On medical mission, Boston Children’s doctors find Rwanda at a crossroads

_MG_9513Kigali, the capital of Rwanda, may not be on the exact opposite side of the world from Boston. In fact, if you were to dig a tunnel straight down through the Commons, you would end up treading water a few hundred miles off the southwestern tip of Australia. All the same, you would be hard pressed to find two more dissimilar places on Earth—at least when it comes to the availability of pediatric physicians.

“The country had fewer than 20 pediatricians working in public settings, serving a population of 4 to 5 million,” says Kim Wilson, MD, assistant director of Boston Children’s Hospital’s Global Pediatrics Program in the Division of General Pediatrics.

And the situation actually declines when it comes to pediatric specialists.

“The latest data we have for anesthesiologists, for example, is that there are probably 12 for the whole country,” explains Craig McClain, MD, a Boston Children’s anesthesiologist, who with Wilson, was part of a team of Boston Children’s clinicians working were in Rwanda last year as to shrink the physician-to-patient disparity.

“Most of the anesthetics there are delivered by anesthesiology techs that have undergone a couple years of training out of high school,” he says.

But despite these numbers, Rwanda has become a global success story in recent years when it comes to health care. Following a brutal genocide in 1994 that claimed the lives of nearly 1 million, average life expectancy in the country had plummeted to 30 years while rates of infectious diseases soared.

Fast-forward 20 years and you’ll find a country on track to meet most of the Millennium Development Goals by the upcoming 2015 deadline. Rwanda is one of the only African countries to come this close. Life expectancy has doubled, and deaths from communicable diseases like HIV/AIDS, tuberculosis and malaria have drastically declined. To maintain that progress and meet new health care demands, Rwanda’s Ministry of Health has partnered with caregivers at Boston Children’s.

The Human Resources for Health is a seven-year program aimed at strengthening Rwanda’s residency programs in pediatrics, anesthesiology, surgery and otolaryngology, among others. With funding from U.S. aid agencies, the Rwandan Ministry of Health (MoH) is partnering with U.S. academic institutions to match American teachers and physicians with local residents and medical students. For the past two years—and for the next five—two Boston Children’s physicians have worked alongside pediatricians at Kigali hospitals in year-long twinning partnerships. Three rotating specialists form similar partnerships, but for two-month stints.

Of course, physician education is only one part of the problem. Drug and equipment shortages, equipment m

alfunctions and persistent supply chain problems are a fact of life, even in Kigali. “Some of the difficulties these settings have aren’t just about resources and training; they also involve issues of systems management,” Wilson explains.

To address some of those challenges and supplement the boots-on-the-ground efforts of McClain, Wilson and o

ther clinicians, OPENPediatricsTM is developing needs-specific curriculum for clinicians in Rwanda, including a curriculum to train new pediatric residents in cardiology (Rwanda currently has two trained pediatric cardiologists).

“It’s a difficult environment,” Diane Stafford, MD, an endocrinologist who participated in the program last year, says. “Everyone’s working really hard, but there are limited resources.” Stafford was part of a rotating team of three specialists stationed in Kigali last winter. Although they’re there to teach, they often end up learning a lot as well.

“Rwanda has only recently been able to shift its attention away from communicable diseases to chronic diseases like diabetes or growth disorders,” she says. Treating chronic diseases like diabetes is a resource-intensive process. In a resource-limited country like Rwanda, that has meant Stafford and other visiting specialists have had to get creative