Hannah Adams, MPH
April 13, 2023, Thursday
Our morning began with a trip to King Faisal Hospital - the largest referral hospital in Rwanda. Through some preliminary research, I knew that the hospital offered a range of specialty services through the physicians able to provide these services were difficult to come by. I was struck by the reality that there are only two cardiologists caring for the entire population. After spending time with one of the fellows I began to see just how burdensome the lack of widespread specialty care is on the healthcare system, its providers, and patients.
Throughout the remainder of our trip, I am looking forward to better understanding what the barriers are to developing a robust system of specialty care within Rwanda. Overall, the country has made tremendous strides in establishing a functional primary care system and appears to be prepared to focus some efforts on developing a widespread system for specialty care. One factor that will be essential in doing this work is collaboration, particularly with regard to medical education. After sitting in on lectures with fellows and medical students, I would like to learn more about their experiences in medical school and how the curriculum is designed/delivered. I think it could be quite interesting to spend some time with a few of the medical students at least one of the days while at CHUK.
April 14, 2023, Friday
The morning began with rounds at the pediatric cardiology unit of CHUK. Standing alongside Dr. Bradley and the medical students, I listened as the clinical team discussed each case and developed a care plan. One of the most impactful moments of this experience was learning more about the challenges pediatric patients and their families face when seeking specialty care. While speaking to one of the pediatric cardiology fellows about the referral process we learned that mothers of patients will often sleep on the lawns next to the ward throughout the night and find food outside of the hospital campus. Hearing about these challenges in combination with the well-known logistical barriers to accessing clinical care provided much more context as to why we commonly see late-stage cases of disease at the district and referral hospital level. I think this is particularly important to understand when attempting to implement an intervention regarding preventative care.
In the afternoon, we also ventured on our way to check out one of the community health centers to gather more information about the relationship between CHWs and the community health center. While we were able to learn more about the overall referral process for a patient, I hope that we will be able to learn a bit more about what the CHW training truly looks like.
April 17, 2023, Monday
While visiting the genocide memorial and museum in Kigali this past weekend, Ifrah and I thought it was wonderful to see that psychological and counseling services were available to those visiting. This sparked our curiosity about the psychological services available in the clinical sector. During our recent trip to CHUK, we were fortunate to hear about the services offered to residents and learned that nearly all services were covered by Rwandan National Insurance. Considering the difficulty many individuals face in accessing affordable mental health services in the United States, I thought it was incredible to see how Rwanda has made these services available.
Later in the afternoon, we had a lovely conversation with one of the pediatric cardiology fellows learning about the openness of the Rwandan President to hearing concerns from the people of Rwanda. Through sharing a quick story with us we learned that the President appears to have an open-door policy to listen to the concerns of all people, not just those in positions of power and privilege. I thought this was a real testament to the polite and respectful nature of the Rwandan people and supported the statement in the Kigali airport that this is a country of doers and individuals who will make changes for the better.
April 18, 2023
Following the lecture and rounds with Dr. Laird at King Faisal, Ifrah and I decided to walk back to our hotel to work on the project proposal. On our walk back, we took a wrong turn and subsequently, ended up taking the long route. Our wrong turn allowed us to see a different side of Kigali that we had not previously seen. As opposed to the remarkably clean paved roads, with sidewalks and bike lanes for miles, we walked along red dirt roads past some of the agricultural fields and homes. Given the modernization of Kigali, it was interesting to see areas where the development is not occurring as rapidly.
April 19, 2023
After our morning lecture on pulmonary hypertension, Ifrah and I got right to work on our proposal. From previous experience searching for information on rheumatic heart disease in Rwanda, we knew it would be difficult to locate accurate, up-to-date data. Though the few papers available provide estimates regarding the prevalence of RHD, information such as the annual incidence of strep throat, acute rheumatic fever, and rheumatic heart disease, especially among Rwandans in rural areas is not reported. However, we were able to learn how other sub-Saharan nations are mitigating rheumatic heart disease. In nearly every country whose RHD rates are improving, the country introduced rapid strep throat testing and initiatives to increase community awareness of the link between strep throat and RHD. This information shows the strong potential for our project to be effective in Rwanda.
April 20, 2023
Following a fun lecture on exercise physiology, Ifrah and I spent some time revising our proposal prior to meeting Dr. Laird for a quick lunch at The Hut. The Hut is located near the Rwandan Convention Center in an area undergoing major development. The modernization of this area led to a discussion regarding how countries can maintain key aspects of their culture and lifestyle practices while simultaneously moving towards a potentially more modern society. For example, it looked like a big shopping mall accompanied by a hotel and restaurants was being developed as opposed to the traditional markets such as Kimironko. Additionally, I think this topic brings up the question of how we might be able to integrate cultural practices and rituals into both traditional clinical care and public health.
Later in the evening, we joined the cardiology and gastroenterology fellows for dinner. I enjoyed seeing the collegial nature of everyone and realized the importance of getting to know people beyond who they are in the clinical setting. It was such a pleasure to learn a bit more about our colleagues, their families, as well as their journeys in medicine.
April 21, 2023
This morning we celebrated Eid with traditional Rwandan pastries. After our lecture, Ifrah and I walked around the hospital providing the remaining to the staff at KFH. While offering a treat to a receptionist and a nearby patient, we noticed the patient spoke English and said a quick hello. After introducing ourselves briefly the patient shared that they had come to Kigali from Italy to escape the “fake pandemic”. We found this statement quite interesting considering that everyone we had met on the trip so far was adamant about ending the pandemic and the Rwandan Ministry of Health was serious about reducing the spread of the virus. With their quick action to implement testing and mandate masks, Rwanda was among the nations that effectively reduced the spread of Covid-19. However, I think this may indicate that mistrust and or lack of knowledge regarding the pandemic and public health persist beyond the US. I’m curious to see how the fields of public health and healthcare can build trust with our communities once again.