Monday, February 1, 2010

Discussing Safer Surgery by Moonlight

The World Health Organization has a campaign called "Safer Surgery Saves Lives". The concept is that surgery is now more common around the world than childbirth, with 234 million operations taking place every year. If these are done safely and appropriately, this could be a huge benefit. If not, it represents a huge public health risk. A big study published in the New England Journal of Medicine showed that implementing a perioperative check list, similar to a pilot's pre-flight checklist, could have the risk of death and serious complications of surgery in both developed and developing countries.

A couple of days ago one of the senior residents asked me to come to his place to discuss implementing the program in Rwanda, so on Saturday he picked me up and lead me to his place. It sits high on the hills above Nyamirambo with great views. There are concrete walls all around, and a large gate which was opened by a house boy, a small older car in the driveway. He has a wife and two cute small kids. The house was airy and spacious, but very sparse by western standards.

We sat under his fronch porch at a pine table, drinking Fanta, going over a presentation I had made three weeks earlier, using his laptop, the power cord trailing through an open window. It seemed so worthwhile, so pleasant, so professional. We talked about what would work in Rwanda and what would not, what could be done soon and what would take time. With most of the pressing issues resolved for the present, we walked to his local pub. I am getting used to the concept. Bare concrete floors, a lot of the area open to the sky. This place also had a great view as an orange full moon rose over Kigali. I had a breer and we shared gioat liver brochettes and fries.

No doubt there will be lots of twists and turns along the way, but it is nice to think that this evening might result in implementing a program which could halve the perioperative death and complication rate in Rwanda.

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