GEMx Blog

Rwanda: A Land of a Thousand Hills and a Thousand Opportunities

October 14, 2019

Filed under: GEMx Global Network GEMx Student Ambassador Network GEMx Student Reflections

New Blog By: Myles Dworkin medical student at Sidney Medical College at Thomas Jefferson University who has completed his elective at the Central University Teaching Hospital of Kigali (Rwanda) through GEMx

Rwanda is a small country located in eastern Africa covered by lush green forest and smoldering volcanoes. While the country is known as the land of a thousand hills, its capital, Kigali, might better be characterized as the city of a thousand opportunities. New businesses can be seen popping up on every corner and towering buildings appear as if constructed overnight. It represents one of the few places on earth where one can witness innovation in real-time. I have been lucky enough to work in Rwanda in various capacities for the past 5 years. When I became aware of the opportunity to formally study in Kigali at the Central University Teaching Hospital of Kigali (CHUK) through the GEMx partnership I immediately schedule my next trip.

One of the first things you notice when arriving at CHUK is the beauty of the surrounding areas. Kigali is constructed in the peaks and valleys of a series of large hills and you can see exactly what this means at the hospital. For those interested in studying at CHUK, the hospital is located close to the city center and there are several different housing options. I had a few friends living in Kigali, so I arranged to stay with them, but Airbnb and limited international student housing are also available. My colleagues at the hospital quickly made me feel welcomed and provided all the information I would need regarding where to stay and how to get around. On the first day, several of them accompanied me to the nearest market to ensure that I could get my phone and data plan set up. I cannot speak highly enough of my fellow students. Their hospitality and willingness to support me while dedicated to the rigors of medical school were fundamental to my experience and I look forward to the day when I can repay the favor.

My greatest passion and academic area of interest is surgery, specifically in resource-limited environments. As such, I arranged to spend 6 weeks working with the orthopedic surgery department at CHUK. While the international effects concerning communicable diseases have received attention in the past, the burden of surgical disease has only recently been identified as a growing public health crisis. A 2015 study performed by the Lancet Commission identified many of the areas of greatest need for improved surgical capacity to be located within low- and middle-income countries such as Rwanda. As a student pursuing a career in global surgery, I found CHUK to be the ideal place to study the intersection of surgery and public health.

Orthopedics is a dedicated specialty is still relatively new in Rwanda as they have only recently graduated their first residency class. This provided me the opportunity to spend time with the residents and medical students in their dedicated orthopedic curriculum. Each day we would meet at 7 am for the morning conference. During this time, we would present new patients from the previous day and review approaches for upcoming cases. This was followed by a lecture by a student or resident on a relevant orthopedic topic. We would round on the orthopedic ward around 8:30 am before heading to the operating theater where we would spend the rest of the day. We would typically perform between 5-10 procedures per day with trips to the emergency room to consult new patients or lectures by attending physicians between cases.

Orthopedic trauma is a significant contributor to the burden of disease in the country, so the primary area of focus was on traumatology. This was ideal for a young student interested in surgery as it allowed for an in-depth review and exposure to anatomic relationships. I was especially interested to learn the similarities and differences in approach to care between CHUK, which is the primary trauma center in the country, and orthopedic trauma care in the US. I was comforted to find many similar protocols and procedures and was fascinated by the ingenuity and problem-solving ability of the Rwandan residents and surgeons I worked with. Despite well-documented resource limitations, they found a way to provide the best possible care to their patients allowing them to return to their friends and family. I was inspired by the compassion and work ethic of these physicians and hope to be able to obtain the education and training need to join them. I was exposed to a wide range of orthopedic trauma and learned an incredible amount in my short time at CHUK.

Despite the busy schedule at the hospital, I was able to take some time to see Kigali and the surrounding countryside. Kigali is a great city with an up and coming arts scene and great restaurants. As I have mentioned, I have been working in Rwanda for the past 5 years, so I have been to many beautiful places. This includes monkey trekking in Nyungwe Forest, safaris in Akagera National Park, and relaxing beach vacations on Lake Kivu. Unfortunately, I have not had a chance to see Rwanda’s world-famous gorilla population in Volcanoes National Park, but I guess I’ll just have to return for another trip and another opportunity.

Journey to the Art of Medicine and Life

October 1, 2019

Filed under: From GEMx Staff GEMx Global Network GEMx Student Reflections

By: Kirellos Atef Zaki Abboud from Ain shams University (Egypt) who has completed his elective at The University of Pavia (Italy) through GEMx

It was my first time in Europe. I was a bit afraid and was expecting a lot of troubles. When the plane was landing, I could see how Italy is beautiful and how it’s so green. You could only see green areas, homes, and roads. It was so charming and relieving just to look at it for 15 minutes before landing. I landed safely and started my journey in a foreign country. I searched for a place to stay hoping for an apartment and luckily, I found a suitable one. I traveled on Friday so by the time I arrived it was the weekend. I decided to have a tour on foot to explore the shops and transportation. I found it difficult to communicate at first because not many Italian speak English, but after about ten days I could speak some Italian words that are useful at shops and transportation, and of course google translator was a savior in many situations.

(Left to right) with Prof.Ciro Esposito. Prof.Massimo Toreggiani. & Prof.Marco Colucci.

I called Prof.Ciro Esposito – The Head of Nephrology Department at ICS Maugeri – and informed him that I’d arrived, and he explained to me the way and the transportation I should take to reach the hospital. I met my colleagues, there were three from Poland and one from Cameroon all on an Erasmus elective. I enjoyed their company a lot, they were kind and helpful.

My first 2 weeks at the hospital were in the ward, every morning the professors accompanied us to the inpatients and started explaining their condition, different possibilities for treatment and what we should focus on such cases. Some days our professors had some checkup visits for patients who were discharged from the hospital within the last few months. It was so informative to see such a huge number of patients in such a small time. The average number of patients we see daily was about five patients in the ward and maybe one or two for a checkup. The professors taught us a lot of things concerning Nephrology, how to take a history, how to examine patients, different kidney markers in lab tests and many things that I would list later.

(Left to right) with Professors at the Dialysis unit: Dr.Alice Mariotto, Dr.Giuseppe Sileno, Dr.Ettore Pasquinucci, & Dr.Alessandro Gaballo

My second 2 weeks were in the dialysis ward, every day the professors accompanied me for the round, we checked the patients performing their dialysis session concerning their compliance to medications, their overall health, if there is any pain, the patency of the vessels used in dialysis, their diet, and their last lab values. I noticed that dialysis session became a routine for these patients with little suffering, the hospital supplies them with the drugs and provide good, advanced and comprehensive health care services and ambulance help people with some health problems that where they provide transport for them to the hospital on the sessions days and bring them back home. I was amazed by the continuous assessment and care for the patient.

I attended some surgical procedures including:

An arteriovenous fistula in the arm between the median cubital vein and brachial artery, it was done by Prof.Ciro Esposito and Prof.Massimo Torregiani.
Central jugular catheterization is done by Prof.Massimo.
Femoral venous catheterization is done by Prof.Massimo.
Replacement of an obstructed femoral venous catheter done by Prof.Giuseppe Sileno.

I was honored to work and learn from these great professors, I owe them a lot, I will never forget what they have taught me.

Let’s talk about my daily routine there, I woke up at 5:30 every day, took a shower, brushed my teeth, drink my coffee and go out. After that, I’d spend about an hour commuting. I would arrive at 8 o’clock nearly, then I’d spend about four to five hours with the professors, after that, I’d go home to study or finish some of my work. Some days I would walk to explore the cities or visit historical places.

Visit to Como

On weekends I would travel. The first weekend I went to Como, it’s a small city with a lot of charming places and a wonderful lake. The second weekend I visited Venice, the most beautiful city I’ve ever seen. I wish I could go there every year. The third weekend I visited Milano and the Duomo; Milano is a huge city with many people. I was enriched with a lot of personal benefits and experiences, starting from traveling to a European country by myself, searching for an apartment, washing my clothes, preparing my food and doing everything alone, I had the chance also to visit a lot of beautiful historical places and cities. Italy is a country of art, that’s what I liked the most about it. I managed to deal with a wide variety of different personalities including the pedestrians, colleagues, professors, officers at different means of transportation and the friends I could make in such a short time. It was a wonderful experience that changed me a lot and the way I think and sees the world and I will do my best to repeat it.

Visit to Venice

Visit to Milano: Duomo di Milano.

With my GEMx Award

GEMx and American University in Beirut Making Dreams Come True One Robot at a Time

September 26, 2019

Filed under: GEMx Global Network GEMx Student Reflections

Blog By: Mostafa Sedky medical student from Ain Shams Univerity who has completed his elective at eye-caching American University in Beirut, Lebanon through GEMx

I went through an elective for one month at the eye-catching American University in Beirut. As it was one of my lifetime dreams to go there, GEMX provided great chance for me to apply for an elective and visit the place. Despite facing some difficulties to arrange for my travel, I used all my efforts and made it there. The amazing historical campus with the unique seafront view was fully equipped with a state-of-the-art entertainment, medical, surgical and educational equipment’s, which all added to the unforgettable learning experience.

One of my dreams that was also fulfilled was to learn more information about robotic surgery with the Da Vinci robot that was at the university and which is now the talk of the town in all the surgical fields. I had an opportunity to meet some kind and famous Lebanese professors and surgeons and learn from them about every single incision and suture while attending in the OR during my elective in the Department of General Surgery. I received a hands-on laparoscopy and suturing workshops on a simulator to add to the excitingly thrilling experience.

The administration has provided me with full access to the medical library which had a separate huge building with calm and encouraging weather and the latest medical news and information to indulge your knowledge with as well as a high-speed internet connection with subscriptions to open a lot of scientific databases and journals. I also had access to the student activity center which had a private beach, warm indoor swimming pool with an A/C surrounding as I was there during cold winter as well as an amazing Gym and an indoor basketball court. There were a lot of other courts like a stadium for football and tennis and volley courts but the basketball one was my favorite.

Regarding the exceedingly reputable and scrumptious Lebanese food, it was one of the best things in this country starting from the sizzling cheese of the street mankoosha to the mouth-watering ice cream of el Bachir, it was one of the best things in the country. When I wanted to be more healthy I resorted to the delicious Lebanese fruits especially apples which were unique than any other apples I have ever tried as well as the ambrosial honey from the cedars.

To add to the experience, l spent the weekends exploring this amazing country Lebanon from the far north in Tripoli visiting Faraya, Jetta, Junia, Byblos, Dora to Beirut then reaching to the south visiting EL Shouf, Beit el-Din, Deir El Kamar, Saida, Tyre to Baalbek. It was the first time in my life I built a snowman and went skiing then go to the beach on the same day. I spent some quality time talking to my new Lebanese friends and taking photos that make me perpetually happy whenever I remember them. It’s undeniable that this elective experience has called upon my untapped reservoir of tenacity, perseverance, fortitude, curiosity, and willingness to learn. It has opened the gates for me to believe more in my dreams and turned some of them into precious memories.

GEMx-SNO Exchange 2019: Refreshing My Passion for Medicine

September 23, 2019

Filed under: GEMx Sponsored Events GEMx Student Reflections GEMx-SNO

Blog By: Roxana Ramos, medical student from Faculated de Medicina UNAM who was selected as this year’s GEMx-SNO exchange winner, by GEMx and SNO TUFH and participated in a five week exchange at Flinders University NT in Darwin NT, Australia

I am a Mexican 5th-year medical student that was selected to participate in the exchange to Flinders University in Darwin NT, Australia. It took me a while to believe the great news, and after I did, my excitement grew every minute until the day of departure.

Flinders University

I spent 4 weeks in the Pediatrics Department of the Royal Darwin Hospital, each week in a different ward: General Pediatrics and Adolescent Medicine, Pediatric Infectious Diseases and Malnutrition, Postnatal and Special Care Nursery, and the Outpatient Clinic. Every day started with the 8 am handover, where each patient was reviewed and after that everyone left with their teams to their ward. I liked this part because it was when I could hang out with the other med students for a little while. Each team was composed by a consultant, a registrar, a resident, an intern (or not), and a student. During the ward rounds it was like what I’m used to: follow the doctors, write some notes, answer questions, examine patients, get papers, and the most important job of a med student: awkwardly be in the way. Since I had already had my Pediatrics placement in Mexico, I felt confident about what I was seeing and listening, but the cool part is I got to experience different epidemiology and learn about diseases like Acute Rheumatic Fever and Rheumatic Heart Disease, that are very rare in Mexico. The two major differences I noticed from my home country to Australia are: – Doctors care for a good work-life balance and the system allows them to do it. The hours are reasonable, the pay is great and in general, the environment in the hospital is so nice and happy. Since the first day I was there I’ve been trying to think how to change the mindset of thousands of years and millions of doctors in Mexico, so that we can have a better quality of life. No clue until now, except lead by example. – Material resources are abundant, so they don’t struggle as much to give the best management and treatment to their patients. This also has to do with the Health System structure, which is very efficient in Australia. Although in Mexico we have a universal Health System, people still must pay (at least a symbolic amount) for consults, hospitalizations, and medicines. Meeting some of the doctors there gave me an idea of the way I want to be when I grow up, not just as a doctor, but as a person too. It refreshed my passion for medicine. We also had occasional teaching sessions, which were outstanding. Some of them included taking history and checking a patient by ourselves, others were to review a specific topic, etc. The Department also had other activities like the Journal Club, X-ray meetings, and Grand Rounds, which were great as well. Apart from the one-month rotation, I got to fly to a Health Clinic in a remote community called Warruwi in the South Goulburn Island. To prepare for this, I had to attend a Cultural Awareness Workshop. I enjoyed learning about the Larrakia people, mainly because I knew little about them before this exchange. I was surprised by some of their traditions, like their kin and family relationships, their traditional medicine history and their actual epidemiology.

Receiving my diploma from Justin Seeling (GEMx Manager) and Vishnupriya Vijayalekshmi (SNO President)

After those wonderful and enriching weeks, I got to assist the TUFH 2019 Conference, which was the cherry on top. I met med students from around the World, I was inspired by the talks and workshops, and pleased to know that there are good people everywhere who are trying to help others. I was excited to learn that next year’s conference will be held in Mexico City, and the best part: I’m the new Local Team Manager. I’m looking forward to the exchange and the whole event.

SNO International Executive Committee 2019-2020

It was a very enriching experience in all aspects of life. I feel blessed for this opportunity, and I think that it impacted me (in a good way) to see how Medicine is practiced in other places.

Njera, castles, and compassion: just three of the wonderful things I experienced at Mekelle University

September 18, 2019

Filed under: GEMx Regional Exchanges GEMx Student Reflections

By: DAPHNE KIBANDA , 5^TH YEAR STUDENT (MBChB) at MBARARA UNIVERSITY OF SCIENCE AND TECHNOLOGY

Day out at Emperor Yohannes’ castle with Kidus(L) myself(C) and Henry(R)

The thought of an exchange study program away from my home university and country was as excitingas it was scary. With the GEMx website and with help from Ms. Faith Nawagi, the GEMx Africa representative, the application process went smoother than I expected. Within less than a month, my colleague and I were ready to travel to Mekelle University, College of Health Sciences, in Ethiopia. Ms. Sheila and Ms. Angela Nakato from the International Relations Office were also key in our travel preparations.

At about 5 a.m. on Saturday 13th July, we landed in Addis Ababa. Our flight to Mekelle was at 7.15a.m so we had some time to lounge. This was both our first time in Ethiopia and at Bole International Airport and so locating the different terminals took some bit of time. It can’t go without mention that every single person we interacted with at the airport, both passengers and employees, was very welcoming and helpful. Unfortunately, the flight was delayed for over 3 hours due to unfavourable weather at our destination and since we had no way of communicating with our hosts yet, we missed our transport from the airport. Nevertheless, we were very well received into Mekelle by the staff, students and even the locals.

With some of the C11 class members after a management session.

We joined the C11 group on the Internal medicine rotation as soon as we arrived and made very many friends. The students always readily helped with translation during clerkships as we were not conversant with the local language. I particularly remember an incident where I went to the ward to clerk a patient and all the members of my group were not around. I walked through the ward looking for a familiar face in vain. Later, I met a student from another group and when I explained myself to her, she was more than willing to help. They made the environment very comfortable and conducive for the one month we spent with them. Every day on the ward at Ayder Comprehensive Specialised Hospital was a new learning experience. Although the prevalent conditions didn’t differ much from those in Uganda, we were able to compare National treatment guidelines for common communicable conditions in both countries. We also participated in ward rounds, bedside teachings, and management sessions and were able to share and expand our knowledge further.

Outside of class, we appreciated the diverse culture of the people in Mekelle. We learned several words and phrases in Tigrinya, the native language, and by the end of one week, “Selam” which is a word for “hello” came much more easily to me. They have a unique taste in food, and I fell in love with “Njera”.

I could not go an entire day without this traditional dish and to date, Ethiopian food is one of my favourites and Ethiopian restaurants in Uganda are a go-to. We also witnessed a traditional Ethiopian wedding and I must say the African culture is rich and full of diversity. We managed to visit Emperor Yohannes’ castle in Mekelle city, which serves as a museum currently and had some of our new friends show us around the rest of the city.

Our stay in Mekelle came to an end after exactly 4 weeks and on 9th August, we had to travel back home. We said a couple of emotional and even tearful goodbyes and promised to keep in touch with our friends. It was an educative, humbling, inspirational and fun experience for me, and I look forward to more of these opportunities with GEMx. Thank you so much for this amazing opportunity.

Camels and Cataracts: an Ophthalmology Elective at Lighthouse for Christ Eye Center

September 12, 2019

Filed under: GEMx Student Reflections

By: Denis KAMARA, Ophthalmology resident Mbarara University of Science and Technology for electives at Lighthouse for Christ eye center, Mombasa July 2019

With a lot of appreciation to GEMx, I am a Ugandan who just completed my elective and I will be starting my second year come August at Mbarara University of Science and Technology (MUST) where I joined in August 2018 from St. Joseph’s Hospital Kitgum, Northern Uganda. During my second semester a colleague, Dr. Naome Kyomugahso shared with me electives opportunity offered by GEMx which looked interesting, so I moved forward and applied. I must admit, it wasn’t all easy. In attempts of applying I had trying moments I gave up due to some technical and requirement challenges, but I was greatly encouraged and guided by Ms. Faith and Ms. Phiona to move step by step till I was accepted at Lighthouse.

Denis at the airport

My journey started from MUST on 28th of June, I arrived at Lighthouse at 7:30 pm Saturday for the flight from Nairobi had been rescheduled. Being weekend the facility was so quiet but Victor Indeche, staff welcomed me and showed me the accommodation. The next day, I requested to join him for the church at the satellite for Lighthouse churches. I got my first ride in a Tuktuk as they were so many of them as well as taxis called matatus (small minibuses). They were so different from the taxis in Uganda. They played loud music and were raised at the back like Pavilions. They move so fast even through inroads under construction, you find that they were moving in between two trailers whose containers look as if they will be falling off any second but to my surprise everyone else seemed fine, not bothered at all.

One thing that struck my sight was the architecture of most of the buildings which were connected and had blue-white colors as a symbol for the Mombasa County.

Denis with colleagues

On Monday 1st July, Lighthouse for Christ Eye Center became quite busy with many patients and staffs; I was warmly welcomed by Mrs. Gladys, she introduced me to the Medical Director, DR.Fredrick Korir who orientated me to all units. The facility has special clinics of cornea and pediatrics in addition to the private and general clinics of pediatrics and cornea. Operation in the theater is from Monday to Thursday; outreach teams carry out screening within the communities and there also satellite clinics. The facility provides a lot of services in eye care and spiritually nourishes the people from Mombasa and far beyond.

In my time at Lighthouse, I saw and managed patients from the general clinics most of the time when there was no theater so I learned and perfected my examination skills, did many investigations and learned basic refraction. I discussed several cases with Dr. Fredrick Korir, Cornea specialist and Dr. Ibrahim Matende who taught me enormously. Learning continued during theater where I learned

different surgical techniques in cataract, glaucoma and corneal surgeries. Thanks to Dr. Sawe David who provided me the opportunity to do 3 cataract surgeries under close supervision that challenged the energy and feeling within me so much so, that I now have the passion and desire to continue with that and be able to do them alone.

Thee second week was amazing and so fortunate for me because Lighthouse hosted a surgical camp with specialist in Cornea (Dr.Bowman Brad), Glaucoma, ( Dr.Tosin Smith) and oculoplastics ( Dr.Jorge Corona) all from Texas who taught me a lot after

knowing I was an ophthalmology resident on electives. We worked together in theater and I observed and assisted in a number of procedures for my first time such as phacoemulsification,keratoplasty-DSAEK, blepharoplasty, Gonioscopy Assisted Transluminal Trabeculotomy, stent and tube insertion and so many others. Thanks to the elective, I am in touch with them for guidance greater inspiration in my ophthalmology career.

Weekdays were all spent at Light House and weekends were when I moved around with friends and spent much time at the beaches riding camels and swimming in the oceans. The last Saturday was well-spent thanks to Lighthouse where we went to Flamingo beach hotel for team building where a lot of lesson activities were provided. The weather was a bit cooler compared to another period although I felt it hotter compared to Ugandan weather. I also polished up my Swahili quite a bit as I interacted with patients and staff though English bailed me out most times.

In general it was one of the best opportunities in my life though the time seemed short which was due to other university obligation that I was required to fulfill in the same time period limiting me to only one month, I call it the fruitful month of July for I gained a lot of knowledge, skills, and the uniqueness in how different the facility operates.

I am so grateful to GEMx for making a big difference in my life by offering me such a big opportunity to improve on my career, thanks a lot for those who were in contact with me to make it possible, Ms. Faith Nawagi, the GEMx Global Partnership Development Rep- Africa, Ms. Phionah Asaba Kinwa the GEMx Africa administrator, Ms. Hulda from COECSA finance, Dr. Simom Arunga from MUST is your GEMx manager, Dr. Frederick and Ms. Gladys of Light House in Mombasa. Thanks to Dr.Simon Arunga, senior lecturer and GEMx coordinator who confirmed my details and guided me accordingly.

In the same spirit of thanks to Lighthouse family for hosting me as one of their own and each member contributing to my learning, Asante Sana to the entire team from management, administration, and everyone.

All things have a beginning where you start from and always return, great thanks to Mbarara University of Science and Technology for the collaboration and allowing me to come for electives. Be blessed for your good works in Jesus, name.

From Kampala to Rwinkwavu: Experiencing Rwanda and its Health Systems

September 9, 2019

Filed under: GEMx Regional Exchanges GEMx Student Reflections

By: Tinka George William, Makerere University School of Medicine to University of Rwanda College of Medicine and Health Sciences

At Nyabugogo Bus Park

On the 27th day of July, at about 7:15 pm, I left my room and headed to the Trinity bus parking lot. By 8:45 pm Marvin, Martin, Emmanuel, and Edward had come. Our other friend Reagan was not able to get to the bus by its departure time and he joined us the following day.

This began the longest bus trip I have taken to date. I went listening to George Carlin’s “When will Jesus bring the pork chops?’’ I have listened to it before, so the jokes were a little less funny since I already expected what he was going to say. At some points, I slept off, then woke up to the bus hitting a hump or something of the sort. By about 4 or 5 am the following morning, we were at the Uganda-Rwanda border of Katuna. The process of crossing over was a little fast yet, somehow, a little slow. It was so cold and my hands were freezing!

After the immigration bureaucracies, we sped off into the land of a thousand hills. For a moment we were confused about the actual time. The weather outside looked like 8 am (Ugandan time). My phone, however, was showing 7 am! We later found out that Rwanda is in a different time zone from Uganda. It was 7 am (Rwandan time).

Kigali, Rwanda was quite different from Uganda. It appeared, without a doubt, cleaner (I deliberately went on looking out for plastic bag litter but I hardly saw any). Their water channels weren’t clogged (like a good number of ours back home), we were being driven on the right side of the road (unlike the left for Uganda), there were indeed many hills, and their city looked relatively less busy than ours. The rest were the same Ugandan stuff. Same house architecture (especially in the urban areas), same people lifestyles: clothing, general activities, and the same weather. By 9 am we were in Nyabugogo parking station.

We took our first major bunch of snaps in Rwanda there. Those of us that hadn’t exchanged our Uganda shillings to Rwanda Francs also did so from there. I was surprised (and a little embarrassed) that the Rwandan currency has more weight than the Ugandan currency. Our Rwandan contact, Mr. Nepo found us shortly thereafter and took us for our very first Rwandan meal- breakfast. It was enjoyable. Mr. Nepo was a nice host. He told us of many interesting stories about Rwanda. We received a pleasant welcome.

Another apparent difference between Uganda and Rwanda that I noticed as we broke our fast was that the ‘’boda-bodas’’ (motorcycle taxis) there seemed to much more strictly follow the rule of carrying only one passenger. They all had helmets for the passengers. This is unlike what takes place back home, and it is good as it reduces road accident-related trauma cases and deaths.

Next was the drive to Rwinkwavu in the Eastern province of the country. We were driven through Kigali. I must say that I had always imagined Kigali to be a small city (since it is in a small country!). Oh boy, I have always been wrong. Kigali is a relatively large city.

The drive to Rwinkwavu was rather long. We had been told it would take about two hours. I can’t say I am sure how long it took because I slept off along the way. You see, one other difference between Uganda and Rwanda was that the roads in Rwanda never seemed to have humps or potholes. It is no wonder therefore that the journey to Rwinkwavu was so smooth that we almost all slept off at some point. Not to mention that we were also tired by then.

All journeys come to an end, and so did this one. By 1 pm, we had arrived and settled into the secluded home of Partners in Health (Inshuti Mu Buzima), our hosts in Rwinkwavu. The place was a nice, quiet, and peaceful countryside settlement on one side of a hill overlooking a far way valley. It had most of the amenities to make our two weeks stay enjoyable.

The following two weeks:

Students after University of Rwanda walk and talk session grouped outside building

The following day, we were joined by twenty students from the University of Rwanda. We were to study the Social and Community Medicine (SOCOMED) course with them. By the end of it all, they were to become our very tight lifelong friends.

The following two weeks saw us having lectures, presentations, community visits, a screening session, a trip around Kigali, and a mine visit. The lecturers always made the sessions fun. Our sitting arrangement in a U-shape setup with students facing each other made the lectures more of interactive sessions and less of the traditional boring classes. The different topics we had over the two week period included; an introduction to the SOCOMED program, the Rwanda Health system, the SWOT analysis technique, communication skills, the community health program in Rwanda, leadership, social determinants of health, palliative care, research, health equity, disease prevention & health promotion, traditional medicine, quality improvement and team building, etc. We got to listen from the Executive Director of PIH in Rwanda- Dr. Joel Mubiligi, the Chief Human resource officer of PIH, the Head of informatics, the head of medical education and training and many others. This ensured that we got to learn knowledge and experiences from more than the medical perspective. We got career guidance, leadership skills, and strategies and many other attributes.For presentations, we were divided into different groups. We were sometimes then given group and individual assignments to present to the class. My assignment was to present about SDG 9 using Sao Tome and Principe as a case study.

Students huddled around community health worker

With the Community Health Worker, Mr. Emmanueri (2nd from the left)

We had several community visits. We visited community health workers first. We were surprised at how much the Rwanda Health Care system is relying on them. I realized they play a relatively bigger role in Rwanda than in my country (Uganda). They are provided with more resources also. For example, they must fill in the Health Information Management System (HMIS) Reports, they have clinical guidelines and treat malaria, pneumonia, diarrhea, cough & flu, and do health screening. They also seemed to have a relatively more advanced precision of clinical examination skills than their counterparts in my country.

They could identify jaundice, anemia, cyanosis, edema, dehydration, the different signs of respiratory distress, etc. They also had the necessary tools like Mid-Upper arm circumference (MUAC) tapes, thermometers, timers, drugs, etc. Another community visit we had was to a chronically ill patient. Here I learned that Rwanda, unlike my home country, has a working health insurance scheme called ‘Mutuelle de Santé,’ and people pay subscription fees according to their economic groupings (ubudehe) which ensures that the poor ones pay relatively less than the rich ones to ensure equity. During this community visit, we passed by Akagera national park. It was an amazing view.

We also appreciated that in rural Rwanda, people live together in distinct villages called ‘umudugudu.’ This is unlike in Uganda where it is not uncommon to find people living in scattered homes away from everyone else. The umudugudus in Rwanda make it easier to get services closer to the people since they live in groups.

We had two non-communicable diseases screening sessions in Ndego. My role during the session was to measure random blood glucose levels using a glucometer.

Trip to Kigali.

The first week ended earlier, on a public holiday called Umuganura (Friday). It is a Thanksgiving Day. The day Rwandans celebrate their ever-bountiful harvest. We used the opportunity to have the following three days for ourselves in Kigali. In Kigali, we put up at the PIH house. We found Dr. Akiiki there with a good number of other people from different nationalities and career fields. We were nicely welcomed and had a good time there. By the time the three days of the long weekend were up, we had been to; the Kigali convention center, the genocide memorial center, Amahoro Stadium, Kigali airport, Kigali arena, Inema art gallery, downtown Kigali, etc.

The Rwinkwavu mines.

To appreciate different aspects of occupational health and safety, we on the second last day of our placement, went and visited the Rwinkwavu Wolfram mining site. We visited their offices where we were first told about the different health measures they have in place. We then proceeded to the mine itself and went a good number of meters down the mine tunnel. It was dark! I am kidding. There was light, but it was cold down there. Apart from appreciating the different health risks miners are exposed to, it was an exciting experience.

On the evening before the last day, PIH organized for us a farewell banquet. We had some good time with everyone and got our certificates. On the last day, the 9th day of August, we had the last presentations and sessions. We then prepared ourselves and were driven to Nyabugogo Bus Park where the whole story had started from. The bus we boarded departed at 5:45 pm and arrived in Kampala at 8 am. The story that had started with a long bus journey ended with an even longer bus journey.

Passion to Practice: Nzeeke Herbert’s Path to a Transformative Elective Exchange

August 29, 2019

Filed under: GEMx Regional Exchanges GEMx Student Reflections

By: Nzeeke Herbert, fourth-year medical student from Kabale University School of Medicine, Uganda

My name is Nzeeke Herbert, a fourth-year medical student from Kabale University School of Medicine found in south-west Uganda bordering Rwanda. It is one of the nine Universities in Uganda that offers a degree in Medicine and surgery. I am privileged to be one of the pioneers of this medical school and one of those who had the first chance to participate in this elective program through GEMX.

Growing up, I used to admire health workers putting on white coats. I then started getting the passion for medicine seeing how the health workers were caring for the sick and especially whenever there would be an emergency with everyone running up and down in a bid to help. Watching my father and mother die before I achieved my passion was another painful moment for me, but this didn’t stop my hopes of pursuing a medical course.

I joined a clinical school for my diploma in clinical medicine and community health in 2002 to 2005. I developed a positive attitude of doing my best whenever I handled the sick/suffering without segregation. I had no hopes of joining the university for the degree because I was supposed to look after my siblings since I was the first-born child. However still with my passion for medicine, I didn’t lose hope and through Prayer God made a way in 2016 when I was finally admitted to Kabale University to pursue this noble course.

Pioneering

The GEMx program gave me another rare opportunity to have an experience in Kenya where I didn’t have any hopes of traveling during my undergraduate studies. It started with a simple announcement at the University notice board calling for students to apply and participate in the exchange program with a deadline. I thought it was not serious and kept busying myself until the deadline date when I finally submitted my application. To my surprise three of us, we were called to the office of the dean of the school of medicine where we were told that we were selected by the faculty among ten applications to participate in the GEMx program.

It was such a joy. I wondered how best I could handle this as to be one of the first people at my medical school and a pioneer of the program. However, I had to be with hope and wanted to experience how other countries carry out their training of medical students in their medical schools.

Safari to Kenya

We traveled by road from Kabale, Uganda to Nairobi Kenya via Busia border, a journey that took me twenty-one hours. This was the first time I had ever traveled such a long distance. But it was rather an adventurous journey as I viewed the beautiful scenery of Africa; the landscape, parks, different animals, and valleys provided such a good tourist view.

Acclimatizing to Kenya

I found that Kenyans were welcoming and friendly. Swahili was the main language of communication and initially, it was challenging but some locals tried English, which made me learn more Swahili so I would be able to communicate. Their main meal was “Ugali” (posho in the simplest terms) with greens (sukuma wiki). It was not easy to cope up with the diet as I was used to Matooke and Irish potatoes. I had to adjust to fit within the local dishes.

The Elective Begins!

At Kenyatta University the coordinator GEMx welcomed us and introduced us to the different head of departments including the dean School of Medicine. This made me feel at home. A time table was drawn that helped me go through the expected objectives smoothly. The teaching hospital-Kiambu level 5 Hospital in Kiambu county was located approximately 30Km away from the university. This called for waking up early morning to catch the bus that would transport students to and from the hospital daily. The University had a six-year degree program for medicine and surgery compared to our Ugandan program of five years.

Forensic Medicine

In forensic medicine, I was able to attend a few lectures and five autopsies with lots of learning and getting expertise from the experienced government pathologists. The pathologists were such good people who made me learn when, why, and how to do an autopsy. I had the chance to visit the biggest government chemists’ laboratory where samples are taken for analysis concerning forensics and the law. This improved my knowledge in forensic medicine and skills in carrying out autopsies which will help me become a good medical officer in the future.

Mental Health

In mental health at Mathari Hospital, I gained skills in clerking mental cases and attended rehabilitation sessions in a private rehabilitation center for substance abuse clients at Blessed Talbot. This gave me great experience in understanding the relationship between drug addiction and mental health and the team approach in handling such clients.

Surgery

The experience in surgery rotation was such an amazing one especially the radiological investigations in managing surgical cases for example; MRI, MRCP, CT scan in addition to other routine investigations were readily available within reach and patients would go for them when requested. The surgeons were such good people as they made me learn a lot with their good advice and teaching.

This was such an interesting experience as it contributed to my knowledge that will help me go through medical school smoothly and use it in the future during my practice so I can become a good professional medical worker with the relevant skills. On the social aspect, I made friends, interacted with many students and visited many malls around Nairobi and markets. It was very interesting staying in Nairobi. Would wish given another opportunity to go back. Traveled back Kabale-Uganda by road and had a safe journey. All my travels and welfare were fully facilitated by GEMx. LONG LIVE GEMx LONG LIVE KABALE UNIVERSITY.

Group Reflections on a GEMx Family Medicine Exchange from University of Zimbabwe to University of Kwazulu-Natal

August 12, 2019

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Nyasha Manyeruke, Leslie Mashayahanya, and Talent Munjombi, medical students at University of Zimbabwe College of Health Sciences who completed a elective exchange at University of Kwazulu-Natal School of Nursing and Public Health (South Africa) through the GEMx-AFREHealth Regional Exchange Partnership.

INTRODUCTION

When we signed up for the GEMx Elective experience in South Africa, we hoped to experience and gain better understanding of the clinical setup in a neighbouring African country and improve our overall clinical skills in preparation for our final year of medical school. We happily report, that the experience exceeded our expectation and broadened our knowledge overally.
Under the supervised guidance of Proffessor Mergan Naidoo, we had an opportunity to rotate in different wards at the hospital, that is- High Care Unit, Out Patients Department, HIV clinic and Accident And Emergency Department. We had multiple opportunities throughout our elective to interact with Family Medicine constultants and Registrars for “one on one” tutorials as well as group tutorials. We also interacted with other members of the clinical team including interns, counsellors and nurses, who taught us and encouraged us to perform certain procedures, such as, drawing blood for investigations, inserting urinary catheters, suturing and so forth. Outside clinical activities at the hospital, we also explored Durban –visiting the beach, shopping malls, indulging in local delicacies, and interacting with fellow Zimbabweans living in South Africa, as well as the other locals we encountered in our day to day activities. We gained a greater appreciation of the multicultural and diverse society that makes up South Africa, Durban in particular, and how this correlates to patient management in the hospital setup.
In this report, we have summarized our elective experience into experiential sections and attached pictures accordingly.

Hospital Clinical Experience
1. Out-Patients Department
We each spent a week attached to the outpatients department, participating in local procedures and guidelines. In our logbooks we had clear learning objectives and subjective measures to assess our progress throughout our elective. We enjoyed ourselves thoroughly, and below in Figure 1.1, the picture illustrates Leslie clerking patients seated on the bench waiting to be served at the Out-patients Department.

2. High Care Unit
We each spent a week attached to the high care unit. We mainly learnt ward management of patients and ward conduct as well as protocol. Besides knowledge learnt on commn ailments in our setting, such as, HIV, TB and Myorcadial infarctions, from the various ward rounds and tutorials,we also assisted the interns in performing their daily ward duties, such as, taking blood, performing lumbar punctures, inserting chest drains and so on, as well as interpreting lab results for investigations. Figure 1.2 below illustrates Talent taking blood from a newly admitted patient, with the assistance of one the nurses.

3.HIV clinic
We each were attached to the HIV clinic for one week, and we mainly participated in patient adherence counselling, reviews, as well as initiation of patients on Antiretroviral medication. We learnt about the importance of the multi disciplinary team and we often assisted the nurses at nearby clinic( gateway clinic) in using the referral system tool effectively in ensuring patients receive the best care. Figure 1.3, is a picture showing Nyasha, standing at the entrance for Gateway clinic.

4.Accident and Emergency
We each spent one week at this department. This was a very busy department, it was very interesting learning about the triage system at this hospital and the acute management of patients. We learnt about the importance of time and sharing tasks amongst members of the clinical team in order to manage patients adequately. In figure 1.4, the picture below illustrates Leslie, preparing bloods to be sent to the laboratory for investigation.

5. Other Hospital Related Activities

Talent and Leslie reviewing clinical magazines for updates on recent research findings, new additions to clinical guidelines and for Continuing Medical learning(CME) in the doctor’s tea lounge during some of our lunch breaks.

Talent(female) and Leslie, standing in front of college of health sciences building for the University of Kwazulu-Natal. We visited the medical school a few times during our stay and we marveled at the architecture

A selfie taken after our GEMx end of elective exercise and discussion with us and Professor Ross( one of the consultants at the hospital. We enjoyed our interactions with him during ward rounds and our various tutorial sessions.

As we come to the conclusion of our elective experience, we would like to thank all the people who made this elective experience possible, we thank you for impacting our careers in our fruitful and adventure filled manner. We hope you continue your great work.

THANK YOU
Siyabonga

That was epic: my one month rotation at Universidad Iberoamericana!

May 10, 2019

Filed under: GEMx Global Network GEMx Student Reflections

Basel Magdy Abdelmohsen Abdelazeem

For those who dare to dream, the world spreads out its arms, and for those who aspire to realize their dreams, they conquer the world. This belief has made my family and I walk diverse paths to learn, compete and shine. Due to the continuous strive to chase our passions, we became a family of dreamers.

My name is Basel, Student at Ain Shams University – Faculty of Medicine, Cairo, Egypt. My nickname is Dr. Nobel because My dream is to get the Nobel Award in Medicine in the future Insha’Allah.

Abdel in front of Hospital General de la Plaza de la Salud emergency center

I’ve gone on a lot of electives worldwide, but this was a totally new different experience in the Dominican Republic. My rotation was divided in two hospitals. The first one in Hospital General de la Plaza de la Salud (HGPS) which is a teaching hospital facility and has helped more than 140,000 low-income patients with discounts and waivers of its health treatment plans. I did one week at internal medicine Department both inpatient and outpatient in addition to one week in ICU and Emergency Department.

At the second hospital,Hospital Escuela Dr. Jorge Abraham Hazoury Bahles (INDEN), one of the greatest hospitals in diabetes’ management in Latin America, I went through every aspect in diabetes management starting from the outpatient clinic by ordering basic lab & imaging and adjusting the doses of medication and Insulin up to management of diabetic retinopathy and surgical aspect of the Diabetic foot. It was really an amazing experience.

Abdel with several colleagues in a classroom

Can you imagine that you go through all medical specialties in a month while getting the opportunity to improve your Spanish at the same time?! We had morning case report, grand round, interacted with physicians and residents and finally the awesome UNIBE students who are all so nice, humble and willing to help you as much as they can. And fortunately, they speak both English and Spanish so you Ain Sham Universcan overcome the language barrier while interacting with the patient.

There are seven broad benefits of my rotation there and you should consider them in your next medical rotation.

First, I expanded my clinical knowledge and skill set as the style of medicine you’re studying is not universal, nor are the cases you’re familiar with.
Second, I must admit, I was nervous on my first day on the wards. I had no idea what to expect but the doctors made me feel like a part of the team. I found out what I’m made of and strengthened it.
Third I made myself more employable as an elective abroad stands out as a badge of durability, resourcefulness, and aptitude.
Fourth, traveling is an opportunity to see a part of the world you’ve never seen and might never otherwise consider.
Fifth, an elective helped me in building my personal and professional network and if you’re clever about it, you can also build an international network of professional contacts
Sixth, I sharpened my language and communication skills, right now I’m confident enough to take history and doing the complete physical examination in Spanish.
And finally, it renew my perspective on the worldwide health and I mentioned before my life goal is Nobel award and you should know a little bit about everything in each field in this world and you must know everything about your specialty.

Away of medicine, let’s talk about the country and culture. The Dominican Republic is the most popular tourist destination in the Caribbean region. I traveled a lot, so I learned how to enjoy each country to the most.

Abdel with friends from UNIBE having fun at a bar

This country is awesome if you have the correct company, I mean that you should interact with the real Dominican people and hang out with them. There is an amazing beach here, the old city, jungles– I mean literally– great nature. If you like dancing and drinking we’d definitely have a lot of fun as everyone literally is dancing to Latino music everywhere., Don’t forget to visit the Colonial Zone and Punta Cana. And make sure that you eat Dominican food made by locals and ask them to teach you how to dance to Latino music. You will have a lot of fun if you have good communication skills and know a little bit of Spanish.

My last word is thank you for everyone who helped me to get this rotation, for every doctor who taught me during the last month, for every student I met there and helped me.

Thank you, Dr. Mejia, Program Manager of HGPS

Thank you, Dr. Ammar Ibrahim, Director General of INDEN

Thank you, Danny, UNIBE Coordinator

Thank you, Eunice Kamami, GEMx Student Engagement Assistant

And Big Thank you to GEMx to giving us these opportunities.

GEMx Blog

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Camels and Cataracts: an Ophthalmology Elective at Lighthouse for Christ Eye Center

From Kampala to Rwinkwavu: Experiencing Rwanda and its Health Systems

Passion to Practice: Nzeeke Herbert’s Path to a Transformative Elective Exchange

Group Reflections on a GEMx Family Medicine Exchange from University of Zimbabwe to University of Kwazulu-Natal

That was epic: my one month rotation at Universidad Iberoamericana!

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