Why Rwanda must push the envelope to accelerate progress in the health sector

Wednesday November 28 2018

Doctor

A doctor vaccinates a citizenin Kigali, Rwanda. 

By Nyanja Brodin

As a Rwandan, I have my own experiences of my nation’s health care system.

For me the most vivid example involves my mother, a previously healthy and middle-aged woman, who presented to her local gynecologist eleven years ago with an aching stomach, poor appetite and weight loss.

The verdict of the Kigali gynecologist was that these long-lasting symptoms were caused by intestinal worms and provided a prescription for multivitamins. As any good patient left to the mercy of her physician, my mother followed the regimen, but her condition deteriorated.

I was living in the US at the time, and my mother did not want to worry me with her health problems. When she finally did, I and my husband, a Swedish physician, were immediately alarmed and flew to Rwanda.

We managed to get my mother examined at King Faisal Medical Center in Kigali, which was and still is one of the top medical institutions in the country. We used our savings to pay for the examination at King Faisal and my mother was diagnosed with cervical cancer.

Surgery

Within a few days, my mother was operated on by a talented gynecologist who has since left the Rwanda to work in Canada. After surgery, my mother required radiotherapy to increase her chances for a cure.

Radiotherapy was not available at the time in Rwanda and we were recommended to take her to Uganda. No referral was granted, and again we had to take matters in our own hands, bring my mother across the border and show up at Mulago Hospital with a bag of cash borrowed from friends.

This story of my mother’s cancer has a happy ending, we are glad she is still with us, healthy and full of life. Many of my friends and their loved ones are not as fortunate.

Had we trusted the first physician’s verdict and had we not had the means to pay for my mother’s treatment at King Faisal, my mother would not be alive today. As a rapidly developing country with high ambitions, Rwanda must aim for better. My country has come a long way in the last few decades.

By implementing basic health care for everyone across the country, successfully implementing our national immunization program and improving maternal and infant mortality rates, many lives have been saved.

This is illustrated in the recent primary health care performance initiative, PHCPI (https://improvingphc.org/), a fantastic achievement that Rwandans should be proud of.

Not enough

However, for any developing nation, succeeding in implementing basic health care cannot be enough. Instead, we now must push the envelope. In my opinion, the next frontier in Rwanda is improving the quality of care and providing specialized care beyond the basics.

As young Rwandans, we should not accept that our parents and children must be sent to India, Europe or US to get the care they deserve. As our country evolves, our priority must be to build such capacity, to improve the number of physicians, improve their knowledge, and provide working conditions for them to want to continue practicing medicine in the country rather than leaving.

One hopeful example is the new state-of-the art radiotherapy unit, currently being established at the Military hospital in Kigali.

Such an institution run by competent experts and funded long-term to support upgrades and maintenance will serve thousands of patients in years to come and become a regional hub for radiotherapy with additional benefits to the people of Rwanda.

Supporting such institutions, instead of expensive referrals abroad is the right thing to do. Well-educated physicians and nurses are the doers of medicine and deserve our utmost respect and support.

By shifting our focus from theoretical arguments around public health towards supporting the doers, change will be made possible and our ambitious goals reached.

By building strong institutions that can deliver more complex care within the country, we can do justice to our elderly, the generation that liberated our country and brought us this far. These actions will also build healthy and strong foundations for the next generation of Rwanda – our children. 

In Rwanda, we must be able to help the many children born into the modern Rwanda today and tomorrow. Me and my friends who are fortunate to have the means of traveling, should not have to move to Kenya or beyond, just in order to feel safe about delivering our children. Rwanda can do better.

As Rwanda competes with neighboring countries to attract foreign talents needed for our development, health care quality becomes an important factor to consider. With good quality health care available in Rwanda, the country will be more likely to recruit and attract talented people.

Advantages

It will also potentially gain financially from patients flowing in from neighboring countries to take advantage of its quality health care. It is also important to note that Rwanda has a lot of advantages over other countries in improving the quality of its health care system.

By being a relatively small, but densely populated country, with a centrally-located capital, the establishment of referral systems is easier in Rwanda than more sparsely populated countries.

Also, the recent push in Rwanda for improved IT infrastructure and connectivity provides an opportunity for using this infrastructure also to advance quality of health care by implementing electronic health records, registries and monitoring patient outcomes continuously across the country.

To personally contribute in this important process, I have started together with my husband and friends, an organization called Little Hills which aims to gather international teams of medical expert to work closely with the Rwandan government as volunteers, in order to establish a national center for diagnostics and data collection, and in the longer perspective a first dedicated children’s hospital in Rwanda.

I believe Rwanda is now ready to take its health care system to the next level of quality - Let’s make it happen together!

Nyanja Brodin is a Rwandan based in Sweden.  nyanjan@gmail.com