We arrived in Rutshuru yesterday around 10 am by MSF Landcruiser. It was an interesting 70 km ride from Goma that took three hours, through a city that has seen more than its share of disaster – both natural and human-made – in the past 20 years, past a smoking volcano (Mount Virunga) and a handful of military checkpoints. I am told that the road was newly paved in 1994. Now however, the pavement is either gone or piecemeal for the most part the entire way. We passed through verdant farm land on both sides with terraced hills growing corn, cane, onions, carrots and coffee plus occasional herds of cattle and sheep. I was accompanied by the driver and a French anesthesiologist on her fifth mission with MSF, also scheduled to be in Rutshuru for the next month. We were greeted by one of the logistician/administrators who gave us a quick tour of the compound where we will be living for the next month, showed us to our rooms and left us to unpack and get settled.
I met Dr M. just before noon. He is a Congolese surgeon who has worked at the hospital for the past two years. Over lunch, he gave me my orientation to the surgical service including explaining our schedule. We have three surgeons with a three day rotation. On day 1, the surgeon works at the hospital from 07:30 until 11:00, returns to the base for lunch, then returns to the hospital from 13:00 (1PM) until 17:30 (5:30PM). Day 2 goes from 07:30 until 13:00, then lunch and a break until 17:30 when you return for overnight call which is called “la garde” over here. Day 3, you are off until the next morning when the rotation begins again. Like many schedules, it may seem overly complicated at first but it works in Rutshuru, assuring that there is always a surgeon at the hospital 24/7. And if we are short staffed, two surgeons can simply skip their day off and go to a two day rotation.
After lunch we went to the hospital which is 10 minutes away by Landcruiser. I got the tour including the emergency department, intensive care, burn ward, two surgery wards, an orthopedic ward, maternity ward, medical ward and pediatrics. The last three are under the auspices of the DRC Ministry of Health and we supply consultative services for them, and contribute to incentives for the staff. In Rutshuru, caesarian sections are done by five Congolese general medical doctors who have had extra training in obstretrics. Currently, three of the doctors here are experienced enough to be “validated” to perform surgery on their own. The other two still require the presence of the on-call surgeon in the room during the caesarian section, though not necessarily scrubbed unless requested. The on-call surgeon is also expected to be available for any complicated caesarean such as when there have been multiple previous surgeries or unexpected problem arise.
The tour ended in the OR (operating room), called the Bloc Operatoire here or simply the Bloc. After introducing me to the staff and showing me the two OR’s and a third room for minor procedures, Dr M. explained the purpose of the two large, erasable marker white boards in the front hall. The one on the right lists the planned schedule for the day while the one on the left is a list of patients to be seen in the emergency department (here it is called the “salle d’urgence”) or in consultation in the wards. There is a smaller board by the OR which is the updated list of the exact order of pending operations including cases that have been fit into the schedule unexpectedly such as caesarian sections and emergencies. There were three remaining cases for the day on the board, a caesarian section and two others. I asked Dr M. who would be doing the last two cases and the answer is me. Orientation is over and it’s time to go to work.
Dr. G. was scheduled to perform the caesarian section on a woman with a history of two previous c-sections. He invited me to scrub in and do the operation even though he is one of the “validated” Congolese medical doctors who doesn’t need me there. I assume he was interested in either learning something from how I did the operation or to see if I know what I’m doing or both. The internal scarring was minimal and the caesarian went easily for a re-do procedure; it’s a girl! After that I did the two other procedures, placing a chest tube in a 10 month old to treat a lung infection and draining a chest wall abscess in an adult. By then it was 5:30pm and time to return to base, dinner and off to bed early to get over the last of the jet-lag.