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
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Canadian Anesthesiologists’ Society International Education Foundation(CASIEF) in Rwanda Support to the Anesthesiology Residency : Achievements,Challenges.
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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)
• 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