Collaborative Models: Training Surgeons in Rwanda

Together, Operation Smile and Partners in Health were able to build surgical capacity by providing training for general and plastic surgery residents for a selected cohort of trainees. Addressing the lack of reconstructive plastic surgeons in Rwanda, Operation Smile, in conjunction with the University of Rwanda, formalized a three-week surgical rotation template, identified target trainees, and began putting curriculum in place for plastic surgery residents, general surgery residents, anesthesia residents, nurses and hospital staff.

Training Surgeons in Rwanda
By: Andrew Karima, Operation Smile Rwanda Coordinator

Despite a large NGO presence and many interventions, Rwanda still faces a huge problem: Within the country’s population of 12 million people, there are only two reconstructive plastic surgeons and 18 anesthesiologists. Many Rwandan citizens suffer from trauma and burns that require surgical intervention, but there are simply not enough surgeons to help.

Drawing on a history of medical missions and surgical programming in Rwanda that dates back to 2010, Operation Smile recognized that the country’s surgical needs extended far beyond cleft conditions. Operation Smile thus revitalized its relationship with the University of Rwanda to begin hosting new surgical training rotations in October 2015 with the goal of closing gaps in the national health care system related to cleft care and plastic surgery.

Most health care professionals in Rwanda are concentrated around Kigali, the capital city of this very densely populated nation. However, once Operation Smile volunteers began working at Rwinkwavu District Hospital with Partners in Health/Inshuti Mu Buzima in the region, an opportunity emerged for Operation Smile to support targeted surgical training at that site. The effort started informally with small teams of volunteers in anesthesia and nursing both at Rwinkwavu District Hospital and Butaro Hospital in Rwanda’s northern region before focusing on surgical training. The partnership grew, especially as both Partners in Health/Inshuti Mu Buzima and Operation Smile realized that they could treat, successfully and effectively, the backlog of cleft patients in Rwanda while impacting the surgical capacity for an entire country.

The idea of a formalized surgical training rotation then took hold after a chance meeting with Rwanda’s Minister of Health. The Minister questioned the sustainability of such surgical training. After an explanation of existing partnerships and program strategy, the Ministry of Health signed on as a partner with Partners in Health/Inshuti Mu Buzima at Rwinkwavu Hospital, with Operation Smile as the designated training organization. In conjunction with the University of Rwanda, Operation Smile formalized a three-week surgical rotation template, identified target trainees, and began putting curriculum in place for plastic surgery residents, general surgery residents, anesthesia residents, nurses and hospital staff.

Most recently, Operation Smile conducted a three-week surgical training rotation with Hilton Prize Laureate Partners in Health at the Rwinkravu Hospital in October 2018. Together, Operation Smile and Partners in Health were able to build surgical capacity by providing training for general and plastic surgery residents for a selected cohort of trainees. Partners in Health/Inshuti Mu Buzima contributed expertise and resources throughout planning and execution of the rotation that included identifying and mobilizing patients, transporting patients and medical team volunteers, clearing medical cargo through customs, providing food for the team and lending logistic support. Our trainees and Operation Smile volunteers were able to treat 73 patients, with procedures ranging from burn contractures and critical wounds to tumor excisions and cleft surgeries.

Under the leadership of Partners in Health/Inshuti Mu Buzima former Medical Director, Dr. Alex Coutinho, and now with the current leadership of Dr. Joel Mubiligi, Operation Smile credits its significant impact in Rwanda to the positive and growing contributions of resources deployed by Partners in Health/Inshuti Mu Buzima.

Operation Smile fills system gaps with specialized training and additional programming that includes Wound Care workshops; nutritional counseling and treatment of malnourishment with Ready-to-Use-Therapeutic nutritional food supplementation; American Heart Association (AHA) life support training courses and ongoing equipment and biomedical training for hospital staff.

Operation Smile’s previous Regional Program Manager for East Africa, Roy Kariuki, says, “In 2015, Rwanda was a beautiful country, filled with hope and promise of a sustainable health care system for her people, but was staggering under a huge population who could only access two plastic surgeons in the entire country. Through sheer drive, hard work, and the resiliency of amazing partnerships, we can now proudly say Operation Smile Rwanda has launched the country’s first ever plastic surgery program. I am so proud to have been part of the Operation Smile team that led the charge in making this a reality.”

The training of Rwandan anesthesiologists is led by Dr. Paulin Banguti, who completed much of his medical training in the Democratic Republic of Congo before returning to Rwanda in 2004 to make an impact on the nation’s health care system. “If we can train 60 active anesthesiologists by 2024,” he says, “we’ll see if we can get to 100 or 120 anesthesiologists by 2030 — then we will be closer to the goal.” As noted by all involved, the goal is for Rwanda to produce enough doctors and trained health care professionals to meet the nation’s surgical needs.

Operation Smile continues to stand with the World Health Organization in recognizing access to safe and effective surgical care as a fundamental right for all people. While approximately one third of medical illnesses are surgically treatable, and as many as 5 billion people lack access to safe, effective, and timely surgery. Operation Smile remains committed to working with its partners, and especially the Hilton Prize Coalition, to meet this surgical gap, particularly for low-and middle-income countries.

(Photos courtesy of Operation Smile)

About The Hilton Prize Coalition

The  Hilton Prize Coalition  is an independent alliance of the 23 winners of the Conrad N. Hilton Humanitarian Prize, working together to achieve collective impact. Through three signature programs—the  Fellows Program, the  Collaborative Models Program  and the  Storytelling Program—the Coalition leverages the resources, talents and expertise of each of its members to innovate and establish best practices that can be shared with the global NGO and donor communities. Working in more than 170 countries, the Coalition is governed by a board comprised of the leaders of the Prize-winning organizations led by an Executive Committee and a Secretariat,  Global Impact.

To learn more about the Hilton Prize Coalition, visit  prizecoalition.charity.org, or contact  prizecoalition@charity.org. Follow  the Hilton Prize Coalition on  Twitter and  LinkedIn, and “Like” us on Facebook.

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