Vital Times 2022 - 72

GLOBAL HEALTH
Residents' Reflections
in Global Engagement -
An Education Exchange
Helen Heymann, MD (Stanford University)
Isaac Ndayishimiye, MD (University of Rwanda)
Brendan Morgan, MD (Dalhousie University)
Christina Tull, MD (Stanford University)
Vivek Vallurupalli, MD (Stanford University)
Ana Crawford, MD (Stanford University)
P
reparation for rotations in different clinical
contexts, especially ones with significant
cultural differences and resource availability,
requires thoughtful planning. Considerations include
ethical dilemmas, as well as mental and emotional
preparation for high disease severity and increased
patient mortality. Maintaining respectful and effective
engagement requires conscientious evaluation of social
and professional interactions. Reserving judgment
and engaging openly, with patience, facilitates
greater understanding, compassion for colleagues,
and an invaluable learning experience. Bi-directional
partnerships lead to shared obligation to improving
global patient outcomes and life-long friendships.
The academic partnership and anesthesia training
program in Rwanda started in 2006. Started between
anesthesiologists' professional societies in Canada
(CASIEF) and the United States (ASA-GH), this wellestablished
academic program has successfully
trained close to 50 physician anesthesiologists. Yet,
the Rwandan program still suffers from brain drain
and significant resource challenges. Three Stanford
Residents and one resident from Dalhousie University
traveled to Rwanda in October of 2022 to engage in a
month-long academic exchange. Strong bonds formed
with their Rwandan colleagues. The reflections of North
American and Rwandan residents are shared here.
What were the areas for which it was difficult to
prepare before arrival?
It can be emotionally and mentally shocking to transition
from a high resource setting to a low resource setting.
There may be equipment deficits, limited system
capacities, and a different standard of care or safety
culture when compared to a high resource setting.
Unfortunately, these resource limitations can translate
into increased morbidity and mortality. Prior to traveling
to Rwanda, we had multiple conversations with mentors
and previous exchange residents, who shared stories to
help our preparation. However, no number of anecdotes
could ultimately prepare for how jarring some of these
differences were. Very early in the exchange, our mentor
shared that we would need to consciously practice
patience and kindness. The poor outcomes and critical
events we witnessed were not the result of a lack of
compassion or sense of responsibility to the patients,
and to pass judgment would both stifle our opportunity
for understanding and knowledge exchange, and simply
be insulting to the integrity of our hosts. With regard to
72 | CSA Vital Times
Vital Times 2022

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