"Better for learning"

Yesterday I left Kigali and was driven to Butare, about two hours away, to spend two days teaching in the OR at the medical school hospital. The road curves over and around terraced, cultivated hills. Some of the crops are recognizable, like banana trees and sugar, while some are a mystery. My driver was not able to help me, between my French vocabulary and his English vocabulary of about a dozen words each! Butare is a little higher elevation, and near the rainforest. There was fog this morning and rain off and on.
The hospital here is well stocked, with several medicines not available at Kigali. I spent the day with two trainees at the end of their first year, named Fred and Alfred. I am impressed that they are expected to take quite a bit of responsibility, even so early in their training. The monitors, anesthesia machines and equipment are antiquated, and simple things like tape, paper towels, a scissors, a pen are often hard to find. The patients present with advanced disease states. Today's patients had a breast mass present for two years, and an abdominal mass treated with cutting and scarification of the abdomen by a traditional healer. This woman had a large ovarian cyst, and when the surgeons opened her abdomen, everything was stuck together with widespread adhesions, likely from pelvic infection. They called in the general surgery resident and eventually the attending surgeon to help. She was anemic pre-op, with a hemoglobin count of 8 (about 60% of normal.) As the blood loss was accumulating, I was quite anxious to get blood to transfuse her. The resident's response was to look at her conjunctiva (the lining of the lower eyelid) and comment on its color. In most of us, this area is pink. Her conjunctiva was pale to begin with, but by the time we got the blood to tranfuse her, it was absolutely white. I think the trainees here are exposed to more desperate conditions than in the U.S. Neither Fred nor Alfred were visibly anxious about the situation. At the end of the day, Alfred told me that cases like this one I am describing are "better for learning and more interesting." I have to say I have a few more gray hairs after today.