‘Having nice medical facilities without the skills is useless’
When Mahoro developed stomach problems, the doctor who examined him decided that surgery would be required. That was in February; today, Mahoro is still waiting for the operation which is planned to take place in June.
It is not an uncommon situation. While major efforts have been made to increase the access to healthcare, and make it affordable to everyone, the sector is still struggling when it comes to human capital. In addition, as the battle against former killer diseases such as malaria and TB is being won, others such as cancer and cardio-vascular diseases are becoming more common, yet so far there are very few doctors specialized in these areas.
“This is very challenging as the number of specialists is currently limited compared to the number of cases,” explains Dr. Theobald Hategekimana, the director general of CHUK.
An even bigger challenge is the fact that the specialized doctors that are there are mostly practicing in referral hospitals, the majority of which are in Kigali, with only CHUB in Huye district. This means that those lucky enough to get an appointment have to travel a long distance.
Such was the case of Consolée Nyirasafari, who had never left her village in the remote parts of Rubavu and had to be transferred to CHUK for a serious intestinal problem that required a specialist. Knowing no one in Kigali, she had to rely on the goodness of strangers for meals and other necessities including covering her hospital fees and transport back home.
The increasing number of cases (due to better access) and limited number of skilled doctors are contributing to the heavy workload in referral hospitals and a backlog in caring for patients.
“In February 2011, of all 661 doctors in the country, only 133 of them were specialists,” points out Dr. Jean de Dieu Ngirabega, the director general of clinical services at the ministry of health.
Hategekimana adds that it was a question of priorities. “At first the priority was to build a proper healthcare system by forming enough general practitioners to cover at least district hospitals,” he remarks, adding that today the focus is shifting to the formation of specialists.
In order to ensure a better healthcare for the population, Minisante has planned to have one doctor per 10,000 citizens by 2020, as opposed to one per 16,000 now.
According to Ngirabega, some of the areas in which the lack of specialists is currently mostly felt are pediatric surgery, sports medicine and oncology. “We have started a post-graduate program where our general practitioners can specialize in internal medicine, surgery, pediatrics, gynecology and obstetrics, and anesthesiology among others,” he explains.
“When you want excellence in healthcare as our country seems to do, you need excellent doctors to deliver it.”
For private clinics, the situation is even worse. “There are not enough general doctors, leave alone specialists, in the country,” remarks Dr. Jean-Chrisostome Nyirinkwaya, doctor and CEO at the La Croix du Sud hospital, adding that the rare available specialists are working in public hospitals. “Their education is sponsored by the government, so they are bound to those hospitals, which makes it very hard for us who have private practices,” he says.
As a result, they can only get those specialists for a few hours in the evenings – and given the high demand even that is not guaranteed – which complicates the treatment of patients. “So we would be left with hiring foreigners, but that is not feasible on a sustainable, permanent and satisfying basis due to the expensive compensation and maintenance they require,” observes Nyirinkwaya, who is himself a gynecologist.
He points out that this poses a threat to the quality of healthcare, even if you have sophisticated equipment. “When you want excellence in healthcare as our country seems to do, you need excellent doctors to deliver it,” Nyirinkwaya says.
Over the past few years, teams of foreign specialists have regularly visited the country to perform specific types of operations, in which local medical staff assisted to gain some experience. Yet according to Minisante’s Nigirabega, the problem is also being addressedin a more fundamental way, and plans have been made to bring in professors to train doctors in different specialties.
“We have already signed a memorandum of understanding with some American universities,” he explains, adding that they will not only train doctors into specialists, but also train existing and new specialists to become teachers. “This will ensure sustainability of the capacity building program by the time our partnership with the Americans comes to an end.”
Ngirabega also explained that in order to decentralize healthcare, provincial hospitals will be put in place in the next four years. “We are currently working to fill the gaps in equipment and skills, which will help to alleviate the burden on referral hospitals.”
And the efforts to get specialists is not only limited to the doctors. “It’s also important to have nurses who know exactly what they are doing,” Nigirabega says. “This is why we will also provide training for them to be specialized in different areas such as pediatric and oncological nursing.”
Clinical officers who can do consultations and perform some relatively simple operations like C-section will be trained to be at health centers’ level. “The program has already started at the Kigali Health Institute KHI,” Ngirabega explains.
The health ministry recently also signed a statement of intent with MIOT Hospitals International, an Indian group of hospitals, where their doctors will provide specialized training for their Rwandan colleagues, focusing mostly on pediatrics, orthopedics and oncology.
“With the government’s programs to build skills and capacity of health care providers, we can hope that in the future we will have capable doctors and specialists,” Nyirinkwaya says, adding that although quality healthcare is costly, it is worth the investment. “Having nice facilities without the needed skills would be useless.”