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PATHOLOGY IN THE +250 (RWANDA)

Filed under: GEMx Regional Exchanges GEMx Sponsored Events GEMx Student Reflections

Blog by Job Magare, medical student from University of Nairobi School of Medicine, who has completed his elective in general anatomic pathology at the university of Rwanda College of Medicine and Health Science through GEMx.

It was just after a busy examination period that I found out that my application for an elective term in Rwanda had been accepted. Having never travelled to Rwanda, I didn’t know what to expect but I maintained an optimistic demeanor. This paid off and even exceeded my expectations. I arrived at the Kigali airport at around 0930 CAT and took a taxi to CHUK (Centre Hospitalier Universitaire de Kigali), my working station for the next 4 weeks.

MY TIME AT CHUK

I was warmly welcomed from the first day, quickly sorted my accommodation and was taken on an elaborate tour of the entire hospital by Dr. Marie Claire Ndayisaba (Consultant Pathologist). The laboratory works round the clock but for residents we are required to be present during the week days from 7am to 5pm. I was mostly attached to the Histopathology department. On a normal day, residents are responsible for: grossing of surgical tissue specimens, performing FNAC, conducting slide review sessions under the guidance of a Consultant Pathologist for both cytology and histology cases, do weekly presentations on pre-selected topics in the department. Present cases at the hospital tumour board meetings every Friday of the week and attend to ward and accidents and emergency consults. All these duties we clearly elaborated in a monthly rota prepared by the Chief resident.

ACHIEVEMENTS

I learnt how to stain and interpret cytology slides using Diff Quik. Back at UON we routinely stain using H&E and PAP stains. I was also fortunate to go to the T.B unit and learn how to stain using Auramine stain. This even afforded me the opportunity to use fluorescent microscopy that I had not yet experienced before. During my elective term, we collectively came across two rare diagnoses (Sex cord tumor with annular tubules and Brain Hydatid cyst disease) that may end up as case reports in the foreseeable future. This, I feel will help me keep in contact with both my Rwandan and Tanzanian colleagues, laying ground for future collaborations in both scientific writing and case consultations. Other than CHUK, I got to visit the pathology laboratories in the University teaching Hospital of Butare (CHUB), King Faisal Hospital and Kanombe Military Hospital.

LEISURE

Every Friday afternoon, government employees are encouraged to engage in physical exercise. I got my weekly dose of physical exercise playing basketball at Cercle Spotify. I also visited the famous Kigali arena where there was an all-star basketball exhibition game to close the local basketball season. During the weekends, I spent most of my time touring the city under the guidance of my hosts. What I noticed is that Kigali is the true definition of a clean and safe city in Africa. I got the chance to try various foods Kigali had to offer but the Fish and skewered meat dishes were my favorite. My visit to the ethnographic museum in Butare also remains memorable.

SUMMARY

Rwanda is a very enjoyable place to be. The people are very welcoming and endearing. Getting to learn about their culture and customs was also very exciting and helped me gel with my new-found community. Overall, I feel the elective term was very beneficial from both a professional and academic growth standpoint and I will recommend these exchanges to learn how pathology is practiced in other countries. I would like to thank GEMx-COPECSA for the wonderful opportunity they afforded me by fully sponsoring this elective term at CHUK. Lastly, I would like to thank Dr. Annette Uwineza (my Host) who warmly welcomed me and ensured that I had a comfortable 4 weeks stay and the Chairperson, University of Nairobi, (Pathology department), Professor Angela Amayo, for approving of my elective term in Rwanda.

 

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.

 

 

 

 

Eric and Aline’s Elective Exchange to Uganda

Filed under: GEMx Regional Exchanges GEMx Student Reflections

NIZEYIMANA Eric and AKAYEZU Aline, 5th Year Medical Student from University of Rwanda. We completed GEMx Exchange on Family Medicine at Makerere University 

INTRODUCTION

Eric and Aline on the way toward Makarere University for Elective

Our hearts were very full the first time we received an email confirming that we were chosen to be a part of this amazing elective. The Family Medicine is not yet initiated in Rwanda health system. This was a golden opportunity to learn more and bring back a package of knowledge to share with our colleagues.

It is the dream of every Medical student to do an exchange outside of their usual setting so that they work in another healthcare system to learn and have a different experience that’s why I can’t hesitate to say this was our turn to realize our own.

 WELCOME TO MAKERERE UNIVERSITY  

Eric, Ms. Phionah and Aline at Makerere University

 

 

 

 

 

 

 

 

Our journey took 718 km2 from Kigali-Rwanda to Tororo-Uganda training center in Uganda, where the training about family medicine took place.  Arriving at MAKERERE University, we met  Ms. Phionah, the international students’ coordinator at this university. With warm welcomes, she gave an explanation about the exchange and introduced us to the rest of the team.

It was a great experience to travel the long distance on a bus. It was the first time, we took the time to observe the Uganda country, environment, and appreciate how well it is.

ACCOMMODATION

During our elective, we stayed at the Crystal Hotel. The hotel was close to the hospital. It was safe, comfortable and calm when you were studying. They had all kind of foods and it was delicious.

 

Eric and Aline at Crystal Hotel

The hotel was close to the hospital. It was safe, comfortable and calm when you were studying. They had all kind of foods and it was delicious.

ORIENTATION AT TORORO DISTRICT HOSPITAL   

Our 2nd day in Uganda was for the introduction to family medicine and orientation at training center, Tororo district hospital. We met with Dr. George Welishe and Dr. Okuuny Vincent, the senior consultants in Family Medicine who greeted us with warm welcomes. We had a  tour of whole hospital, introducing us to all departments of the hospital. We visited patient hospitalization wards, general theater, labor and administration offices &staff, emergency ward, HIV patients department and antenatal and family planning services. Everyone was happy to host us and we were also happy to be among them and excited to be in different healthcare settings. It is a large district hospital, which has many departments.

Eric, Aline, Dr.Okuuny and Dr.Maria (intern from Italy)

The daily schedule was made by morning staff meeting which was followed by ward round, theater, or labor or other department visit in the hospital.

1.Morning staff meeting

Every morning we have presentations on the topics that we were given on schedule. The topics that was chosen by trainers according to two conditions: 1.The most common cases in medical career related to the family medicine in which they think that will be useful to us along our internship and medical career. The second condition is the cases that are mostly found in Uganda healthcare setting especially in Tororo district hospital.  . Under consultant supervision, we had discussions in which they taught us on both our presented topic and presentation skills.

 2. Hospitalization Patients, Internal Medicine wards round

Aline, Eric, with Family Medicine Post-graduates Dr.francais and Dr.Christine on right and word round team on right

We had a daily attendance of ward round with the rest of the team which was made by family medicine consultants, family medicine postgraduates, nurses, and other medical doctors. I gained more experience in patient clerking and presenting during this activity and from this I understood that medicine is the same all over the world because it was very exciting to be able to make a diagnosis for a patient from another setting and participate in patient management by the same knowledge.

This ward round also emphasized on bedside teaching according to the case as long as also that most of the attendants were students. This was occupying a big part of our exchange where we learned much as found more cases that we didn’t see in our healthcare setting. Here I can list sickle cell diseases associated with malaria which is more common in the pediatric setting here, sepsis secondary to septic abortion, HIV and TB were more frequent in general wards especially in young people. We have seen some special cases like Asthma attack, dog bite, and pregnancy on sickle cell disease.

We learned from all the cases and were involved in their management process. We can confirm without hesitation that we are confident in managing patients.

3. Gynecology and obstetrics department

Eric using fetoscope

This was another interesting and productive service that we rotated in. The main objective was to know what services they deliver and get experiences in them as a future clinician and the objective was achieved. The major services that we provided were TORCH screening (toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex/HIV)  and counseling on results, Prevention of Mother to child transmission of HIV, Family planning, Immunization, Examination of pregnant mothers to assess for any complications that might arise during pregnancy.

We experienced also on the procedures done included vaginal examination, head to toe examination focusing on the abdomen for the pregnant mothers to check for the fetal heart rate through the use of the fetoscope. The LEOPOLD Maneuver like palpation of the abdomen to check for the lie, presentation, and engagement of the fetus. Not only this but also in labor they taught us, conducting spontaneous vaginal delivery, neonatal examination, and resuscitation for the newborn with fetal distress and other complications.

We enjoyed the rotation since we could learn more from each other through discussion of patient’s condition and be sharing an idea with the rest of the team which was mostly made by midwives.

4. HIV patients clinic

Eric (left) and Aline *right in HIV clinic consultation

In all the time we work at Tororo district hospital, we rotated also in HIV clinic. The services provided were history taking and physical examination for HIV patients to access drugs adherence, new HIV diagnosed patients counseling, viral load monitoring and shifting of patients from drugs line to another.

Of course, as a referral hospital, the number of attendants was big, At the time we helped around 80 patients and surprisingly the 2/3 was women and reason was that of the polygamy culture in Tororo community which makes the prevalence of  the HIV infection to rise in women than in men

BENEFITS

We met friends and we made friendships, we learned much from each other and we made strong networks. Finally, we had fun.

SKILLS AND KNOWLEDGE GAINED

Together with family Medicine post-graduates having fun

Four weeks at the Tororo district hospital for family medicine was productive beyond our expectations. Along all time, rotating in different departments we gain many skills in Family Medicine, the way it works and the services it provides. As long this specialty is not yet initiated in Rwanda health system, I hope to share with my colleague medical students, and other health professionals this skills or others who will be interested in family medicine. In addition to this, we gained also more about presentation skills.

The knowledge gained includes patient history taking and physical exams to list differential diagnosis, appropriate patients management, conducting a normal lobar and c/section delivery. Antenatal care includes Leopard maneuver and use of fetoscope and management and follows up of HIV patients.

CHALLENGES

All the time we spent in this amazing elective, the main challenge we meet is the languages. After arriving in the Tororo town, we have found that they are more local different languages spoken in the community which account more than 5 which also is related to different tribes with a different culture. This has brought some limitation during patients caring especially in history taking and management, explanation on medication taking and patient diseases education.  So to handle this, we used to organize a team during ward round such that there is one health care provider who speaks both English and one of the local languages so that he/she will translate.

The other challenge we met was to work in low facilities hospital where some materials were not available especially medications and septic environment, which was a barrier in patients treated and also we thought it could be a source of spreading diseases among hospitalized patients. To handle this will need multidisciplinary involvement including Minister of Health in Uganda and other health institutes but we did some advocacy about the problems.

LESSON I LEARNT

Dr. Cecilia and Enrica (left)

Of course, learning is a continuous process, but in this elective, the first thing I learned is that every healthcare professional can deliver the health services to the community according to his or her level.

The 2nd lesson is that working in limited health facilities can be challenging in the medical career while you were delivering health services but it’s good and important to adapt and use the few we have effectively to help the patients

The 3rd lesson, learning from each other and sharing information and respecting each other is most important in terms of both helping patients and teaching during health care services delivered.

The 4th lesson is As a student I got a lot about professionalism at work during this elective at Tororo district Hospitals. The healthcare professionals were having a positive attitude of medics towards students and their work made me enjoy my stay and practice as a student there.

ACKNOWLEDGE

We want to express my sincere gratitude thanks to the executive committee of GEMx represented by Carol Noel Russo, GEMx Regional representative in Africa Faith Nawagi, the host coordinator at MAKERERE UNIVESITY Mrs. Phionah and my university of Rwanda GEMx coordinator, Dr. UWINEZA Annette and everyone who contributed to making this elective happen

It great pleasure to thank all confident you hard toward us and offer this opportunity in which we learned much skills and experience and all your commitment and effort you made to create a way so that the elective on Family Medicine at Makerere university lead to success.

Special are destined to our trainers, senior consultants in Family Medicine at TORORO District hospital, Dr. Welishe George and Dr. Okuuny Vicent with the rest of the team who showed strong commitment to teach us as much they can, we really highly appreciate their motivation and strategies they use during training  health professionals and I wish they could spread that attitude among the rest healthcare professional trainers around the world.

 

 

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