Jesse Raiten MD
Human Resources for Health
October 15, 2013
I arrived in Kigali, Rwanda on September 30th, and am now two weeks into my two month assignment teaching critical care at the King Faisal Hospital. I am working for a program called Human Resources for Health, a project in Rwanda which falls under the umbrella of the Clinton Health Access Initiative. It is a 7 year program, currently in year 2, which recruits American faculty in medicine (all subspecialties), dentistry, nursing, and health policy/ hospital administration. Most faculty come for one year, although some plan to spend the entire 7 years in Rwanda. Depending on one’s length of assignment and specialty area, their focus may be on developing clinical policies to improve patient care, creating an entire residency curriculum (as was recently done for emergency medicine), or focusing on bedside teaching and resident education. As I am here for only 2 months, I have focused on resident education (anesthesia and internal medicine residents in the intensive care unit), the development of a critical care journal club for anesthesia residents at 2 different hospitals, and working to improve the daily schedule for faculty, residents, and medical students in the ICU.
King Faisal is a major referral hospital in Kigali, and accepts patients from across Rwanda, Congo, Burundi, and parts of Uganda. While technically a private hospital, it accepts the Rwandan national health insurance plan, and is thereby accessible to almost everyone (the national health insurance plan may cost as little as $6 per year, for those with very low income). The majority of patients treated in the ICU at King Faisal initially present to community clinics, where they are referred “up the chain” to a community hospital, district hospital, and finally to a referral hospital. This means that King Faisal’s resources are the best the country has to offer. They have a CT and MRI machine, 2 dialysis machines, a wide range of surgical capabilities, and an emergency department that is staffed 24 hours a day. While this may sound up to Western standards, in reality, it is far from it. There are no invasive monitors in the ICU, there is only one nephrologist (in the entire country), we routinely run out of even the most basic drugs, it takes approximately 12-24 hours to get lab results, the ABG machine is frequently broken and delivers unreliable results, etc.
Because there is no well organized system to identify and transport critically ill patients to the ICU in a timely fashion, patient’s often linger at the community or district hospital for long periods. This means that when they finally arrive at a referral hospital, their pathology is too advanced for our medical capabilities, and the mortality rate is very high. While the ICU does admit patients with diseases classic to sub-Saharan Africa (late stage AIDS, malaria), these are usually treated in the district level hospitals, and most of the patients in the ICU at King Faisal suffer from non-communicable diseases such as stroke, heart disease, or cancer. There is currently only one cardiologist in Kigali, one center in the country that can do basic chemotherapy, and 2 neurosurgeons in the country- who treat mostly head trauma from the incredible rate of motorbike accidents on the street. That being said, we do our best to treat who we can, with relatively little resources, and hope for the best.
In the next entry, I’ll detail what exactly I’ve been focusing my time on, and some of the major challenges I’ve identified to improving critical care services in Rwanda.