Muraho from Kigali!

Our names are Alice Burgess (UVa 2017; GDS) and Emily Romano (UVa 2016; GPH) and we are in Kigali this summer researching, shadowing, and learning tons. We cannot thank CGH enough for this incredible opportunity.

Burgess Romano_Rwanda - street sign

Research

Our focus project is investigating local physicians’ attitudes towards using Rwandan honey to treat acute care burn injuries. While this sounds a bit unconventional, beekeeping is a fast-growing industry and honey actually has miraculous antibacterial properties. When we went to tour the burn unit at CHUK (the Teaching Hospital of Kigali), it was a pleasant surprise to discover many of the nurses already use honey during burn treatment, often following the application of Flamazine. Since the head of the surgical burn unit, Dr Faustin, gave us the official “go ahead” to conduct a needs assessment (and desired opinions from not only physicians but also from nurses and patients), we have adjusted and now hope to conduct a “case study”. Getting feedback from these different parties will hopefully shed a broader light on how medicinal honey is viewed and used, and perhaps our findings can even be brought back to the UVa Hospital — which would be a very cool instance of “reversing the flow” of information and technology between the US and Rwanda.


We have also been working on developing a research proposal under the guidance of a UVa surgery resident, Allison Martin, one of the Harvard Human Resources for Health surgeons, Dr. Ainhoa Costas, and Rwandan oncologist Dr. Pacifique Mugenzi. This research aims to shed light on the most prevalent risk factors for premenopausal women with breast cancer in Rwanda. With the help of Bryan Kwizera, a Rwandan medical resident, we have designed a survey tool that will helpfully help shed light on the most prevalent risk factors (including family history, birth control usage, socioeconomic standing, breastfeeding patterns, age of menarche, weight changes, hormone receptor status, and nutrition habits). We hope that completing a detailed literature review, designing the research study, and having the help of Bryan, Allie, Ainhoa, and Pacifique will allow for this project to get IRB approval and get “off the ground” in the fall!


The Hospital

When we first arrived in Kigali, we were struck by the high cost of living, the modernity of the architecture, and the overall wealth of the city. However, we came to realize that the sophisticated spaces and clean streets we’d been frequenting are in stark contrast to the hospital facilities… and despite the boundless economic success that Rwanda’s capital has experienced over the past decade, the referral hospital doesn’t have a steady supply of running water, enough blood pressure cuffs, or even a working AED!


Burgess Romano_Rwanda - radiologyCHUK


CHUK (the Teaching Hospital of Kigali) is not a multi-story complex (as one might expect for a hospital that is the “last stop” for the sickest patients)… it is a collection of one-floor brick buildings that house different specialties. Families nap on the grass outside the wards, patient beds are a few feet apart, and a collection of doctors and residents from all over (Canada, Belgium, Rwanda, and the US) move in teams to administer medications and diagnoses as quickly as possible. While the Rwandan healthcare system is growing and progressing each day, physicians use the word “frustrating” to describe the availability of technology, treatment, and resources. Although many families are covered by the popular insurance Mutuelles de Sante, families without insurance are often unable to afford a $5-$10 course of drugs or simple scan. Doctors sometimes pay out of pocket (especially when a few dollars is the difference between life and death), and many departments have started emergency funds so no patient dies due to an inability to pay. Unfortunately, the mortality rate is much higher than in Western hospitals — the tragic news that a patient did not make it through the night is something we are sure you never get used to.


Shadowing

Over the course of our time in Kigali, we are hoping to shadow doctors in different healthcare settings and specialties. Shadowing in a global health context will not only inspire us to collaborate with overseas health systems once we are practicing doctors, but also will allow us to draw comparative conclusions (i.e. the US versus the UK versus Guatemala versus South Africa healthcare models).


Burgess Romano_Rwanda - Emily walking to CHUK


We spent a day shadowing Dr. Samantha Rosman, an emergency pediatrician at Boston Children’s. She was an inspiring doctor to shadow — balancing her empathy & sensitivity (“Someone get this poor kid some pain meds!”) with practicality & directness. A majority of the children on the ward were malnourished (43% of all Rwandan children experience chronic growth stunting), and many were HIV+. From febrile seizures to malaria+typhoid-induced comas, from heart murmurs to brain tumors, we saw a huge range of conditions. One of the saddest cases was a tiny, 8-day old baby whose esophagus was disconnected from his stomach (meaning he had gone  8 days with zero nutrition or sustenance) — it was too late to operate on him, and he tragically passed away during the night.


We were lucky to meet Dr. Clifford Lo, a Harvard pediatric gastroenterologist affiliated with Partners in Health. He taught us fascinating and relevant information about nutrition and growth — in rural areas, up to 90% of the population are subsistence farmers (who undergo a starvation period once the harvest ends). Globally, 1 in 3 child deaths are due to malnourishment — even in the USA! This health issue could be solved with the addition of chlorine to the Rwandan water supply, which could save up to 50% of diarrhea-caused deaths).


The most magical day was in the neonatology unit — from the line of tiny premature babies in their incubators to the new mothers lying exhausted on their beds, it was heart-warming to see the stages of life starting anew. While the premature babies can have many complications due to their weak immune systems (from respiratory challenges to jaundice), most of them will be alright thanks to the amazing technology of incubators (which literally give them more time “in the oven” to grow healthy and strong.) The one baby who was born too heavy was actually in the worst shape — her mum had pregancy-induced diabetes, so she quickly became dangerously hypoglycemic. Shadowing in the NICU emphasized the fragile balance of the human body from the first day we enter the world.


The Genocide

Regarding the horrific tragedy that occurred 22 years ago — no one speaks about it in public, and it is a highly sensitive issue that impacted every single member of this East African nation. The mass-killings occurred between early April and mid-July, claiming up to 1 million lives (70% of the Tutsi population and 20% of all Rwandan lives). Annual remembrance during the 100 days is seen as crucial, so the tragedy is never forgotten and never repeated. Tribal classifications are now illegal, and the Gacaca justice system is seen as a huge success in promoting national healing. While the genocide is never mentioned in daily life, the memorial and museum painted a vivid picture of the build-up, events, and aftermath of the genocide — there is a children’s memorial, photos of the deceased, mass graves, symbolic gardens, and even broader history of genocidal violence around the world (from Germany to Cambodia, from Turkey to Namibia).


Daily Life & Exploring

Kigali is massive — more of a province than a city, with most major landmarks a few miles apart. So far, we have loved exploring — highlights have been a visit to the past Rwandan Presidents’ mansion (the garden contains  Juvénal Habyarimana’s shattered plane from when he was shot down, the event which caused the genocide to erupt in April 1994); weekly dance practice at Niyo Arts (a local cooperative and art gallery that raises money to support the street children, the dancers, so they can attend school… Pacifique, the founder, and Cyusa, the visionary, have become our close friends); and a visit to Kimironko Market to buy beautiful kitenge fabric (such vibrant colors and patterns — hard to choose just one).

Burgess Romano_Rwanda - Niyo exterior

The food has been lots of plantains, bananas, mangoes, white bread, rice, and beans — but Porter Nenon, a recent UVa graduate who is working on developing business education initiatives for Rwandan refugee communities,  introduced us to the Rwandan version of “chipotle”! Unfortunately, our flatmates have now left us, but we were living with Claire Romaine (rising third year who is doing a gastric cancer survey funded by the Hannah Graham award) and Eliza Campbell (rising fourth year who is the mental health policy intern for the Honorable Rwandan Minister of Health) — they introduced us to many amazing contacts and passing on their wisdom (namely: be flexible and expect major bureaucratic roadblocks).


As for exploring outside of Kigali — we spent a brilliant weekend relaxing on the shores of Lake Kivu in Northern Rwanda — just a few miles from Goma, DRC. We kayaked (very slowly!), found the Congo-Nile trail, and even stumbled upon some live music! Just yesterday, we went over the border to Uganda to climb Mount Sabyinyo, a tri-summit moutain whose final peak stands in Rwanda, Uganda, and the DRC all at the same time!! (After those terrifying ladders and intensely steep portions, our legs are quite wobbly today to say the least!)


Burgess Romano_Rwanda - congo borderBurgess Romano_Romano - lake kivu viewBurgess Romano_Rwanda- hidden door


All in all, our time in Kigali is flying by — and we endlessly grateful to CGH for all the “kwihugura” [learning] experiences we are having.

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