Rwanda: Investing in Health Care
By David Shaye, M.D.
2014 marks the 20th anniversary of the Rwandan genocide. But traveling around Rwanda’s bustling capital city of Kigali, unofficially called the “Singapore of Africa”, shows that every aspect of life in Rwanda is bursting forth with energy. There is a palpable momentum among the Rwandan people to rebuild from their recent past a society that is truly an example to the rest of the world.
If we invest correctly in people, we are as well off as anyone else.
Health care in Rwanda leads the way with an “investment in human capital” that President Paul Kagame spoke of at his recent speech at UCSF: “If we invest correctly in people, we are as well off as anyone else.” Not only has Rwanda dedicated 17% of the national budget to health care, but the Rwandan medical system is becoming a hotbed of global health exchanges with the rest of the world.
Global health initiatives have traditionally concentrated on areas thought to have the greatest impact: the prevention and treatment of communicable disease. But based on new research by the World Bank and others, a surprisingly high burden of disease is attributable to unmet surgical need. Global Surgery, or the field of surgical delivery in resource poor settings, is emerging as a legitimate component of global health.
Many of the advances in Rwandan health care are taking root in the medical education system. A joint U.S. – Rwandan Ministry of Health program known as Human Resources for Health (HRH) has been funding U.S. nurses and physicians to integrate into existing Rwandan medical training programs. These doctors and nurses serve as teaching faculty, giving lectures, assisting on rounds, and teaching in the operating theater and wards.
I am here to save the broken leg that occurs ten years from now.
In CHUK teaching hospital in Kigali, the general surgery morning meeting begins with a morbidly and mortality hour to discuss complications and systemic improvements. Dr. Christian Paletta, an HRH plastic surgeon, follows with a lecture on wound management. Questions from the audience initiate a debate on the appropriate treatment for open tibial fractures. As open tibial fractures are often seen at the central hospital well after 7 days of the initial injury, high numbers of limb loss results. The Rwandan general surgery residents, who very soon will be posted in district hospitals around the country, are learning the importance of timely referral and surgery for these patients. The hope is these trainings will result in more prompt, quick referrals and less overall amputations. Visiting surgeons, instead of working to repair the endless numbers of lower extremity fractures that stream into the national referral hospital, have turned their focus on the education of the next generation of doctors and nurses. As Dr Paletta said, “I am here to save the broken leg that occurs ten years from now.”
Across Kigali at Kanombe Military Hospital, Alphonse awaits facial reconstruction for injuries suffered from the genocide years ago. Dr Charles Furaha, the country’s only plastic surgeon, has arranged 50 of the most challenging cases in need of facial reconstruction. Dr. Furaha hosts Face the Future™, a returning team of international facial plastic surgeons with a focus on teaching. The traditional mission trip model has been discarded for focused education and international collaboration. The number of patients treated takes a backseat to the transfer of knowledge.
A week of operating at the military hospital amounts to much more than a few dozen happy patients. Rwandan surgical residents are led through cases by members of the visiting team, while at the surgical back table a Rwandan OR technician receives instruction on how best to assist his surgeon. Behind the anesthesia machine the team’s anesthesiologist reviews drug concentrations with the trainee. There is a free flowing exchange of ideas during the week that culminates in a day of facial plastic & reconstructive surgery lectures given by some of the world leaders in the field. This conference on facial reconstruction attracts over fifty Rwandan surgeons and residents from across multiple surgical disciplines.
The field of global surgical delivery is growing as the world medical community recognizes the importance of access to surgical care. In Rwanda, this is being targeted through education, in a joint effort between the Ministry of Health and visiting physicians.