Dispatch # 7

Rwanda spends $111 per capita on health care, compared to $4,445 for Canada and $8,223 for the US. Unless the economy grows exponentially for the next 20 years, material resources for healthcare are unlikely to increase. But another resource, the human kind, provides Rwanda its best hope for some improvement in health care standards.

Every morning at University Hospital Kigali starts with morning report, where surgical residents present their cases from the previous night, as well as pending cases. Residents come clearly prepared and present well. In my interaction with residents and students, whether in the operating room, at the bedside, or in didactic teaching, I’ve noticed a real hunger to learn. When we did an advanced laparoscopic case, the room was full of genuinely interested trainees.  The pediatric residents in many ways remind me of pediatricians anywhere, true advocates for children. Staff physicians and surgeons are dedicated to their work, and clearly want to push Rwanda forward to higher levels of care. I’ve repeatedly called the physicians here heroes, and I meant it.

The University Hospital is also a unique place because of its international feel. In addition to visiting physicians, like myself, and nurses from many regions in the world who stay weeks to months, Rwandan teaching hospitals benefit from a unique American aid program, Human Resources for Health. This program sends American physicians, surgeons, and nurses to Rwanda for prolonged periods to practice, teach, and help transform health care. I’ve been impressed by how well these HRH physicians have integrated into the hospital and how well they interact with their Rwandan counterparts and the Rwandan staff.

The struggles of Rwandan patients to receive adequate care have also caused me to reflect back on the struggles of some of my own patients to do the same, whether due to lack of insurance and health care coverage in the US or the chronic waiting lists and cancellations in Canada. Rwanda is a poor country less than 20 years out of a genocide that devastated it. It ranks 150^th in the world in healthcare expenditure. The US and Canada are in the top ten. What is our excuse? 

Photo, top left: Rwandan physicians from CHUK and American physicians from the HRH program working closely together.

Rounds with team: With large team of staff, surgical residents, and students after rounds.

Teaching: Surgical residents and students attend a didactic lecture. 

Dr. Sherif Emil [1] is a pediatric surgeon and Director of Pediatric Surgery at the Montreal Children's Hospital. His trip to Rwanda is part of a McGill program to train surgical residents at the National University of Rwanda and the Centre Hospitalier Universitaire Kigali.

Read more dispatches: 

• Dispatch #1: From the African skies [2]
• Dispatch #2: Edmond [3]
• Dispatch #3: An African solution to an African problem [4]
• Dispatch #4: The first (not so) easy case [5]
• Dispatch #5: When good people do nothing [6]
• Dispatch #6: Winning battles but losing the war [7]
• Dispatch #8: Thanksgiving [8]