Marisa Smith, MD
Marisa Smith, MD
Resident Physician · Worcester, MA

Emergency Medicine in Kigali, Rwanda

September 1st
Kigali, Rwanda

Project Description

The purpose of my trip is to spend a month at the University Teaching Hospital of Kigali (CHUK) working with their Emergency Medicine faculty to help build their didactics/educational materials for their Emergency Medicine residency program. I will also be working in the Emergency Department at CHUK, and with a research fellow from Brown. The goal is to help share some of the teaching materials and techniques used at my home institution (UMass) to help improve education and training for Rwandan Emergency Medicine residents.

Population Served

The goal is for this project to benefit both the current residents in CHUK's Emergency Medicine Residency and the patients in Kigali, Rwanda. CHUK is the largest hospital in Kigali and the biggest referral center in the country, caring for many patients across the country.

Expected Impact

The aim of my project is to improve the training of Emergency Medicine residents through development of teaching materials for their weekly didactics. By improving their knowledge of ultrasound techniques, critical care, and procedural skills, the goal is to ultimately have an impact on the quality of care provided to patients at CHUK. By creating a curriculum that can be used year after year, the hope is that it will impact resident education and therefore patient care longterm.

Trip Photos & Recap

I spent a month in Kigali working at CHUK, the main public referral hospital for Rwanda. It was a challenging, but incredibly rewarding experience! My main focus was teaching. I worked alongside medical students and residents in the ED, helping with patient care and doing bedside teaching, ultrasound, and brief lectures on shift. Every Wednesday the EM residents had didactics, for which I would give a lecture related to their curriculum theme for that week. I was very fortunate to also work with an EM global health fellow who was there for several months. Together, with faculty from CHUK, we organized a simulation session for the resident to practice hands-on airway management skills (as pictured).

While I hope that some of my teaching made an impact, I have to say that I felt like I gained so much more. The faculty and residents I worked with in the ED were incredible. I was so fortunate to work alongside these amazing physicians, who taught me a lot about how to work in a resource limited setting and find work arounds with alternative supplies. We used ultrasound as our main diagnostic tool, as our CT scan was not functioning for the month I was there. We would often create our own pressor drips using code cart medications. Many patients came in due to trauma (MVCs, motorbike accidents, pedestrian struck by moto/car). As there was no “trauma team” or dedicated trauma surgeon, the ED residents would handle it all until they could go to the OR with general surgery—from doing their own reductions, managing open fractures or threatened limbs, and running resuscitations. Additionally, many patients would board in the ED who were admitted to hospitalists, but the ED residents would manage them primarily for as long as they were in the ED. I was blown away by the breadth of the ED residents’ knowledge and ability to care for so many patients, practicing both emergency medicine, inpatient medicine, and critical care.

I hope to return to Rwanda during my EM global health fellowship next year, with the plan to do more ultrasound teaching and curriculum development!