We have been having a busy time at Gahini recently with several sets of visitors, and ongoing clinical work. There have also been a significant number of changes in the hospital, many of which we just couldn’t see happening even a year ago!
When we started looking for where Church Mission Society (CMS) and God wanted to place us back in 2016, we had in mind that it would be somewhere that we could use our Surgical and Anaesthetic skills to benefit people who wouldn’t otherwise be able to access such healthcare, but also where we could be involved in teaching and training with a view to leaving behind a sustainable service staffed by locals after a five year period.
Gahini Hospital in Rwanda was the place that we felt called to be, but the situation when we arrived seemed to be less on developing a service and training local staff, and more on setting up a service and running it ourselves. The idea that we might be able to do any more than this seemed quite fanciful.
Over the last two years we have tried to be involved with training Rwandan doctors, but despite gaining contacts in the Kigali training schools of Surgery and Anaesthesia, there has been little progress. Catriona was asked to teach in Kigali on Paediatric Anaesthesia, but here sessions were then cancelled in favour of some visiting Canadian Anaesthetists. Steve has taught on a UK-credentialled Surgical Skills course for the last three years, but has not been able to progress further than this. We have been teaching our own hospital staff, but this has been basic surgery to generalist doctors and anaesthetics for non-medical anaesthetists, which has been thoroughly worthwhile, but not really helpful in terms of sustainability.
We were discouraged by the fact that the Government seemed to be developing a different hospital in the East of Rwanda to become the specialist centre, and did not seem to be supportive of having specialists in their other District Hospitals. However, Rwanda produced a National Surgical Plan in December 2018, which had the aim of each District Hospital having a Surgeon, Anaesthetist and Obstetrician by 2030. We have therefore been continuing to explore teaching opportunities, meanwhile trying to help develop the hospital facilities so that Gahini becomes a very easy place to send specialists in future as the infrastructure will already be in place.
Since the beginning of December, three very big developments have taken place, which has amazed us.
Firstly, the Government has sent two Orthopaedic Surgeons to Gahini, and plans to send an Anaesthesiologist next year. They actually appointed one Orthopaedic Surgeon to the specialist hospital an hour away from us, but then discovered that they had no facilities to allow him to work – no operating theatre capacity, no orthopaedic operating instruments, etc. At Gahini, Christian Blind Mission (CBM) have recently built and furnished a complete Orthopaedic operating suite, which is in use by a visiting Orthopaedic Surgeon who they employ to operate on children with disabilities one day each week. It’s probably one of the best Orthopaedic facilities in the country. After some discussion between the newly appointed Surgeon, Gahini Hospital, and the Ministry of Health, that Surgeon has been moved to Gahini, and joined by a colleague to form what will soon become the Orthopaedic Referral Centre for the whole of Eastern Rwanda. From my point of view, this means that I am no longer the only Surgeon here, and am able to let others look after the Orthopaedic patients (for whom I did my best as needed, but for whom my surgical skills were limited).
Secondly, and at less than 24 hours notice, I received four recently-graduated Rwandan doctors attached to my Surgical Service. The only students we usually get are from overseas, but Rwanda has decided that each of their newly qualified doctors need a five-month intensive preparation for practice course, and Gahini will receive four doctors in Surgery for a month each over the next five months. The main aim is to get them clinical experience as preparation for being doctors in potentially isolated settings, as their medical course is great on theory, but not quite as good as they would like on practical experience. This means that I am getting to teach some of the newest doctors in the country, which is really quite exciting!
Thirdly, a week ago I was asked by the University of Rwanda to become an Associate Dean of Hospital-based Medical Education. I found out more about the role at a meeting yesterday. It is linked with the placement of the newly qualified doctors at Gahini, which is likely to happen for five months each year, but is likely to be developed with more under- and post-graduate medics being placed at district hospitals. I am to be what in the UK might be called the hospital Director of Medical Education, basically overseeing all aspects of Medical Education at Gahini. Several other hospitals are having one of their specialists appointed to the role too, but it appears that I am the only non-Rwandan to be asked – something which is rather special to me. I only hope that I am able to fulfil the brief well over the next couple of years.
In essence God has been able to do something which we saw as being beyond possible for us here in Rwanda: We have local Rwandan Specialist Surgeons working at Gahini (which makes it extremely likely that a General Surgeon will come in the next couple of years); We have student doctors placed at Gahini, and I have a role within the University of Rwanda, and so should be able to further develop training opportunities. It’s all rather humbling, and is a good reminder to me that God works through our weaknesses and limitations, rather than through what we are able to do ourselves. As God said to Joshua thousands of years ago, “Be strong and courageous. Do not be afraid; do not be discouraged, for the Lord your God will be with you wherever you go.”