Canadian Anesthesiologists’ Society International Education Foundation(CASIEF)

in Rwanda

Support to the Anesthesiology Residency : Achievements,Challenges & Perspectives

Theogene TWAGIRUMUGABE, MD

Anesthesiology Programme Director

Department of Anesthesiology & ICU

National University of Rwanda

RWANDA :In the centre of Africa

Background

Socio-economic: * Total population: 8,2 millions

* Per Capita GNP: 250US $ * Infant and Maternal Mortality * Infant mortality: 86/1000 (DHS,2005)

* Under 5 Mortality: 152/1000 (DHS, 2005)* Maternal mortality: 750/ 100,000 (DHS, 2005)

* Doctors: 1/50,000 inhabitants * Nurses: 1/3,900 inhabitants

Background

Lack of personnel, very crucial in rural areas

• A large proportion of MDs practise in urban centres where only 15%population live:

3 referral hospitals ↔ 40 district hospitals

• 17% of Nurses in rural areas

• Anesthesia = among depressed areas of specialisation in developing world / Rwanda

Rationale of Postgraduate programme in Rwanda

• Growing demand of specialist care in the world

• European universities do no longer accept candidates for the clinical training

• Anti-brain-drain mechanism?• Community-based educational system

orientation

►Introduction of Postgraduate programme of Medicine/ National University of Rwanda (NUR)

Postgraduate at NUR• Launched in 1997 at NUR :

Obstetrics/Gynecology, Internal Medicine, Pediatrics, General Surgery

• Anesthesia joined in 2002: part of residency in France, Tunisia and/or Belgium

• The whole training in Rwanda began in 2006 with CASIEF’s support (MoU 2005)

November 2005

Signing of Memorandum of Understanding

CASIEFGovernment of Rwanda

National University of Rwanda

Kigali Health Institute

The CASIEF support• Start: January 2006 • Goal : To assist NUR and Rwanda to develop and run its

own sustainable residency training program in anesthesiology ( previous experience in Nepal, 1980s)

• Training programme duration: 4 years• Degree: Master’s in Anesthesiology from NUR

• Send Lecturers: volunteers• CASIEF to pay flight & visa expenditures (Members’ donation) • Lodging/Transport: Ministry of Health & NUR

• Teaching mission duration: at least 1 month/volunteer

ACHIEVEMENTS

Year Volunteers CASIEF

Volunteers USA/Australia

Residents

CANADA

2006 3 3 1

2007 5+Pain Nurse

3 3

2008 7+Pain Nurse

2 4

2009 8 (+2 RT, 1 Pain Nurse)

1 3

ACHIEVEMENTS

Volunteers’ mission

• Formal Teaching (seminars): one half-day/week

• Clinical Training in OR in the 3 training hospitals

• Mentoring of dissertations & final assessments of the first graduants

• Curriculum review

ACHIEVEMENTS

Residents (2009): 9

• PG-Y4: 2• PG-Y3: 2• PG-Y1: 5

ACHIEVEMENTS August 2008: Visit of CASIEF chair

Review of the programme to build a self-sustaining programme:

• Coordination of teaching/symbiosis: - Programme Director (PD) - Assistant PD - Chief Resident

• Other Important issues: - Training staff in educational and assessment techniques -Fellowships in the main & important specialisations - Rwandan Residents Overseas Rotation to improve skills and

knowledge

CHALLENGES

Volunteers:• Working conditions: old equipment, shortages of drugs

and other supplies• Living conditions • Some clinical sub-specialities absent• May be asked to teach a block/module different from

their area of expertise• Not really involved in the assessment ( 1 month?)• Continuity of the programme?• Creation of symbiosis

CHALLENGES

Local staff/Residents:• Very young staff• Number of staff: 10 anesthesiologists in

the country• Not enough time to fully devote to

education• Symbiosis volunteers-local staff• Lack of attraction of Medical students to

the program

Local staff with Dr Carli F.

PERSPECTIVES

• Residents Elective in Canada(6 mo at least): - settled objectives - before their final assessment - Educational license?

• Young Staff: - Fellowships tailored to the urgent needs/key

areas: Obstetrics,Emergency,Paediatrics,Intensive Care ,…

- APD: training in Educationnal techniques

Summary

• Crucial need of anesthesiologists in Rwanda→Patient Safety: WHO 2008« Safe Surgery Saves Lifes »

• Training supported by CASIEF: fruitful ( volontary service)

BUT:

• A self-sustaining programme needs:1. Training of trainers: Fellowship2. Residents to rotate abroad ►future trainers; for skills&

knowledge in safe anesthesia, enthusiasm, attraction

Support from Canadian Institutions is

welcomed

THANKS