Kigali, Rwanda Surgical Training Collaborative

The third ACS Surgical Training Collaborative is based in Kigali, Rwanda, and focuses—at the request of the Rwandan Ministry of Health—on developing surgical specialties, including cardiothoracic surgery, plastic surgery, and vascular surgery as well as trauma systems development. Based on lessons learned in Hawassa and Lusaka, the program in Rwanda will utilize a similar approach, with continuous on-site involvement of US and senior surgical faculty from US academic medical centers to support training, patient care, and workforce development. 

Cardiothoracic Surgery

Dr. Valerie Rusch, ACS Past President and esteemed thoracic surgeon currently based at the Memorial Sloan Kettering Cancer Center in New York City, has been the primary leader of the ACS H.O.P.E. cardiothoracic initiative in Rwanda. Through her tenacity, diplomacy, and wisdom, she has made invaluable contributions to the initiative and continues to lead all stakeholders toward the common goal of building a sustainable cardiothoracic program in Rwanda. Dr. Douglas Wood, current ACS regent and world leader in thoracic surgery and thoracic oncology from the University of Washington, has been by her side giving time, expertise, and guidance to the ongoing effort to develop the specialty.

Upon receiving an official invitation from the Human Resources for Health Secretariat under the Rwanda Ministry of Health and conducting a needs assessment, Dr. Rusch and ACS H.O.P.E. encountered other organizations in Kigali working toward the same goal.

• Team Heart—led by ACS Fellow Dr. Chip Bolman and Ceeya Patton Bolman, his wife who is an OR nurse—has been working in Kigali since 2009, focusing on treatment and education of rheumatic heart disease. Over the past 15 years, they have touched the lives of hundreds, if not thousands, of patients, trainees, and community members in Rwanda.
• Since 2006, Chain of Hope Belgium has focused on the pediatric population in Rwanda affected by heart disease and defects. They have focused on knowledge transfer not just on pediatric cardiac surgery, but on specialized care in anesthesia and intensive care, equipment maintenance, and specialized training abroad for local physicians.
• CR-OP Halifax has been involved since 2019, focusing on OR skills training and postoperative care.

As The House of Surgery™, the ACS functions as a convener across specialties and organizations. Dr. Rusch, in collaboration with Dr. Zerihun Abebe, CEO of King Faisal Hospital; Dr. Maurice Musoni, an adult cardiothoracic surgeon, and Dr. Yayu Mekonnen, pediatric cardiac surgeon, has established a standing biweekly leadership meeting with all organizations and stakeholders to ensure effective coordination and strategic planning. The Rwanda team has made significant strides in independent consumable procurement for these complex surgeries and logistics coordination with the help of the King Faisal Hospital Foundation and the Rwanda Surgical Society.

Overall, the initiative is progressing—moving away from missions with 20-30 people providing all aspects of care to smaller mentoring trips focused on complex surgical skills. The Rwanda workforce now provides most of the ancillary care such as anesthesia, perfusion, nursing, and acute care. Progress continues with recruitment of more trainees into the specialty and creation of a fully independent local training program.

Plastics and Maxillofacial Surgery

Plastic and maxillofacial surgery was the second specialty identified as a priority for the University of Rwanda and the Ministry of Health. Dr. Faustin Ntirenganya, chair of the department of surgery at the University of Rwanda College of Medicine and Health Sciences, and Dr. Charles Furaha, head of plastic surgery at the Rwanda Military Hospital, developed a comprehensive postgraduate plastic surgery curriculum. They invited ACS H.O.P.E. to send volunteers to provide supplemental instruction for their residents based on the scheduled teaching modules. Together with the Plastic Surgery Foundation’s SHARE Program, ACS H.O.P.E. has created rosters of excellent surgeons and teachers who have made a huge impact so far in the program.

As of August 2023, 12 volunteers across five trips have contributed nearly 700 hours of service. The volunteers have demonstrated techniques in the OR, given lectures, run simulation sessions, and more. Trip topics from the past year have included burn care, hand surgery, maxillofacial surgery, microsurgery, and cosmetic surgery. As ACS H.O.P.E. continues to build the calendar for 2023–2024, it will focus on sending both returning and new volunteers to maintain relationships while still growing the program. This coming year will add a plastics basics rotation, which will cover a general introduction to plastic surgery.  

Vascular Surgery

Since July 2022, ACS H.O.P.E. has coordinated six vascular surgery skills training trips with six volunteers who have given 250 hours of service. There are currently no formally trained vascular surgeons in Rwanda. The six volunteers have been working with Dr. Clement Uwase—a trained general surgeon working to specialize. Sending one volunteer at a time provides room for one-on-one devoted time and more opportunities to grow in relationship. Through this partnership, Dr. Girma Tefera, UW-Madison, and Dr. Katherine Kane, Texas Health Care, continue to develop a community of vascular surgeons across the country and from diverse backgrounds who provide a network of support as Rwanda works towards creating their own vascular surgery training program.

Trauma Systems Development

In March 2023, Dr. Barclay Stewart, University of Washington; Dr. Eileen Bulger, University of Washington; and Dr. Jeff Kerby, University of Alabama Birmingham; traveled to Kigali, Rwanda with ACS H.O.P.E. staff, Dr. Girma Tefera and Miranda Melone, to perform an official needs assessment. Dr. Patricia Turner also traveled to Kigali from Addis Ababa to participate in some of the meetings with Rwanda trauma leaders, King Faisal Hospital Foundation administrators, and key officials in the Rwanda Ministry of Health.

Through the Ministry of Health, ACS H.O.P.E. Rwanda colleagues will form a Trauma Task Force (TTF) to work with ACS H.O.P.E. and the ACS Committee on Trauma to develop trauma systems through trauma education, evaluation, and standards. The Rwanda TTF is scheduled to visit the United States and the University of Washington in August 2023 to observe US systems in trauma care and participate in a workplan meeting to discuss next steps in the partnership.