Happy Independence Day from Rwanda!
For the past week and a half, Jonathan and I have been braving it on our own in Gisenyi. All of the EWH SI participants were assigned hospitals in more rural parts of Rwanda, and ours is located right next to the DRC (Democratic Republic of the Congo) border where a firefight took place just a few weeks ago. Needless to say, we were slightly apprehensive. But when we arrived, our misgivings were quickly allayed; the Rwandan side of the border is very safe. In fact, nestled on Lake Kivu, Gisenyi is a beautiful city and offers a resort-like lifestyle to tourists that can afford it. We’ve been spoiled with luxuries like hot and running water, American style toilets, awesome lake views, and great food. Just a few kilometers away, though, many Rwandans face a very different reality. Our two worlds converge at the hospital.
The city of Gisenyi overlooks Lake Kivu.
“Our” hospital is moderately sized for a district hospital but, like many of them, is short on resources. Dr. William, the director, explained that the infrastructure is old and disorganized, and that the hospital lacks a lot of equipment. After doing our inventory, we found they had about 100 pieces of equipment (not including lab equipment, of which they have over 200 pieces), ranging from anesthesia machines to dental drills. We spent three days trying (and failing) to fix an anesthesia machine. Turns out it’s tough to fix something when you’ve never used one and don’t know how it is supposed to work. Although we still haven’t figured out the anesthesia machine, we’ve now fixed multiple vitals monitoring units, a couple oxygen concentrators, and a centrifuge. Fixes can be anything from re-soldering connections for a new power cord to building a new pulse oximetry sensor out of spare parts.
Rubavu District Hospital.
While we work with Celestine, the head of maintenance at the hospital, doctors and nurses are busy serving patients. In general, the hospital seems quieter and less urgent than U.S. hospitals, but that’s not to say people aren’t busy. Even the director, who is in charge of administration of the hospital and 10 health centers in the district, pitches in by doing surgeries, working in the ER, and delivering babies.
We’ve been speaking a lot with the Dr. William who has great insights into the healthcare system here. His is fluent in English and has done fellowships in infectious diseases and emergency medicine in Holland and South Korea, respectively. He views the infrastructure as the biggest challenge at his hospital, but acknowledges that a shortage of doctors and poor maintenance of equipment are major issues. I introduced him to the world of mHealth and let him try out some devices I brought from Quantified Care. He was like a kid in a candy store. As one of the few Rwandans with an iPhone (although a decent number have smartphones, they are all Android), he enjoyed using his phone for pulse oximetry, ECG, and blood pressure.
The director uses the Cellscope Oto to examine my ear with his iPhone.
After speaking with him about telemedicine and mHealth, I believe there is great potential for these fields in the realm of community health workers. These ‘lay’ people (numbering about 50,000 in Rwanda) have some minimal training in medicine. They know how to test for and administer treatments for things like HIV/AIDS and malaria. With a shortage of doctors, it is these community health workers that have allowed Rwanda to make significant public health gains in such a short time. Dr. William said that the Ministry of Health was working with the South Korean government to equip the workers with smartphones, which would open a world of possibilities—leveraging mHealth devices to do telemedicine in rural areas could be a huge boon!
With just three and a half weeks left, it’s starting to hit that we won’t be here forever. I’ve been redoubling my efforts to meet people who can help me understand Rwanda and ways their health system can benefit from new technology. I recently met an American physician, Patrick, who works at the hospital here full-time. He serves as an on the ground coordinator for his non-profit, Go Beyond the Cross, which sends medical equipment to Rwanda. Over dinner with him and a group of Americans returning from Goma (they are part of the nonprofit Project Congo), I started to hear bits and pieces of a different perspective on the genocide and ensuing reconstruction. Needless to say, it was a very different viewpoint than the one we were fed at the Kigali Genocide Memorial and the Millennium Village.
Last night, I had dinner with Mike, who I know from the local market where I buy crackers and peanut butter for breakfast. He is tapped into a diverse network due to his job and has promised to connect me a range of people, including both community health workers and doctors from a local private hospital. I am eager to hear from these people and get their reactions to my ideas for new medical technologies.
Celestine, our BMET, insists that we keep our toolbox in the refrigerator when we are not using it.
An anesthesia machine and patient monitor, respectively.
Even the most modern looking buildings here are a façade covering the mud bricks.
On the way from Kigali to our hospitals: Five large guys in a car no bigger than a Ford Edge. We each had a suitcase. By the time we all climbed in the suspension rode 5 inches lower. Right after we pulled out of the IPRC driveway, we pulled into a gas station where the driver had two of the tires replaced.