The Emergency Medicine residency at Africa Health Sciences University (AHSU) in Kigali, Rwanda was first developed in September 2024. As a new residency program, it is seeking ways to advance its training and curriculum, which I will participate in through this project. The residency splits clinical time at three different hospital sites: King Faisal Hospital, Kibuye Hospital, and Kibungo Hospital. For the purposes of this project, I will be discussing King Faisal and Kibuye hospitals.
King Faisal Hospital is the main teaching hospital and the largest multi-specialty quaternary hospital in Rwanda. At this unique site, trainees care for and learn from a large spectrum of patients and can more easily connect patients to important specialized care. In comparison, Kibuye Hospital is set in a more remote location with less resources. Both clinical sites in tandem provide significant insight to an emergency physician’s training.
My emergency medical training has primarily been at Massachusetts General Hospital and Brigham & Women’s Hospital through the Harvard Affiliated Emergency Medical Residency. Both hospitals are large, specialized teaching institutions in the United States. I have also sought more remote clinical experiences, from a study abroad experience in rural India to an emergency medical clinical rotation in rural Alaska.
As a senior emergency medical resident with experiences in both large, specialized and remote, rural settings, I hope to share my perspective and expertise with fellow trainees at AHSU in clinical and educational settings. I plan to attend and help with their weekly teaching and simulation sessions during this rotation. I will work with the chair of emergency medicine to improve their residency curriculum by designing various small group sessions, lectures, and simulations. I will also work directly with the residents in the emergency department. I will spend half my time at King Faisal Hospital and the other half at Kibuye Hospital.
One important aspect of Rwandan history that has affected the health of its people is the Tutsi genocide in 1994. Besides the large death toll, other longstanding medical effects include communicable diseases, such as HIV and hepatitis spread by rape, and generational trauma and socioeconomical strain caused by the violence.
Despite this, Rwanda has met many of its health challenges with resilience and grace. Rwanda has one of the most organized healthcare systems in Africa. It only costs about $2 per year for citizens to obtain health insurance. The country has also had a phenomenal response to the COVID-19 pandemic, with 82% of the population receiving at least the first dose vaccine within two years of distribution. Regarding the Marburg virus outbreak this year, the country implemented contact tracing and isolation of the virus so that the outbreak was declared over in less than three months and about 75% of affected patients have since recovered.
The patient population in King Faisal Hospital, one of three referral hospitals in Rwanda, is unique in that patients are referred to the hospital for highly specialized care that is not provided elsewhere in the country. The hospital has buffered care through the collection of advanced technology and development of live-saving programs, such as the new kidney transplant program. While the patient population is still faced with issues of poverty and communicable diseases common throughout the country, specialized care and advanced medical technologies allow for improved healthcare access in this population.
In comparison, Kibuye Hospital, which is in the Karongi District, is more remote and afforded less resources. The hospital is located next to Lake Kivu, seeing tropical waterborne infectious cases, such as malaria and Schistosomiasis, and even drowning cases. Furthermore, the hospital is only 15 kilometers away from the oldest Rwandan refugee camp, which continues to house many Congolese refugees.
The purpose of this project is two-fold: medical education and clinical contact. I hope to impart my experiences and perspectives from training at a U.S. residency program to the AHSU residents. I will incorporate my knowledge of ultrasound, leading traumas and medical codes, and caring for medically complex patients into medical teaching during didactic sessions as well as on shift. Earlier this year, I worked with my residency program leadership to develop a novel healthcare equity simulation day. We wrote four different simulation scripts to represent various health equity issues our residents commonly face, trained standardized patients, and led feedback and reflection groups after each simulation. I am excited to use these skills to develop permanent tools to supplement the AHSU residency curriculum. I am passionate about medical training, especially in a global health setting, because this directly supports the patient population by empowering local providers with clinical knowledge and instilling confidence in their medical skills.
During this rotation, I look forward to interacting with patients to learn more about local disease patterns and epidemiological factors. I would like to learn about specific diagnostic assays and therapeutic interventions limited by lack of healthcare access. Working in a clinical setting in rural Alaska taught me practical skills like applying tools for indications outside their original intended use and important considerations prior to transferring a patient to a distant location for definitive care. While my experiences are quite distinct from those of AHSU faculty and trainees, the exposure I have had so far will help us to communicate and learn from one another how to best serve our patients. This experience will add to my clinical expertise so that I can continue to care for and improve healthcare access for socially disadvantaged patients both globally and in the U.S.
We conducted teaching on Broslow/peditape and tourniquet use throughout various departments at King Faisal Hospital. We also led a mass casualty training session with department leaders. A majority of our time was spent supporting medical education for the African Health Sciences University emergency medicine residents. We helped plan and lead their first journal club, led various teaching and simulation sessions during their weekly didactics, and attended their daily case discussions. I am excited to see how the department and hospital continues to grow and improve care for Rwandans.
