons Army Medical Center (the old hospital is now dwarfed on the Anschutz Medical Campus in Aurora).  As I was told in anesthesia school “all anesthetic medications are dangerous; it’s how they’re administered that makes them safe.”

Working in austere locations during my 23 year stint with the Army, I feel comfortable using the anesthetic medications given to me by the Rwandan Ministry of Health and administering a safe and effective anesthetic for the orthopedic surgical cases we will perform in Rwanda.  With that said, there is one intravenous anesthetic, Propofol, which is not available in Rwanda and is the backbone of my anesthetic technique when providing regional anesthesia for most orthopedic surgeries.

The beauty of Propofol, as an anesthetic technique, is that you don’t have to rely on an anesthesia machine to deliver the anesthesia gases normally used to keep patients asleep during their surgery.  All you need is an IV, or intravenous line, and a syringe pump.  It is simple, there are very few moving parts and Propofol does a great job keeping the patients asleep.  The members of the team that arrived early are asking the Ministry of Health for permission to bring Propofol into Rwanda but I haven’t heard yet if I can.

I’m looking forward to teaching regional anesthesia techniques to the anesthesia providers in Rwanda and learning from them as well.  Every medical mission I’ve been on, from those in the military, to faith based, to relief work has their own unique challenges but in the end they are also small in comparison to the rewards gained.

Matt Cowell

Matt Cowell is a Retired Lieutenant Coronal after 23 years in the Army. He has been providing anesthesia as a CRNA (Certified Registered Nurse Anesthetist) at Summit Medical Center with a great group of Anesthesiologists and CRNAs for the past 5 years.  He has been to Rwanda twice before (2010 and 2011) with Dr. Peter Janes, Patty Janes and Kay Roth.

About the Rwanda Medical Missionary trip
Dr. Peter Janes of Vail-Summit Orthopaedics and a medical team will be traveling to Rwanda July 22-August 11 on a medical missionary trip. The group will be providing no-cost surgical, medical and community health programs, education, training and relief in an area where health care is often limited or difficult to obtain. Most surgeons fled the African country or were killed during the major genocide in 1994.

The group involves 20 participants, eight from Summit County, working on seven defined projects. Dr. Janes will be performing surgeries and conducting workshops to train local health care providers on how to correct club foot in newborns. This year he will be at three different hospitals; Rilima, Mugonero and CHUK, for a week each. In addition, there is a surgical team at King Faisal hospital in Kigali, working at the orphanage, and a team building a gazebo at Mugonero.

The group is sending home daily blog entries with photos and depictions of their daily experiences.