Rwanda is a small, mountainous, country in sub-Saharan Africa that is densely populated with over 10.7 million people. The population is relatively young, with a median age of 19 and 42.4% under the age of 15 (National Institute of Statistics Rwanda, 2011). Classified by the World Bank as a low-income country, the 2011 gross national income (GNI) per capita was $570 USD in Rwanda compared to $48,450 USD in the United States (World Bank, 2012). Rwanda is land-locked and bordered on the north by Uganda, the east by Tanzania, the south by Burundi and the west by the Democratic Republic of the Congo. The economy of the country is primarily agrarian, with coffee and tea as the major exports; Rwandan leadership is increasingly advocating for information technology and tourism as the country has few natural resources.
The 1994 genocide decimated the socio-economic, educational, and healthcare infrastructure in Rwanda. The violence exacerbated the poor healthcare and extreme poverty present following years of war and civil unrest. In the years immediately following the genocide, Rwanda had some of the worst health indicators in the world. In 1995, life expectancy was 30, infant mortality was 129 per 1000 live births, and maternal mortality was 1000 per 100,000 live births (World Bank, 2012). Yet, the government’s aggressive development and health policies over the past decade have focused on a multi-sectoral, integrative approach and stimulated significant progress in both the economic and the health sectors. Over the past five years, the gross domestic product (GDP) has increased at an average rate of 8.5% with an overall 11% reduction in poverty. The most recent government documents show that 44.9% of the population currently lives under the poverty line, with 24.1% being defined as living in extreme poverty (Government of Rwanda Ministry of Finance and Economic Planning, 2012). The 2010 Demographic and Health Survey in Rwanda showed an increase in utilization of antenatal care and childhood immunization. Life expectancy is now 55 years, infant mortality is 59 per 1000 live births, and maternal mortality is 340 per 100,000 live births (National Institute of Statistics Rwanda, Ministry of Health, & ICF International, 2011). Healthcare improvement initiatives in Rwanda focus on a decentralized approach to healthcare that concentrates on a strong network of community health workers and a socialized national health insurance policy called Mutuelles de Santé.
Despite the improvements in health outcomes, there is still a severe shortage of physicians in Rwanda, with only 5.5 doctors per 100,000 persons. Surgical services are even more limited, with only 1.2 operating theatres per 100,000 persons, 0.15 general surgeons per 100,000 persons,and 0.09 orthopedic surgeons per 100,000 persons (Petroze, Nzayisenga, Rusanganwa, Ntakiyiruta, & Calland, 2012). All of these infrastructure and provider numbers are well below international standards. Consequently, treatments requiring surgical intervention are often delayed or performed by a general practitioner with minimal training or supervision.
As of 2012, there are 44 hospitals in Rwanda, comprised of 41 district hospitals, 2 provincial referral hospitals with university affiliations, and 1 tertiary care hospital in the capital, Kigali. We work primarily at the university hospitals . . .
History of the UVA Global Surgery Initiative and Rwanda
UVA acute care and trauma surgeon, Dr. Forrest Calland, and surgical resident, Dr. Robin Petroze, first traveled to Rwanda in October 2009 at the invitation of the Ministry of Health to explore ways in which the Department of Surgery at UVA could partner with Rwandan surgeons to improve training and research. Dr. Petroze then moved to Rwanda for two years as a Fogarty International Clinical Research Fellow to research the burden of surgical disease and advocate with local health officials and surgeons for improved surgical delivery.
In August of 2012, the Rwandan government announced the start of an innovative partnership—The Human Resources for Health (HRH) plan—with the US government and 13 U.S. medical, nursing, and public health schools to expand training opportunities in Rwanda. Dr. Calland has spearheaded the involvement of the UVA School of Medicine in the HRH program, and over the next seven years, UVA will recruit and mentor up to four surgeons and two anesthesiologists to relocate to Rwanda for a year to train Rwandan physicians.