Lexi Riopelle, MD
Lexi Riopelle, MD
Resident Physician · Boston, MA

Dermatology Clerkship in Rwanda

May 10th
Kigali, Rwanda

Project Description

I will be traveling to Butaro, Rwanda to teach medical students attending the University of Global Health Equity (UGHE) from 5/11-5/19/24. The UGHE is a global university based in rural Rwanda that focuses on community-based learning, social determinants of health, and science innovation to give students the tools needed to repair inequitable health systems. Academic programs are built on the principles of gender equity, social justice, and the concept of One Health, focusing on the interconnectedness of human, animal, and environmental health. Clerkships are administered through a partnership between local (Butaro District Hospital (BDH) and UGHE) faculty and visiting faculty.

I am currently on the clerkship planning committee. In this role, I am finalizing lectures and planning the case-based discussion sessions. We currently have 20 didactic lectures planned, as well as 15 case-based discussions. We have been meeting weekly to refine our educational plan. During my week there, I will be working directly with medical students and leading teaching sessions, case-based discussions, and practical laboratory and simulation skills. Additionally, I will be providing care to the local population by working in the outpatient dermatology clinic and inpatient wards. Working alongside the medical students at UGHE will allow me to engage in a sustainable global health initiative by increasing access to care for the local Rwandan population. I will also be working on designing and executing IRB-approved clinical research projects with the students to improve the quality of care.

I will be one of the first residents from the U.S. to participate in this program. My participation will lead to a long-term relationship between my residency program at Boston Medical Center and UGHE. As part of my role in the planning committee, I have recruited additional participants, including Courtney Hanna, who will be joining the organization for our trip in May.

Population Served

The medical students attending the UGHE and patients in Butaro will benefit from this project. The vast majority of patients in Butaro do not currently have adequate access to dermatologic care. There are only 2 dermatologists in the entire northern province of Rwanda, an area with a population of 1.7 million people. Rwanda’s healthcare system has undergone a large amount of change following the 1994 genocide. It is currently organized into a system of health posts, health centers, and district hospitals throughout the country, as well as four national regional hospitals. The majority of the hospitals, including the Butaro District Hospital, where we will be working, lack critical resources for providing high-quality care for the population it serves. The UGHE program aims to benefit the patients in Butaro and the medical students by emphasizing health systems and health equity within its curriculum, with the aim of training physicians who will be excellent clinicians and leaders in the ever-evolving health system. By providing education and training to current medical students, my involvement will help support this mission by contributing to the development of skilled clinicians who are more prepared to diagnose and treat many dermatologic conditions in the population.

I have chosen to travel abroad and work with an underserved population for several reasons. I currently work at the largest safety net hospital in the Northeast United States, with over 50% of the patient population from racial or ethnic minority backgrounds. Serving these patients has allowed me to realize many issues with access to care and health disparities. For example, I am currently leading a project that has secured over $30,000 in grant funding for providing transportation to and from clinical appointments for those who lack the means. Having a background in global health and humanities, I am committed to advocacy and health equity locally and globally.

Expected Impact

Currently, there are only two dermatologists available for referrals in Butaro. By training all medical students, we expect that future general practice physicians will understand how to diagnose and treat common dermatologic conditions. We also intend for these trained physicians to be equipped with the skills to make proper referrals to dermatologists only as needed. This will significantly help Rwandan patients attain the dermatologic care that they need.

UGHE visiting faculty members may only include board-certified dermatologists or dermatology residents interested in both global health and medical education. I have a goal of forming a longitudinal partnership with UGHE and continuing to develop and refine their dermatology clerkship. This medical school was founded by my mentors, Dr. Jeffrey Dover and Dr. Tania Phillips, and I have a commitment to building the clerkship, returning to northern Rwanda, and assisting in capacity building at BDH. The entire clerkship runs until June 2024 and will continue after I leave.

In addition to health equity, I have an interest in medical education. I believe my participation in this project will allow me to gain a better understanding of the barriers to healthcare that many face. I also hope to gain more perspective on global health systems. Further, I will carry forward the lessons that I learn on this trip to be a better educator.

Trip Photos & Recap

I recently had the opportunity to travel to Kigali, Rwanda, for a one-week experience. During this time, I was able to work directly with medical students at the University of Global Health Equity (UGHE) as they rotated through their dermatology clerkship. These students were at the end of their fourth year in a combined six year undergraduate medical school. We engaged in case discussions and Kodachrome lectures, as well as participated in inpatient rounding and outpatient clinic. Beyond this, we instructed the students on performing procedures, such as intralesional Kenalog injections. I was expecting a hands-off observation heavy experience, but I quickly found that I was tasked with teaching students procedures and treating patients independently. Each day the clinics saw over 60 patients. This was a great way to see and treat a wide range of pathology. While I did not see anything I had never seen before, I did witness patients who had more widespread and severe disease.

Beyond this, I enjoyed learning about Rwandan culture. I ate many new foods and learned about their school and educational system as well as the differences between Rwandan and American medical education. I was thoroughly impressed by how bright and motivated the students were. It was a valuable experience to participate in and better understand a different healthcare system. While they practice Western medicine, the patients do not have access to many of the medications and procedures we have in the United States. For example, atopic dermatitis patients do not have access to dupilumab in Rwanda and therefore other older therapies such as cyclosporine and methotrexate are used more often. Additionally, it was eye-opening to see the genocide memorial in Kigali and read about the tragedies that occurred in 1994. It was apparent in their mannerisms and interactions that this still affected them to this day.

Throughout my time, I drew incredibly close with the medical students. They were all very appreciative of our willingness to teach. It was gratifying to watch their progress during the week, and I left the experience wishing I had more time to spend teaching them. I was able to refine my educational skill because I was revered as an instructor while I was there, and this experience motivated me to attain a teaching position in the future. I plan to stay in contact with the students and faculty at UGHE through social media and WhatsApp, and I hope that my participation in the program will allow future Boston Medical Center residents the opportunity to participate.