Rwanda Endoscopy Week Blog - Sharon Thomson

When Dr. Bensen first introduced the idea of Rwanda Endoscopy Week (REW), I was ecstatic – what better way to combine my interests in global health and gastroenterology. My interest in global health first started in college when I went to Guyana with the aim of bolstering the primary school STEM infrastructure. This was my first exposure to international humanitarian work and I was hungry for more!

Sadly, however, the Rwandan Marburg outbreak was announced on September 27th, 2024. The havoc wrecked by COVID was still fresh in everyone’s minds; the whole world was on the edge of their seat as we relied on the CDC to keep us appraised of this hemorrhagic fever outbreak. Rwanda’s response to this unprecedented health crisis was impressive, to say the least. They were able to contain the outbreak to 66 cases with the last suspected case testing negative on November 8th. The outbreak was officially declared over on December 20th, 2024. Though the country’s heart was heavy with the loss of fifteen individuals, they were committed to making healthcare advances and invited our team to return in the Spring of 2025.

With a team of gastroenterology subspecialists, fellows, residents, nurses, research assistants, and program coordinators, we arrived in Rwanda during the first week of March. We were joined by an invaluable group of Nigerian gastroenterologists. We divided endoscopy towers, screens, and procedural equipment and set out to eight different hospitals scattered across the country.

I was paired with a gastroenterologist from Michigan and a fellow from Philadelphia. Together, we were stationed at the Kibogora hospital, located in the Western Province about 100 miles southwest of Kigali. It is a 280-bed facility and includes surgical, pediatric/neonatal, maternity, internal medicine, emergency medicine, and isolation wings. With the help of the director general and lead general surgeon, we mobilized a team of two CRNAs, two nurses, and an internist. Over the course of the week, we triaged over 140 patients and completed 122 endoscopies at Kibogora alone. Remarkably, the total tally of endoscopies across all sites was close to 900. We diagnosed several patients with gastric cancer, candidal esophagitis, H. pylori-induced gastritis/duodenitis, gastric outlet obstruction, esophageal strictures, and intestinal parasitic infections.

The most meaningful parts of my experience involved hearing from the patients who waited for days, with unwavering resolve, in the scorching dry heat or cold rainstorms, to be evaluated for endoscopy. Many patients never had primary care, let alone a gastroenterology consultation, reminding me of just how much we take for granted on a daily basis. Their immense gratitude for our care was humbling.

The Kibogora hospital is perched on a tall hill overlooking Lake Kivu. In my stolen moments of solitude, I kept finding myself in the hilltop garden, breathing in the smell of wet grass and observing the breathtaking lake view. These moments, above all, afforded me some time for reflection. We certainly had a meaningful impact on this community. Endoscopies that caught undiagnosed gastric cancers expedited much-needed referrals, and normal endoscopies provided patients with clarity, closure, and reassurance. Despite our best efforts though, there are hundreds of people who will still have to wait months for their endoscopy.

Voluntourism is always a concern with international humanitarian work. I was lucky enough to partake in a global health track offered by the Dartmouth College Center of Global Health and Equity (CGHE). This prepared me with lessons on cultural sensitivity and avoidance of the “savior complex”. In order to ensure sustainable change, one of the main goals of REW is to train local Rwandan fellows and advance their endoscopic skills. Since the inception of the gastroenterology and hepatology fellowship in 2022, Rwandan GI fellows have worked hard to improve accessibility of endoscopy in the city. Soon, accessibility will have improved to the extent of obviating the need for external referrals.

The changes that the GI Rising team and Rwanda Endoscopy Society pioneered are revolutionary; I feel honored to have played a small part in this journey and I am grateful to the Dartmouth CGHE for their mentorship and generous financial support. I look forward to participating in future REW and collaborating with the Rwandan team to expand accessibility of complex gastroenterology services for all.