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Journey To A Land Of A Thousands Hills And Unspeakable Beauty Rwanda!

Filed under: GEMx Regional Exchanges GEMx Student Reflections

New blog by Francis Zerd MD, resident in Anatomical Pathology, Muhimbili University of Health and Allied Sciences (Tanzania) who has complete his elective in Pathology at the University of Rwanda College of Medicine and Health Sciences (Rwanada) through GEMx Electives.

It was a busy morning at our department, when an announcement was made in the departmental meeting about an elective opportunity that we could apply for. I was excited and as soon as the meeting ended I approached my senior and asked for more information. She explained very well what needed to be done, and when I saw Rwanda as one of the options for the elective, instantaneously my brain recalled all the astonishing tales of its beauty from people who have visited, without hesitation right away I started the application process and completed successfully.

Life went back to our normal busy schedules, and a few weeks later an email notification popped up in my phone, it was an email from GEMx that I have been accepted to do my elective in Rwanda. Excitement began, all preparations went smoothly with great support from my home academic staffs. On the evening of September 8th, my journey started at Julius Nyerere International Airport, Terminal 3, Dar es Salaam, with great customer care! I took RwandAir and could see the smiles and kindness in the air hostess faces and started feeling home as soon as I boarded the plane ready to depart to start my elective at University teaching Hospital of Kigali.

I spent an amazing 8 weeks at University Teaching Hospital of Kigali, had a fantastic experience, both in terms of histopathology, the hospital community, the country and its people as a whole. Hopefully this post will give some insight into my elective, and why the experience was so beneficial.

The University teaching hospital of Kigali/CHUK is the largest hospital located in District of Nyarugenge at KN 4 Ave, Kigali City. It is also the biggest referral hospital of the country with a capacity of 519 beds. CHUK provides quality healthcare to the population, training, clinical research and technical support to district hospitals. 

The hospital was built in 1918 and in 1928, it worked as health center and upgraded to a hospital in 1965. From April 1994 to 1996, the CHK served as a health center, a district hospital and as a referral hospital as well. In 2000, with the enactment of law Nr. 41/2000 of 7/12/2000 on the establishment and organization of the University Teaching Hospital “CHUK”, the CHK became a public institution with legal personality known as “University Teaching Hospital of Kigali”

The pathology department at CHUK has been active since 2013, and it has 5 pathologists currently. The normal day at the department starts at 7.15am with a meeting mainly in Tuesdays and Thursdays followed by the day’s allocated duty. Each activity is pre planned in a monthly time table which includes pathologists, residents and laboratory scientists. The main activity for residents are grossing, fine needle aspiration clinics and reporting to pathologists slide findings, usually done using a multi headed microscope where most slide review sessions are done. 

As is customary, the residents at CHUK work on rotation in different hospitals with pathology services in Rwanda. They attend to each for a period of one to three months and there is other opportunity to attend different trainings. I was privileged to visit and work in some of the hospitals for at least a day and privileged to attend one of the trainings. University of Rwanda, Huye campus, Southern province with other GEMx resident from Kenya, Dr Job, Kacyiru hospital which forensic pathology is practiced, King Faisal Hospital, one of the largest referral and the first hospital in Rwanda, University of Rwanda, College of Sciences and Technology (CST) during Molecular Pathology (micro satellite instability and short tandem repeats analysis) training, a 3 days training provided by Promega, Rwanda Military Hospital and Rwanda Biomedical Center (RBC) department, where all molecular tests are done.

I had an excellent elective at CHUK and would thoroughly recommend it to anyone who would like to get involved in a friendly, welcoming hospital in a developing country, where they will work hard but be well supported during their stay. In terms of a country for your elective, Rwanda is a great place where you will meet wonderfully friendly people and can do some exciting activities, with several must-do attractions.

In summary, I had a fantastic experience professionally and yet I also enjoyed immersing myself in the life and culture of the local area, leading to a thoroughly rewarding time.

I would like to thank GEMx-COPECSA for the wonderful opportunity and funding support for my visit and entire stay at CHUK, Ms Phionah for always providing guidance whenever needed, Dr Annette for being there whenever needed and making my stay very comfortable. Special thank the hospital staff especially the laboratory staff and fellow residents for their unspeakable cooperation they have showed me during my stay.

I would also like to thank MUHAS pathology department for giving me permission to attend this life changing opportunity and lastly I give my special thanks to my supervisor and mentor, Dr Edda Vuhahula for introducing me to this program, her encouragement and endless support whenever needed, may you all be overwhelmingly blessed.

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

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.

From Kampala to Rwinkwavu: Experiencing Rwanda and its Health Systems

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 

Tinka and other cohorts at the bus park

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).

Students at Rwinkawavu

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.

Students on motorcycles

 

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.

students at screening sessions
  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.

Students in front of statue in kigali

 

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.

 

 

 

 

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