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 Hills of Butare

Hills of Butare

By: Mayano Ochi and Josh Schiller

We’ve just wrapped up a week-long project in the southern city of Butare. This was our first trip to Rwanda, and we focused on the implementation of a pilot program teaching primary healthcare providers at Rango Health Center located on the outskirts of the city.  Rango is a very busy clinic serving the local community 24 hours a day staffed primarily by nurses and midwives.  Their patients suffer from things like trauma, difficult infections--such as tuberculosis, malaria, or HIV-related illnesses--as well as general adult and pediatric disease.  In addition, Rango provides prenatal care and is a safe place for women to deliver their babies.

We chose Rango as a site for our project through a collaborative effort with AIGINET, a non-profit organization run by Rwandan native Claire Umubyeyi, which focuses on community building in Butare.  Since the genocide in 1994, Rwanda has made significant advances in providing healthcare to its citizens, but like many other sub-Saharan African countries, the country still struggles with basic preventable and treatable conditions.

 Rango Health Center

Rango Health Center

Our mission for this trip was two-fold: first, to identify the needs of the health center; and secondly, to supplement their knowledge and skills in recognizing and treating emergent patient conditions. We began the workshop going over how to take a thorough history on the patient and conducting physical exams with an emphasis on “red flag” exam findings. We then discussed abdominal and respiratory conditions that require prompt recognition and intervention and about emergencies that may arise during childbirth such as postpartum hemorrhage and an unresponsive newborn. By the end of our presentations, the participants were able to more accurately estimate postpartum blood loss, identify which patients required prompt transfer to the district hospital, describe management steps to treat severe diarrhea and dehydration, and utilize correct technique for resuscitating a newborn.

The participants were active in describing their clinical practice as well as asking questions; as a result, much of our time was spent in small group discussion. Through our exchange, we learned that these folks demonstrated amazing abilities to be resourceful to compensate for lack of resources.  For example, Rango had new pulse oximeters but were nonfunctional due to faulty wiring, yet the nurses could easily list signs and symptoms of respiratory distress and decreased oxygenation.  Rwanda is one of the few African countries where substantial gains in health indices have been made and that was evident by the amount of pride and care that the practitioners took in their care of the community.  It was no surprise that they took a similar approach towards our curriculum.  As a result, the training was intense but by the end, a feeling of genuine accomplishment was felt by instructors and students alike. 

We have gotten excellent feedback so far, and are in preliminary discussions with the director of the area hospital--who had attended our first day--about expanding our curriculum to multiple clinics district-wide.  In addition, there has been interest among several groups in the area for IMR to serve in a supportive role for medical and psychiatric evaluations of Rwandan widows and orphans. It was apparent that the locals are heavily invested and committed to bettering their community and this inspires us to support them in the best way we can.

We hope to continue building partnerships in Butare to help this community and we appreciate your continued support for these important projects!

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