Rwanda

​Rahel Ghebre, MD, MPH - gynecologic oncologist - and Jennifer Rickard, MD, MPH - critical care surgeon - came to their work in Rwanda through the Rwanda Human Resources for Health (HRH) Program. Established in 2012, Rwanda HRH is a collaborative initiative between US academic institutions and the University of Rwanda to build a robust, sustainable healthcare delivery system rooted in the training of next-generation healthcare providers in Rwanda.

Clinical Care

Centre Hospitalier Universitaire de Kigali (CHUK), also known as the University Teaching Hospital of Kigali, opened as a health center in 1928. Today, it is the largest hospital in Kigali and receives more referral patients than any other hospital in Rwanda.

Capacity-Building

As a product of the Rwanda HRH work, the total number of obstetrics/gynecologists and surgeons has grown exponentially, and the number of hospitals with highly-trained medical staff has increased. The surgical residency program has expanded from a general surgery training program to include specialist training in orthopedics, neurosurgery, urology, pediatric surgery, and plastic surgery. The long-term success and sustainability of these programs relies on Rwandan leadership. Over the years, Rwandan physicians and residents have become increasingly involved in building sustainable, effective systems.

Education

Dr. Ghebre began working in Rwanda in 2014. She served as in-country teaching faculty in the Department of Obstetrics and Gynecology at the University of Rwanda, transferring skills in advanced gynecology surgery and gynecologist oncology. In addition, she collaborated on research and the development of educational material with University of Rwanda faculty. Outputs of research include increasing knowledge and awareness of cervical cancer screening and diagnosis. In the next phase of Rwanda HRH, Dr. Ghebre is partnering with the University of Rwanda and an NGO called BVGH (BIO Ventures for Global Health) on specialist training for gynecologic oncology.

Dr. Rickard began working in Rwanda in 2012. Through the HRH program, she twinned with local faculty members to teach and train medical students and residents in general surgery. As Associate to the Academic Head of Surgery, she was involved in HRH programmatic development. Her responsibilities range from clinical care, education, administration, research, and system-building. She currently spends 6 months each year in-country at the University of Rwanda, where she serves as an active member of the teaching faculty in the Department of Surgery. She teaches courses on research methodology and critical care to surgery residents. In addition to mentoring several residents in their research theses, she has several ongoing research studies on acute care surgery, surgical infections, and antimicrobial resistance.

Research

Research efforts in Rwanda are continually growing as local researchers are stimulated to understand local disease processes and management opportunities. University of Minnesota residents and students have the opportunity to engage in both clinical and research activities in Rwanda.

Get Involved

The University of Minnesota Department of Surgery has established an away rotation that is available to PGY3 general surgery residents who wish to complete a portion of their training in Rwanda. During this 6-8 week rotation, UMN residents will work alongside Rwandan physicians and residents at CHUK under the mentorship of Dr. Jennifer Rickard. Day-to-day activities during this rotation will vary based on current need, but UMN residents will likely find themselves providing clinical care, attending lectures related to the Rwandan residents’ current educational module, teaching medical students, and assisting with ongoing research projects during this rotation. Medical school in Rwanda is conducted entirely in English.

We will not be offering an away rotation in Rwanda during the 2020-2021 academic year due to the COVID-19 pandemic.

Publications

Small M, Magriples U, Ghebre R, Bazzett-Matabele L, Nitrushwa D, Kitessa D, Ntasumbumuyange D, Lantos P, Hill W, Bagambe P, Brown H, Rulisa S. Increased Nation-wide Access to OB/GYNs through a US-Rwanda Training Partnership. Obstetrics & Gynecology. Obstet Gynecol. 2019 Jun 11. [Epub ahead of print] PMID: 31188322

 

Rwabizi D, Bazzett-Matabele L, Ghebre R, Stephen R, Dtasumumuyange D, Nitrushwa D, Nkubito V, Small M. The "Honeycomb Sign": Gestational Trophoblastic Disease Case Series from the largest Tertiary Center in Rwanda. Int J Preg & Chi Birth. 2019 March; 5(2): 45-46. DOI: 10.15406.  

 

Martin AN, Kaneza KM, Kalkarni A, Mugenzi P, Ghebre R, Nitrushwa D, Ilbawi AM, Pace LE, Costas-Chavarri A. Cancer Control at the District Hospital Level in sub-Saharan Africa—an Educational and Resource Needs Assessment of General Practitioners? Journal of Global Oncology. 2019 Jan; 5: 1-8. PMID 30668270

 

Ghebre RG, Grover S, Xu MJ, Chuang LT, Simonds H. Cervical Cancer Control in HIV-infected Women: Past, Present and Future. Gynecologic Oncology Reports. 2017 Jul 21; 21:101-8. PMID: 28819634.

 

Ruzigana G, Bazzet-Matabele L, Rulisa S, Martin AN, Ghebre RG. “Cervical Cancer Screening at a Tertiary Care Center in Rwanda.” Gynecologic Oncology Report. 2017 May 26; 21: 13-16. PMID: 28616457

 

Randall TC, Ghebre R. Challenges in prevention and care delivery for women with cervical cancer in Sub-Saharan Africa. Frontiers in Oncology. 2016 Jun 28; 6:160. PMID: 27446806

 

Randall TC, Goodman AK, Schmeler K, Durfee J, Pareja R, Munkarah A, Rulisa S, Ghebre R, Trimble EL, Chuang L. Cancer and the world’s poor: What’s a gynecologic cancer specialist to do? Gynecologic Oncology. 2016 Jul; 142(1):6-8. PMID: 27210817

 

Nzayisenga I, Segal R, Pritchett N, Xu M J, Park PH, Mpanumusingo VE, Umuhizi DG, Goldstein DP, Berkowitz RS, Hategekimana V, Muhayimana C, Rubagumya F, Fadelu T, Tapela N, Mpunga T, Ghebre RG. Gestational Trophoblastic Neoplasia at the Butaro Cancer Center of Excellence in Rwanda. Journal of Global Oncology. 2016, 2(6), 365-374. PMID: 28717722

 

Rickard J. Surgery for peptic ulcer disease in sub-Saharan Africa: systematic review of published data. J Gastrointest Surg. 2016 Apr;20(4):840-50. Epub 2015 Nov 16.

 

Rickard J, Ntakiyiruta G, Chu K. Associations with perioperative mortality rate at a major referral hospital in Rwanda. World J Surg. 2016 Apr;40(4):784-90.

 

Kabuyaya MK, Ssebuufu R, Asiimwe-Kateera B, Nyundo M, Rickard J. Gastric outlet obstruction among adult patients at two Rwandan referral hospitals: etiology, H. pylori infection and outcomes. East Cent Afr J Surg. 2015;20(2): 62-68.

 

Rickard, J, Ntakiyiruta G, Chu K. Identifying gaps in the surgical training curriculum in Rwanda through evaluation of operative activity at a teaching hospital. J Surg Edu. 2015 Jul-Aug;72(4):e73-81. Epub 2015 Apr 7.

 

Abahuge E, Nzeyimana I, Rickard JL. Introducing a morbidity and mortality conference in Rwanda. J Surg Educ. 2017 Jul-Aug;74(4):621-629. Epub 2017 Feb 7.

 

Ndayizeye L, Ngarambe C, Smart B, Riviello R, Majyambere JP, Rickard J. Peritonitis in Rwanda: Epidemiology and risk factors for morbidity and mortality. Surgery. 2016 Dec;160(6):1645-1656. Epub 2016 Oct 4.

 

Rickard J, Ntirenganya F, Kyamanywa P, Ntakiyiruta G. Utilizing the American Board of Surgery In-Training Exam in a Rwandan surgical residency program: alignment of exam topics with the University of Rwanda general surgery curriculum. East Cent Afr J Surg. 2016;21(1): 24-352016.

 

Rickard J, Ssebuufu R, Kyamanywa P, Ntakiyiruta G. Scaling up a surgical residency program in Rwanda. East Cent Afr J Surg. 2016;21(1):11-23.

 

Ngarambe C, Smart BJ, Nagarajan N, Rickard J. Validation of the surgical apgar score after laparotomy at a tertiary referral hospital in Rwanda.World J Surg. 2017 Jul;41(7):1734-1742.

 

Rickard J, Ngarambe C, Ndayizeye L, Smart B, Riviello R, Majyambere JP. Critical care management of peritonitis in a low-resource setting. World J Surg. 2018 Oct;42(10):3075-3080. doi: 10.1007/s00268-018-4598-6.

 

Mpirimbanyi C, Rickard J, Furaha C, Ntirenganya F. Necrotizing soft tissue infections at a tertiary referral hospital in Rwanda: epidemiology and risk factors for mortality. World J Surg. 2018 Aug;42(8):2314-2320. doi: 10.1007/s00268-018-4515-z.

 

Rickard JL, Ngarambe C, Ndayizeye L, Smart B, Majyambere JP, Riviello R. Risk of catastrophic health expenditure in Rwandan surgical patients with peritonitis. World J Surg. 2018 Jun;42(6):1603-1609. doi: 10.1007/s00268-017-4368-x.

 

Rickard, J, Ngarambe C, Ndayizeye L, Smart B, Riviello R, Majyambere JP, Ghebre RG. Antibiotic use and antimicrobial resistance of surgical patients with peritonitis at a tertiary referral hospital in Rwanda. Surg Infect. 2018 May/Jun;19(4):382-387.

 

Bunogerane GJ, Rickard J. A cross sectional survey of factors influencing mortality in Rwandan surgical patients in the intensive care unit. Surgery. 2019 Aug; 166(2):193-197. doi: 10.1016/j.surg.2019.04.010.

 

Abahuje E, Sibomana I, Rwagahirima E, Urimubabo C, Munyaneza R, Rickard J. Development of an acute care surgery service in Rwanda. Trauma Surg Acute Care Open. 2019 Aug 5; 4(1):e000332. doi: 10.1136/tsaco-2019-000332.

 

Sutherland T, Mpirimbanyi  C, NziyomazeE, NiyoJP, NiyonsengaZ, MuvunyiC, MuellerA, BebellL, TalmorD, Rickard J, RivielloE. Widespread antimicrobial resistance among bacterial infections in a Rwandan referral hospital. PLoS ONE. 2019 Aug 23; 14(8):e0221121. doi: 10.1371/journal.pone.0221121.

 

Munyaneza M, Jayaraman S, Ntirenganya F, Rickard J. Factors influencing seeking and reaching care in patients with peritonitis in Rwanda. J Surg Res. 2020 Feb;246:236-242. doi: 10.1016/j.jss.2019.09.027. [Epub 2019 Oct 11]

 

Abahuje E, Niyongombwa I, Karenzi D, Tuyishime E, Bisimwa J, Ntirenganya F, Rickard J. Malnutrition in acute care surgery patients. World J Surg. 2020. doi: 10.1007/s00268-019-05355-7. [Epub ahead of print]

 

Muvunyi V, Mprimbanyi C, Katabogama JB, Cyuzuzo T, Nkubana T, Mugema JB, Musoni E, Urimubabo C, Rickard J. Community and hospital-acquired infections in surgical patients at a tertiary referral hospital in Rwanda. WJS. Accepted for publication.