Introduction to the Global Health Scholars Program - Rwanda

Transcript

• 00:01Alright. Amazing. So I'm a
• 00:02third year resident at Stanford.
• 00:04I'm in the, Stanford IIM
• 00:05global health track here, and
• 00:06I had the opportunity to
• 00:07go to Rwanda last spring
• 00:09and work at Sayashika,
• 00:11which was amazing. And I'm
• 00:12happy to kind of share
• 00:13about my experience today.
• 00:15So first kind of obligatory
• 00:17map slide here. Rwanda, small
• 00:20landlocked country, in East Africa.
• 00:22You can see it's bordered
• 00:23by,
• 00:24DRC, Burundi, Tanzania, and then
• 00:27Uganda. So there was definitely
• 00:28a lot from Lara's presentation
• 00:30that,
• 00:31I think rings true given
• 00:32kind of the proximity of,
• 00:33Rwanda and and Uganda.
• 00:37Just pointing out here the,
• 00:39rotation
• 00:40site, Seiashukah, this main hospital
• 00:42is located in Kigali, which
• 00:43is the capital of Rwanda.
• 00:44You can see kind of
• 00:45center of the country.
• 00:49And Kigali itself is an
• 00:51amazing city. I absolutely loved
• 00:53living there, for six weeks.
• 00:55It's definitely a very urban,
• 00:57setting, so that's kind of
• 00:59the the health care I
• 01:00guess, kind of the the
• 01:01closest health care catchment, area
• 01:03is is predominantly urban, although
• 01:05you'll see patients kind of
• 01:06from all around the country
• 01:07given that it's the largest
• 01:08referral hospital.
• 01:10It's a very green city,
• 01:12a very walkable city.
• 01:13Lots of people take,
• 01:15the Rwandan equivalent of the
• 01:16Boda Boda as the moto.
• 01:19A lot of people will
• 01:19take those, but, you know,
• 01:21I found myself walking to
• 01:23and from the hospital in
• 01:24most places I wanted to
• 01:25go a lot of the
• 01:26time.
• 01:28This is actually the view,
• 01:29kind of the nighttime view
• 01:30from my,
• 01:31apartment,
• 01:32balcony overlooking the city.
• 01:35So really an incredible place
• 01:36to spend,
• 01:38six weeks.
• 01:40Kind of getting into the
• 01:41site itself. So,
• 01:43the rotation
• 01:44is focused at Seiachukah,
• 01:47which is the largest health
• 01:49center in the country.
• 01:51It's has about five hundred
• 01:52beds,
• 01:54and it's really the primary
• 01:55referral hospital for the entire
• 01:57country. There are three referral
• 01:58hospitals,
• 01:59in Rwanda,
• 02:01but I I saw patients
• 02:02from kind of all over
• 02:03the country who had been,
• 02:05you know, first seen at
• 02:06their local,
• 02:07health clinic maybe by a
• 02:08community health worker and then
• 02:10kind of referred to their
• 02:11district hospital and then referred
• 02:12on to say Oshuka
• 02:14for additional care.
• 02:17And, it's the main teaching
• 02:18hospital for the University of
• 02:20Rwanda Medical School. So I
• 02:22spent, you know, the majority
• 02:23of my days with,
• 02:25Rwandan medical students as well
• 02:26as when I was there
• 02:28with a number of Sudanese
• 02:29medical students as well,
• 02:31who kind of had transferred
• 02:33their coursework to Rwanda given
• 02:35the conflict,
• 02:36in their home country,
• 02:38which was really a highlight
• 02:39of my time. I love
• 02:40med ed,
• 02:41and really love thinking about
• 02:42global health med ed. So
• 02:44having all of that,
• 02:46time with students
• 02:48and and kind of spending
• 02:49my time,
• 02:50on the wards with them
• 02:51was was really a highlight.
• 02:54Sayashi Kah has a bustling
• 02:55emergency department, which I,
• 02:58you know, really kind of
• 02:59only walk through a couple
• 03:01times to see patients and
• 03:02and talk with consultants and
• 03:03other colleagues.
• 03:05But once patients kind of
• 03:06are admitted to the hospital,
• 03:08they get admitted to
• 03:09one of six general medicine
• 03:11wards.
• 03:12And these wards are,
• 03:13in theory,
• 03:15separated by gender. There's male
• 03:17and female wards. A lot
• 03:18of times, it's based on
• 03:19bed availability.
• 03:20So for much of my
• 03:21time there, kind of all
• 03:22of our our wards ended
• 03:24up being, kind of mixed.
• 03:27Rwanda, in contrast to Uganda,
• 03:29does have, public health insurance,
• 03:31and that's kind of the
• 03:32majority of patients who I
• 03:34saw at Seashukah
• 03:36were kind of, paying for
• 03:38their their hospital stay,
• 03:40with their public insurance. There
• 03:42are a couple different tiers
• 03:44of,
• 03:46kind of stay and room
• 03:47and ward,
• 03:49at
• 03:49Seiashuka.
• 03:51I spent really all of
• 03:52my time on the general
• 03:53medicine ward, which costs about
• 03:55five ten
• 03:56or ten thousand, rohan and
• 03:58francs a night, which is,
• 03:59you know, about
• 04:01seven ish dollars or so.
• 04:03There's a VIP ward that
• 04:05costs double that and then
• 04:06a VVIP ward,
• 04:07that costs thirty thousand Rwandan
• 04:09francs a night.
• 04:11So, you know,
• 04:12very, very,
• 04:14inexpensive in comparison to how
• 04:16much you think about, you
• 04:16know, a single night in
• 04:18Stanford or Yale costs. But
• 04:19for many of my patients,
• 04:21you know, ten thousand francs
• 04:22a night,
• 04:23just for their bed, not
• 04:25any of the lab tests
• 04:26or medications or studies that
• 04:27we wanted to send was
• 04:28often cost prohibitive,
• 04:30which I think is, you
• 04:31know, something that's that's really
• 04:32important to think about, even
• 04:33in the context of this
• 04:35really robust public health care
• 04:38and health insurance infrastructure.
• 04:40We had a number of
• 04:41consulting services on the wards
• 04:43with us,
• 04:45and a lot of these
• 04:46were specialists who also spent
• 04:47time at King Faisal Hospital,
• 04:49which is kind of a
• 04:49mixed public private hospital also,
• 04:52located in Kigali.
• 04:54But I had, you know,
• 04:55some of kind of my
• 04:56favorite bedside exam teaching and
• 04:58and patient discussions with the,
• 05:01consulting attendings,
• 05:03and residents who were taking
• 05:05care of our patients with
• 05:06us.
• 05:07Here are just kind of
• 05:09some images from from the
• 05:11general medicine wards. As you
• 05:12can see, very similar to,
• 05:14at Milago,
• 05:16we were using paper charts.
• 05:17There is,
• 05:19an EMR at Sei Ashoka
• 05:21really just for labs and
• 05:23imaging,
• 05:23but kind of none of
• 05:24the other patient data shows
• 05:26up in that computer.
• 05:27A lot of it is
• 05:28kind of written in these
• 05:29inpatient medical records,
• 05:32that
• 05:33get,
• 05:35stacked in a closet in
• 05:36the ward as soon as
• 05:36somebody is discharged.
• 05:40Just to kind of briefly
• 05:41chat about
• 05:42kind of the day a
• 05:43day in the life on
• 05:44the wards.
• 05:45So every day, there's teaching
• 05:46from eight to nine AM,
• 05:48and this is for,
• 05:49both the,
• 05:51I'm residents and also all
• 05:52of the students. Most of
• 05:54the students I was working
• 05:55with were kind of on
• 05:55their medicine clerkship
• 05:57equivalent.
• 05:59And this teaching, you know,
• 06:00Mondays, it usually was physical
• 06:02exam sessions that, the visiting
• 06:03residents like myself would lead
• 06:05with the students in preparation
• 06:07for their kind of end
• 06:08of clerkship OSCE.
• 06:11We would have case presentations
• 06:12often Tuesdays and Thursdays.
• 06:15Usually, a journal club on
• 06:16Wednesdays, and then Fridays were
• 06:17kind of like a grand
• 06:18round evidence based medicine talk.
• 06:20And all of the visiting,
• 06:22global health scholars who come
• 06:24to say Ashoka are asked
• 06:25to give,
• 06:26to help out with definitely
• 06:27the physical exam sessions and
• 06:28then to give,
• 06:30at least one of each
• 06:31of those types of talks,
• 06:32a case presentation, a journal
• 06:34club presentation, and then an
• 06:35evidence based medicine presentation.
• 06:38So that that was really
• 06:39fun for me to put
• 06:40together,
• 06:41and
• 06:42kind of get a sense
• 06:43from from the students on
• 06:44the wards what topics they
• 06:45were really interested in hearing
• 06:46about and, you know, think
• 06:47about what journal articles, were
• 06:49most relevant to kind of
• 06:51talk about in that setting.
• 06:53And then from there, you
• 06:53kinda just go to the
• 06:54wards and,
• 06:56spend the morning rounding with
• 06:57your team.
• 06:58It sounds like very similar
• 06:59to kind of the setup
• 07:00in in Uganda.
• 07:02Medical students who are on
• 07:04their,
• 07:05medicine rotation
• 07:06are kind of in the
• 07:07role of most of of
• 07:08intern here where they're, like,
• 07:09first pass at the plan,
• 07:12talking to the patients at
• 07:13bedside, doing all of the
• 07:14documentation,
• 07:15and they then round with,
• 07:18the resident,
• 07:19at least one time per
• 07:20day. And residents there actually
• 07:21kind of are practicing on
• 07:22their own license.
• 07:24So we had attendings do
• 07:26ward rounds with us once
• 07:27or twice a week, but,
• 07:28otherwise, it kind of was
• 07:29the senior resident who was
• 07:30really running the ward.
• 07:32Each of these wards are
• 07:33split up into
• 07:35three kind of different sections
• 07:36of usually, it's eight patients
• 07:38each.
• 07:39So every one of these
• 07:41six medicine wards has about
• 07:42twenty four patients.
• 07:45And oftentimes, senior residents are
• 07:46covering multiple of these wards,
• 07:48so, you know, fifty or
• 07:49sixty patients at a time.
• 07:51So I really felt like,
• 07:53you know, one of the
• 07:54things I enjoyed most and
• 07:55can really contribute,
• 07:56in this setting was just,
• 07:57like, a lot of teaching
• 07:58for the medical students.
• 08:01When there are busy days
• 08:02with their resident covering, you
• 08:04know, fifty patients,
• 08:05there wasn't always as much
• 08:07of a chance to really
• 08:08talk through a differential or,
• 08:09kind of go to bedside
• 08:11and look at the physical
• 08:12exam together.
• 08:13So I really kinda saw
• 08:14myself in sort of, like,
• 08:15a teaching resident role.
• 08:17And, you know, one of
• 08:18my favorite parts of the
• 08:19experience was talking through the
• 08:20cases with my co resident.
• 08:21I found that to be
• 08:23just such
• 08:24an amazing relationship. I was
• 08:25I was lucky enough to
• 08:26work with two different,
• 08:28residents each for three weeks.
• 08:30So kind of, you know,
• 08:31thinking about spending, like, a
• 08:32whole wards block with somebody,
• 08:33you really get to know
• 08:34them and kind of know
• 08:35their their practice style.
• 08:38So that was amazing. I'm
• 08:39still in touch with actually
• 08:40one of the co residents
• 08:41who I worked with over
• 08:41there.
• 08:44Then a little bit of
• 08:44a lunch break. I have
• 08:45to make a plug for
• 08:46hospital lunch. There's a restaurant
• 08:48on the, hospital campus that
• 08:50has a buffet lunch that's
• 08:51excellent.
• 08:53It's subsidized for residents and
• 08:54students. So usually after, wards
• 08:56rounds, I would go, and
• 08:58get hospital lunch with my
• 08:59team members. And then in
• 09:00the afternoon, there always are
• 09:02these medical student teaching sessions
• 09:04where
• 09:05the med students are each
• 09:06assigned, a topic within internal
• 09:08medicine. And, basically, they prepare
• 09:10a presentation with the help
• 09:11of,
• 09:12a senior faculty member at
• 09:14Sayashukha
• 09:15on that presentation and then
• 09:17kind of teach the rest
• 09:18of their med student colleagues,
• 09:21either on that case or
• 09:22on that topic. And kind
• 09:24of the role there was
• 09:25to sit in, sometimes to
• 09:26help the students prepare their
• 09:28their presentations,
• 09:29and to kind of give
• 09:31additional teaching pearls,
• 09:33clinical advice based on whatever
• 09:35the topic was.
• 09:38So much I could talk
• 09:39about about living in Kigali.
• 09:40As I said, it's an
• 09:41incredibly vibrant city,
• 09:43and a really amazing place
• 09:45to spend,
• 09:46six weeks. Again, I could
• 09:47have many, many, many slides
• 09:49of photos of fun things
• 09:50to do in Kigali.
• 09:51But kind of some of
• 09:52the things that were a
• 09:53little surprising to me, there's
• 09:54an amazing cafe culture in
• 09:56Kigali. So oftentimes after kind
• 09:58of teaching would wrap up
• 09:59at the hospital,
• 10:01I would, you know, find
• 10:02a cafe, do work on
• 10:04my journal club or my
• 10:05evidence based, medicine presentation for
• 10:08the next day or read
• 10:09up on kind of topics
• 10:10that came up in the
• 10:11wards. For any coffee or
• 10:12tea lovers, there is amazing,
• 10:14amazing
• 10:16coffee and tea from Rwanda
• 10:17that you really can find
• 10:18everywhere.
• 10:21There is, of course, the
• 10:22Kigali Genocide Memorial.
• 10:24I was actually there this
• 10:25year during Kibuka, which means,
• 10:28to remember in Kinyarwanda.
• 10:31And that's the the annual
• 10:33kind of genocide,
• 10:34Remembrance Day.
• 10:36I was there this year.
• 10:37It was the thirtieth anniversary,
• 10:38so it was kind of
• 10:39a week long two public
• 10:40holidays, two days of public
• 10:42holiday, and then
• 10:44a week of programming within
• 10:46the city, lots of presentations,
• 10:48speeches, events.
• 10:50And it was really impactful
• 10:52actually to to go back
• 10:53and visit visit the memorial,
• 10:55kind of during that week.
• 10:56And and, you know,
• 10:58it's very recent history for
• 11:00the country,
• 11:01and in in many people's
• 11:04lifetimes.
• 11:05So that was something that,
• 11:07you know, felt felt really
• 11:08kind of important,
• 11:10to
• 11:11kind of immerse myself as
• 11:12much as I could in
• 11:13while I was there.
• 11:15In terms of other things
• 11:16to do in Kigali, I
• 11:17found there's a bowling alley
• 11:18in Kigali. This is something
• 11:20I discovered on my last
• 11:21night there.
• 11:22There's tons of fun restaurants,
• 11:24amazing food.
• 11:26Definitely, you kind of get
• 11:27your fill of typical Rwandan
• 11:28cuisine with hospital lunch.
• 11:30So then there's lots of
• 11:31other places,
• 11:32to try for dinner. There's,
• 11:34a great Italian spot that
• 11:35does a trivia night every
• 11:37week and kind of whoever
• 11:39wins the the quiz from
• 11:40the week before writes the
• 11:41next one. So that was
• 11:42something that kind of became
• 11:44part of many of my
• 11:45weeks there, writing, fun trivia
• 11:47quizzes.
• 11:49I love,
• 11:51you know, trying to practice
• 11:52as much Kenya Rwanda as
• 11:53I can. A great place
• 11:54to do that is in
• 11:54the market. One of,
• 11:57my, great friends who I
• 11:58I made in Rwanda and,
• 12:00again, I'm still in touch
• 12:01with is, a gentleman named
• 12:02Prince, kind of a an
• 12:03up and coming, as he
• 12:04calls himself, fashion designer in
• 12:06Kigali,
• 12:08who it was awesome to
• 12:09kind of walk through the
• 12:10market with and, again, try
• 12:11to practice as much of
• 12:12the conversational canoe Rwanda that
• 12:14I picked up while I
• 12:14was there.
• 12:16And outside of Kigali, there's
• 12:17really no shortage of things
• 12:18to do. It's such a
• 12:19beautiful
• 12:21country. There are a number
• 12:22of national parks in,
• 12:25Rwanda, kind of each with
• 12:26their own biome. Nyongwe,
• 12:29is in the,
• 12:30southwestern kind of corner over
• 12:32here,
• 12:33very much rainforest.
• 12:35You could do chimpanzee trekking
• 12:36there. Akagera
• 12:38is kind of on the
• 12:39other side of the country,
• 12:41much more kind of a
• 12:42spot to go for safari.
• 12:43And then you have Volcanoes
• 12:44National Park, where you can
• 12:46do gorilla trekking, lots of
• 12:47incredible hiking.
• 12:49I actually ended up going
• 12:50to Uganda to do,
• 12:52gorilla trekking, which we'll see
• 12:53if this video loads,
• 12:55was one of the most
• 12:56amazing things I've ever done.
• 12:58You're kind of right right
• 13:00in the middle of a
• 13:00family of gorillas and just
• 13:02kind of get to watch
• 13:04what they do, for about
• 13:05an hour. Something I tacked
• 13:07on to that trip was,
• 13:10a night in Lake Bunyone
• 13:12in Uganda,
• 13:13which is,
• 13:15one of the few Shisto
• 13:17free lakes kind of in
• 13:19the area in contrast to
• 13:20Lake Kivu in Rwanda, which
• 13:22unfortunately does have Shisto.
• 13:24Kivu is beautiful.
• 13:26Definitely would still recommend going
• 13:27there even if you're not
• 13:28gonna swim. It's it's gorgeous
• 13:29views at this photo down
• 13:31here.
• 13:33So really lots of amazing
• 13:35things to do in Kigali,
• 13:37plenty of things to do
• 13:38outside of Kigali on the
• 13:39weekends,
• 13:40and
• 13:41really so much to kind
• 13:42of
• 13:44dive into in the hospital.
• 13:46I had an incredible experience.
• 13:47I would definitely, definitely recommend
• 13:49it, and I'm really happy
• 13:50to,
• 13:52answer any questions that anyone
• 13:54has.