a new nurse's introduction to global health: Reflections from Rwanda

I had the privilege of participating in Rwanda Endoscopy Week 7 (REW) this past March. This was my first time travelling to Rwanda, and while I had heard stories of The Land of a Thousand Hills from my father, Matt, who routinely travels to Kigali with GI Rising, and from our Rwandan friends Drs. Shikama and Marcelin, who came to stay with us in the States in 2019, nothing could have prepared me for what I saw and learned during my stay in this extraordinary country. 

I am a registered nurse, and fairly new to my career. With that being said, I have really only experienced the healthcare system in the United States thus far, and seeing Rwandan healthcare providers at work was truly eye opening. I was struck by a number of things, but to begin, I’d like to provide some context. After the genocide in 1994, Rwanda was reeling from the havoc caused by horrors that occured. The healthcare system lay in shambles, overwhelmed by the volume of patients and lack of enough providers to care for the increasing number of injured. It would be a long road ahead to rebuild and heal. In the past 30 years, the Rwandan people have made incredible strides in rebuilding their community and their healthcare system. Working alongside the international team of doctors and nurses during REW was a true privilege. Each and every Rwandan physician and nurse that I had the pleasure of meeting had sacrificed one thing or another for the opportunity to serve the people of their country by improving the quality of healthcare available. 

Many physicians must travel to other countries to obtain advanced degrees/training that may not be available in Rwanda. Prior to the creation of GI Rising, this was the case for anyone interested in pursuing further education and training in gastroenterology and hepatology. Dr. Eric Rutaganda, a Rwandan gastroenterologist who received his fellowship training in Paris, France is a prime example of the dedication that is so palpable amongst the providers I had the privilege of meeting. “Gastroenterology was my dream when I was in primary and secondary school,” said Dr. Rutaganda,  “It was, for me, a solution to answer the unmet need of patients. There were no more than two trained GI doctors at the time I pursued subspecialty training. This scarcity of GI doctors in my country pushed me to decline more lucrative contracts from different institutions in France and come back to my home country to pay it forward. I want to treat patients and teach trainees to decrease the burden of GI diseases in Rwanda.” 

As I mentioned before, I was struck by a number of things. Most notable was the sense of earnest ambition and drive to rebuild amongst the Rwandan people. The healthcare providers of Rwanda are putting in the arduous work to not only heal a healthcare system, but to heal a nation.

Our team, composed of two physicians, one nurse, and a GI tech, travelled to Butaro District Hospital in northern Rwanda to perform endoscopies. Butaro is nestled in the mountains, surrounded by mostly small villages sustained by subsistence farming. By the time we got to Butaro Hospital, word had spread about our arrival and the line of patients waiting to be seen filled the waiting room and snaked out the door. Endoscopy is not readily available at this hospital, so we had to set up our own sort of endoscopy MASH unit, if you will. This required quite a bit of troubleshooting and caused a number of delays. On our first day in Butaro, by the time we had set up all of our equipment and worked through the kinks, it was already halfway through the work day and the line of patients was still growing. We had only four days to scope, and wanted to see and treat as many people as possible, but there were only so many hours in a day. 

Our Rwandan teammates, Dr. Clement and Joseph, one of the nurses, graciously stayed late each night to help us squeeze in as many patients as we could. This meant postponing seeing their families after a long day and letting their stomachs growl for a few extra hours, likely without compensation for this extra time spent at the hospital. They stayed because they wanted to help. They stayed because they knew there were people who had travelled hours for the possibility of being seen by a gastroenterologist. GI issues are a prevalent affliction among the population in Rwanda, yet gastroenterological care is unfortunately not readily available in many parts of the country. Probably over two-thirds of the patients we scoped had H. pylori, a bacterial infection of the GI tract that can cause inflammation and ulceration. 

While no healthcare system is perfect and I cannot speak for the entirety of each culture or system, there are a few key differences that stood out to me. I was struck by how community-based the Rwandan culture is. Walking down the street, you make eye contact with each person you pass and you greet them. You see neighbors helping neighbors without expecting anything in return. Doctors and nurses working long, extra hours without being asked. The United States, on the other hand, has a very individualist culture. We take the job that is going to benefit ourselves the most. We work overtime only if overtime pay is included. I was struck by the warmth that feels so innate to the Rwandan culture and how it penetrates the healthcare being provided.

 I have a profound respect for the healthcare providers of Rwanda and for GI Rising. It is, in my opinion, the epitome of what global health should be. It is a sustainable program working in collaboration with our Rwandan brothers and sisters to rebuild the healthcare system and advance care in gastroenterology and hepatology. It has been a genuine privilege to be a part of REW and to meet the incredible individuals involved. I am humbled by the work that has been accomplished by the Rwandan people, and I am incredibly proud and grateful to be a part of the international community that is GI Rising.