My proposed project has various facets, namely ultrasound education and medical training of Emergency Medicine (EM) residents. First, I will be providing medical care as a physician at the University Central Hospital of Kigali (CHUK) in Kigali, Rwanda. This is a well established hospital in the capital city of Rwanda and is the major public tertiary referral center for the country, as well as the main public teaching hospital in the region. I will serve as the attending visiting faculty member for the Emergency Medicine residency at CHUK, in charge of the Emergency Medicine resident education, rounding, and patient care in the Emergency Department. My mentor has a longstanding relationship with this hospital; thus I was able to go as a new ultrasound fellow at the start of my fellowship in July. While there, I learned more of what my role would look like as the international visiting faculty member there, and thoroughly enjoyed it.
As a current ultrasound fellow, I will also be utilizing a handheld ultrasound device and doing ultrasound skills training and teaching to EM and other hospital facility during my month in Kigali. Having built relationships during my previous visit to CHUK last summer, I will work alongside residents in their research endeavors while there and aid however possible to ensure successful projects. My personal research project will focus on the use of handheld, portable ultrasound and its utility in resource limited settings. The hospital in Kigali currently utilizing portable ultrasound; however residents are at various stages of training and need educators in this field. Advanced diagnosis can take days or even weeks. By utilizing bedside, point of care ultrasound and honing this skillset, EM residents can come up with a more accurate diagnosis and treatment plan. I did weekly ultrasound lectures during my last visit at CHUK to both EM and surgical residents and am eager to continue this during my trip in April.
Residents, patients and hospital staff in Rwanda and surrounding countries will hopefully benefit from this experience. By teaching the future EM leaders in Rwanda and surrounding countries, I hope that my impact in ultrasound education will be spread throughout the area. I visited this population as a new fellow several months ago and have been eager to go back with new knowledge and skillsets to teach. The residents at CHUK are a group of highly motivated, intelligent and hard working EM residents that I feel truly will make a difference in patient care in Rwanda and wherever they choose to practice. I also will directly serve patients in Rwanda who are at CHUK, the main tertiary referral center. This population needs EM providers, as there is currently only one graduated class of Emergency Medicine trained physicians.
My aim with this project is to expand ultrasound education and its capabilities, since it serves as the main bedside diagnostic tool at the major tertiary referral hospital in Rwanda. EM residents have some amount of ultrasound training; however based on my last experience several months prior, most residents felt they needed more training and to expand the current uses of ultrasound at CHUK. I think by spending a dedicated month as a visiting faculty member at CHUK, I can structure didactics to educate residents on their weaker topics as well as use the simulation lab to provide advanced ultrasound education. The impact of educating future EM physicians in Rwanda and its surrounding countries will carry forward long after I leave. I also plan to assist in the Quality Assurance process, helping residents get better images and interpret these images, once I return to the USA. I realize that usually with international travel, I end up learning more than I am able to teach, and I know this trip will inform my future educational and research efforts. I also plan to aid ultrasound research projects with the residents at CHUK.
My time in Rwanda was incredible. I spent the past one month working at the CHUCK, the main teaching hospital in Kigali, Rwanda. There, I worked as part of the Emergency Medicine (EM) faculty, staffing patients and also aiding the newly formed EM residency in whatever ways I could. I currently am an Ultrasound fellow at Brigham and Women’s hospital and my interests are in international ultrasound education; thus, this trip was a wonderful blend of my work and life interests! Each day I rounded with the residents and I would then supervise scanning rounds where residents and medical students use handheld ultrasound devices to scan patients. The pathology in Rwanda is like non other that I have seen. There is an inordinate amount of trauma as motorcycles still remain a main mode of transportation. The tropical/international medicine was very interesting and I had to brush up on my HIV, TB, Neurocysticercosis, Entamoeba, etc. There is also quite a bit of pathology of advanced diseases and we often had patients in their 70s with no past medical history come in with advanced newly diagnosed heart failure, namely because they had not seen a medical professional for several decades.
I also had the opportunity to be present for Genocide Memorial week, this year being the 25th commemoration ceremony. I marched alongside Rwandans and international travelers alike down the streets of Kigali in solidarity, which is something I will surely never forget. It is amazing to me the resilience of this country, and more directly the residents. For memorial week we had a dedicated room to patients with PTSD. Residents themselves who were affected by the genocide had to work during this week and to see them so dedicated to patient care and well-being while they themselves were likely suffering was extremely admirable. The residents themselves were a joy to work with and teach. This is the only Emergency Medicine residency in East Africa and as such there are residents from Congo, Uganda, and other surrounding countries in addition to Rwanda. These residents are pioneers in their field and upon graduation will work either in their home country or in Rwanda as some of the first EM trained physicians which is no small feat here. It is amazing to round in English, which is some of the residents 4th or 5th language, and discuss antibiotic stewardship, treatment for Neurocysticercosis, and suddenly have a power outage requiring emergent bagging of our 5 patients on ventilators for several minutes to figure out a solution. Again, the resilience of these residents is astounding.
While in Rwanda, I helped to launch the Teleultrasound for East Africa program. This program is designed to provide mentorship and feedback for point of care ultrasound in resource limited settings. Both the residents and faculty are very excited about this launch, and I was delighted to help contribute to the project in any way possible. I’m thrilled at the prospect of this project and and am happy that even if I cannot be physically in Rwanda, that by serving as an ultrasound mentor I can still feel connected to the education of the EM residents at CHUK. Thank you again to the generosity of the Doximity Foundation for making this trip a reality!