Reflections from Rwanda: A Medical Resident's Experience Abroad
Stay tuned for more updates on Celine’s experiences throughout her rotation.
After 2 weeks in Kigali, I think I grasp the main features of the local medical system. Located in Kigali, The CHUK (Centre Hospitalier Universitaire de Kigali), is the university-affiliated referral center of the country. There are 5 established referral hospitals throughout the country (CHUK, CHU Butare, King Faisal, Rwanda Military Hospital and Ndera Hospital) and three newly added (in Kibuye, Ruhengeri, and Kibungo). In Kigali, the CHUK serves the entire population whereas the King Faisal and the Rwanda Military Hospital are reserved for patients with private insurance. Every patient has access to a minimal insurance (mutuelle) but many don’t have it which complicates their care.
Specialists work in referral hospitals and provincial hospitals, generalists in District Hospitals, Nurses in Health centers and health posts and Community Health Workers work at the level of the community where 80% of the burden of disease is managed.
There is one medical school in Rwanda and basic training is 6 years after high school. Every graduating doctor has to serve for a minimum of 2 years in a District Hospital (DH) after completing one year of internship. After these 3 years, they can either specialize (usually 4 years) or remain a generalist. In district hospitals, generalists are expected to perform cesarean sections and manage the labour ward. They also cover the emergency room, pediatric and internal medicine wards, etc.
What struck me the most is the number of postpartum peritonitis (infection of the entire abdominal cavity) transferred to the CHUK. Whether surgical technique or lack of proper sterility is the cause of these peritonitis, the burden of disease is huge. The treatment consists of a supra-umbilical midline laparotomy (opening the abdomen from the pubic bone to the chest), debridement of the infected/necrosed areas (removal of infected and unhealthy tissue), abundant washing and partial closure. Sometimes, if the skin is infected, it is also debrided and the abdomen is left open to close by secondary intention (from the inside). The wound is packed with gauze and daily dressings are done. Patients can stay over a month in the hospital until it heals.
Céline Giordano is the first recipient of the Dr. Alice Benjamin Global Maternal and Child Health Award, awarded in September of 2018. Céline graduated with her Doctorate of Medicine from the University of Ottawa is 2015 and is currently completing her residency in Obstetrics and Gynecology at McGill University. As part of the Dr. Alice Benjamin Global Maternal and Child Health Award, Céline is currently in Rwanda learning from OBGYN colleagues there. This is the first of a series of posts about her learnings and travels.